{"id":7495,"date":"2026-10-27T06:00:00","date_gmt":"2026-10-27T06:00:00","guid":{"rendered":"https:\/\/www.belodonte.es\/?p=7495"},"modified":"2026-08-24T11:04:55","modified_gmt":"2026-08-24T11:04:55","slug":"dolor-cronic-orofacial-classificacio-diagnostic-tractament","status":"publish","type":"post","link":"https:\/\/www.belodonte.es\/ca\/dolor-cronic-orofacial-classificacio-diagnostic-tractament\/","title":{"rendered":"Dolor cr\u00f2nic orofacial: classificaci\u00f3, diagn\u00f2stic i opcions de tractament"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">El <strong>dolor cr\u00f2nic orofacia<\/strong>l \u00e9s una de les condicions m\u00e9s complexes i subestimades de la medicina oral i la cirurgia maxil\u00b7lofacial. Es defineix com el dolor localitzat en la cara, la boca, el cap o el coll que persisteix durant m\u00e9s de tres mesos, i pot tenir un origen musculoesquel\u00e8tic, neurop\u00e0tic, neurovascular o mixt. La seva prevalen\u00e7a s&#8217;estima entorn del 10-15% de la poblaci\u00f3 adulta, amb un impacte significatiu sobre la qualitat de vida, la capacitat laboral i el benestar psicol\u00f2gic del pacient. Diagnosticar-ho correctament \u00e9s el primer i m\u00e9s dif\u00edcil pas del tractament.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Quins tipus de dolor orofacial cr\u00f2nic existeixen?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">La classificaci\u00f3 del dolor orofacial cr\u00f2nic ha evolucionat significativament en els \u00faltims anys. La International Classification of Orofacial Pain (ICOP), publicada en 2020, \u00e9s el sistema de refer\u00e8ncia actual i estableix les seg\u00fcents categories principals.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">El dolor orofacial d&#8217;origen dental i period\u00f3ntico inclou la hipersensibilitat dentinal cr\u00f2nica, la s\u00edndrome de la dent fissurada i el dolor postendod\u00f2ntic persistent, en els quals l&#8217;origen \u00e9s dental per\u00f2 el dolor persisteix m\u00e9s enll\u00e0 de l&#8217;esperable despr\u00e9s del tractament.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">El dolor musculoesquel\u00e8tic orofacial engloba les disfuncions temporomandibulars (DTM) doloroses, incloent-hi el dolor miofascial masticatori, l&#8217;artr\u00e0lgia temporomandibular i la mi\u00e0lgia local. \u00c9s la categoria m\u00e9s prevalent de dolor orofacial cr\u00f2nic en la pr\u00e0ctica cl\u00ednica.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">El dolor neurop\u00e0tic orofacial inclou la neur\u00e0lgia del trigemin (cl\u00e0ssica, secund\u00e0ria i idiop\u00e0tica), la neuropatia trigeminal dolorosa, la neur\u00e0lgia postherp\u00e8tica i la s\u00edndrome de boca ardent de component neurop\u00e0tic.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">El dolor neurovascular orofacial compr\u00e8n la cefalea en ra\u00efms amb manifestaci\u00f3 orofacial i la hemicr\u00e1nea cont\u00ednua amb dolor referit a la regi\u00f3 oral.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">I el dolor orofacial idiop\u00e0tic inclou els quadres en els quals, despr\u00e9s d&#8217;un estudi diagn\u00f2stic exhaustiu, no s&#8217;identifica cap causa estructural o neurop\u00e0tica que expliqui el s\u00edmptoma.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Per qu\u00e8 \u00e9s tan dif\u00edcil diagnosticar el dolor orofacial cr\u00f2nic?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">El diagn\u00f2stic del dolor orofacial cr\u00f2nic \u00e9s un dels m\u00e9s complexos de la medicina per diverses raons que se superposen.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La regi\u00f3 orofacial \u00e9s un territori de converg\u00e8ncia de m\u00faltiples estructures anat\u00f2miques (articulacions, m\u00fasculs, nervis, dents, sins paranasals) la innervaci\u00f3 dels quals comparteix vies comunes, la qual cosa facilita el dolor referit i dificulta la localitzaci\u00f3 exacta de l&#8217;origen.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">El dolor neurop\u00e0tic, en particular, pot presentar-se sense cap lesi\u00f3 estructural visible en les proves d&#8217;imatge convencionals, la qual cosa porta amb freq\u00fc\u00e8ncia a diagn\u00f2stics erronis d&#8217;origen dental i a tractaments (extraccions, endod\u00f2ncies) que no resolen el dolor perqu\u00e8 la causa no \u00e9s odontog\u00e8nica.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La cronificaci\u00f3 del dolor modifica la neuroplasticidad del sistema nervi\u00f3s central, generant canvis en el processament del dolor que perpetuen l&#8217;experi\u00e8ncia dolorosa independentment que l&#8217;est\u00edmul original continu\u00ef present o hagi desaparegut.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">I el component psicol\u00f2gic, especialment l&#8217;ansietat i la depressi\u00f3 (freq\u00fcents en pacients amb dolor cr\u00f2nic de qualsevol origen), amplifica la percepci\u00f3 del dolor i dificulta tant el diagn\u00f2stic com la resposta al tractament.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Quines eines diagn\u00f2stiques s&#8217;utilitzen en el dolor orofacial cr\u00f2nic?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">El diagn\u00f2stic del dolor orofacial cr\u00f2nic \u00e9s fonamentalment cl\u00ednic, basat en una hist\u00f2ria detallada i una exploraci\u00f3 f\u00edsica sistem\u00e0tica, encara que es complementa amb proves instrumentals espec\u00edfiques.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La hist\u00f2ria cl\u00ednica ha de recollir la localitzaci\u00f3, la irradiaci\u00f3, la intensitat (mitjan\u00e7ant escales com l&#8217;EVA o la NRS), la qualitat (quemante, el\u00e8ctrica, pulsativa, sorda), el patr\u00f3 temporal (continu, epis\u00f2dic, paroxismal), els factors desencadenants i els que alleugen el dolor, i l&#8217;impacte sobre les activitats de la vida di\u00e0ria.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">L&#8217;exploraci\u00f3 f\u00edsica inclou la palpaci\u00f3 sistem\u00e0tica de la musculatura masticat\u00f2ria i cervical, l&#8217;examen de l&#8217;articulaci\u00f3 temporomandibular (amplitud d&#8217;obertura, pres\u00e8ncia de desviaci\u00f3, sorolls articulars, dolor a la palpaci\u00f3 preauricular), l&#8217;exploraci\u00f3 neurol\u00f2gica b\u00e0sica de les branques del trigemin i l&#8217;exploraci\u00f3 dental i periodontal completa.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Els criteris diagn\u00f2stics de recerca per a les disfuncions temporomandibulars (DC\/TMD), publicats en 2014 i \u00e0mpliament validats internacionalment, proporcionen un protocol estandarditzat per al diagn\u00f2stic diferencial dins d&#8217;aquesta categoria.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Les proves d&#8217;imatge (resson\u00e0ncia magn\u00e8tica per a l&#8217;articulaci\u00f3 temporomandibular, CBCT per a les estructures \u00f2ssies, TC o resson\u00e0ncia magn\u00e8tica cranial per a descartar causes secund\u00e0ries) s&#8217;utilitzen de manera selectiva segons la sospita cl\u00ednica.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Quines s\u00f3n les opcions de tractament del dolor orofacial cr\u00f2nic?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">El tractament del dolor orofacial cr\u00f2nic \u00e9s multimodal per definici\u00f3: cap intervenci\u00f3 a\u00efllada \u00e9s suficient en la majoria dels casos, i la combinaci\u00f3 d&#8217;estrat\u00e8gies farmacol\u00f2giques, f\u00edsiques, psicol\u00f2giques i, en casos seleccionats, quir\u00fargiques \u00e9s l&#8217;enfocament amb major evid\u00e8ncia.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">El tractament farmacol\u00f2gic varia segons el tipus de dolor. En el dolor musculoesquel\u00e8tic, els antiinflamatoris no esteroidals (AINEs) a curt termini, els relaxants musculars i els antidepressius tric\u00edclics a dosis baixes (amitriptilina) tenen un paper establert. En el dolor neurop\u00e0tic, els f\u00e0rmacs de primera l\u00ednia s\u00f3n els antidepressius (amitriptilina, duloxetina), els antiepil\u00e8ptics (gabapentina, pregabalina) i, en la neur\u00e0lgia del trigemin, la carbamazepina.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La f\u00e8rula oclusal de desc\u00e0rrega \u00e9s el tractament m\u00e9s utilitzat per al dolor musculoesquel\u00e8tic d&#8217;origen temporomandibular: redueix la c\u00e0rrega articular i muscular, especialment durant el somni, i \u00e9s el tractament de primera l\u00ednia amb major evid\u00e8ncia en disfunci\u00f3 temporomandibular.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La fisioter\u00e0pia orofacial especialitzada (ter\u00e0pia manual, exercicis de mobilitzaci\u00f3 articular, t\u00e8cniques d&#8217;alliberament miofascial) t\u00e9 un paper rellevant en el dolor musculoesquel\u00e8tic i pot combinar-se efica\u00e7ment amb la f\u00e8rula oclusal.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Les infiltracions amb anest\u00e8sic local i corticoide en els punts gallet miofascials o en l&#8217;articulaci\u00f3 temporomandibular ofereixen alleujament temporal del dolor i poden facilitar la rehabilitaci\u00f3 funcional. La toxina botul\u00ednica en els m\u00fasculs masticadores hipert\u00f2nics \u00e9s una opci\u00f3 amb creixent evid\u00e8ncia en el dolor miofascial cr\u00f2nic refractari.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">El tractament psicol\u00f2gic (ter\u00e0pia cognitiu-conductual) \u00e9s especialment efica\u00e7 en el dolor cr\u00f2nic amb component de catastrofizaci\u00f3n o quan l&#8217;ansietat i la depressi\u00f3 s\u00f3n factors perpetuadors significatius.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Quan est\u00e0 indicat el tractament quir\u00fargic en el dolor orofacial cr\u00f2nic?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">El tractament quir\u00fargic del dolor orofacial cr\u00f2nic est\u00e0 indicat en un nombre limitat de situacions ben definides, sempre despr\u00e9s d&#8217;haver esgotat les opcions conservadores.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En la disfunci\u00f3 temporomandibular amb despla\u00e7ament discal irreductible sever i refractari al tractament conservador, l&#8217;artrosc\u00f2pia temporomandibular (amb rentada articular i lisi d&#8217;adher\u00e8ncies) o la artrotom\u00eda oberta (amb reposicionament o reempla\u00e7ament del disc) s\u00f3n opcions quir\u00fargiques amb evid\u00e8ncia establerta.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En la neur\u00e0lgia del trigemin refract\u00e0ria al tractament farmacol\u00f2gic, les t\u00e8cniques percut\u00e0nies sobre el gangli de Gasser (rizotom\u00eda per radiofreq\u00fc\u00e8ncia, compressi\u00f3 amb pilota) i la descompressi\u00f3 microvascular (t\u00e8cnica de Jannetta) ofereixen taxes de resposta elevades en pacients correctament seleccionats.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En Cl\u00ednica Belodonte la indicaci\u00f3 quir\u00fargica en el dolor orofacial cr\u00f2nic s&#8217;estableix sempre de manera multidisciplin\u00e0ria, en coordinaci\u00f3 amb neurologia, psicologia cl\u00ednica i fisioter\u00e0pia, i mai com a primera opci\u00f3 terap\u00e8utica.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Preguntes freq\u00fcents sobre dolor cr\u00f2nic orofacial<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Quant temps ha de durar el dolor per a considerar-se cr\u00f2nic?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Per convenci\u00f3 internacional, el dolor es considera cr\u00f2nic quan persisteix durant m\u00e9s de tres mesos. No obstant aix\u00f2, l&#8217;abordatge multidisciplinari del dolor orofacial ha d&#8217;iniciar-se abans que s&#8217;aconsegueixi aquest llindar, especialment quan els s\u00edmptomes s\u00f3n intensos o estan generant un impacte significatiu sobre la qualitat de vida del pacient.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">El dolor orofacial cr\u00f2nic t\u00e9 cura?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">El concepte de capell\u00e0 en el dolor cr\u00f2nic \u00e9s m\u00e9s complex que en el dolor agut. En alguns casos (neur\u00e0lgia del trigemin tractada amb descompressi\u00f3 microvascular reeixida, disfunci\u00f3 temporomandibular resolta amb tractament conservador), la resoluci\u00f3 completa \u00e9s possible. En uns altres, l&#8217;objectiu terap\u00e8utic realista \u00e9s la reducci\u00f3 significativa de la intensitat del dolor, la millora de la funci\u00f3 i la recuperaci\u00f3 de la qualitat de vida, m\u00e9s que l&#8217;eliminaci\u00f3 completa del s\u00edmptoma.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">\u00c9s normal que em diguin que el meu dolor \u00e9s psicol\u00f2gic?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">El component psicol\u00f2gic en el dolor cr\u00f2nic \u00e9s real i rellevant, per\u00f2 no implica que el dolor sigui inventat o imaginari. La neuroci\u00e8ncia del dolor ha demostrat que l&#8217;ansietat, la depressi\u00f3 i el catastrofisme amplifiquen el senyal dolor\u00f3s a nivell del sistema nervi\u00f3s central de manera objectiva i mesurable. Recon\u00e8ixer aquest component no invalida el dolor del pacient: \u00e9s simplement part del diagn\u00f2stic complet que permet un tractament m\u00e9s efica\u00e7.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Haig de consultar amb un neur\u00f2leg o amb un maxil\u00b7lofacial pel meu dolor facial?<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Dep\u00e8n del tipus de dolor. Si el dolor \u00e9s epis\u00f2dic, de caracter\u00edstiques el\u00e8ctriques o en desc\u00e0rrega, i es desencadena amb est\u00edmuls t\u00e0ctils en zones espec\u00edfiques de la cara, la primera consulta amb neurologia o amb un especialista en dolor orofacial \u00e9s adequada. Si el dolor est\u00e0 relacionat amb la masticaci\u00f3, els moviments mandibulars o la musculatura de la cara, la valoraci\u00f3 maxil\u00b7lofacial \u00e9s el punt de partida m\u00e9s apropiat. En molts casos, totes dues especialitats treballen de manera complement\u00e0ria.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">El dolor orofacial cr\u00f2nic no \u00e9s inevitable ni cal aprendre a viure amb ell sense buscar ajuda. Un diagn\u00f2stic correcte \u00e9s el primer pas cap a un tractament efica\u00e7, i aquest pas comen\u00e7a per explicar-li a l&#8217;especialista tot el que sents, quan comen\u00e7a i qu\u00e8 el millora o empitjora.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>El dolor cr\u00f2nic orofacial \u00e9s una de les condicions m\u00e9s complexes i subestimades de la medicina oral i la cirurgia maxil\u00b7lofacial. Es defineix com el dolor localitzat en la cara, la boca, el cap o el coll que persisteix durant [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":7494,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center 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