Persistent Idiopathic Facial Pain Associated with SomatoformDisorder in an 11-Year-Old Boy

Persistent idiopathic facial pain (PIFP) is a poorly understood chronic disorder that rarely occurs in children. An 11-year-old boyinitially presented with right cheek pain and a streptococcal infection 6 weeks previously. Facial cellulitis was suspected, which wasresolved by antibiotic treatment. The right cheek pain recurred within 4 weeks of this initial visit. Because the antibiotic treatmentdid not relieve the pain, the patient visited our outpatient clinic. Physical examination revealed facial tenderness in an area thatcorresponded with the region supplied by the second branch of the trigeminal nerve (maxillary nerve), suggesting trigeminalneuralgia (TN). However, brain magnetic resonance imaging revealed no vascular compression. Furthermore, the continuousnagging and dull nature of the pain experienced by the patient differed from the sudden and severe nature of pain associatedwith TN. Subsequently, PIFP was diagnosed. The patient was unable to attend school because of prolonged lassitude, nausea,headache, and anorexia. Psychological counseling revealed psychological stress related to his out-of-school life. Upon learningstress management through psychotherapy, his general malaise gradually improved, and he was able to attend school with morefacial expressions. This case indicates the psychogenic aspect of PIFP as well as the value of psychological counseling