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Burchiel Questionnaire

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Neuropathic facial pain is diagnosed almost exclusively by the individual’s description of the symptoms. Dr. Kim Burchiel developed a list of questions to help doctors determine exactly which classification may describe a patient’s pain. You may want to complete the Burchiel Questionnaire for your physician as a way of helping to determine the correct pain classification. This questionnaire in the hands of experienced neurologists and neurosurgeons can be very powerful.

1) When you have pain, is it predominately in your face (i.e. forehead, eye, cheek, nose, upper/lower jaw, lips, etc.)?

2) Do you have pain just on one side of your face?

3) Is your pain either entirely or mostly brief (seconds to minutes) and unpredictable sensations (electrical, shocking, stabbing, shooting)?

4) Do you have constant background facial pain (aching, burning, throbbing, stinging)?

5) Do you have any constant facial numbness?

6) Can your pain start by something touching your face (e.g. by eating, washing your face, shaving, brushing teeth, etc.)?

7) Since your pain began, have you ever experienced periods of weeks, months or years when you were pain-free? (This does not include periods after any pain-relieving surgery or while you were on medications for your pain.)

8) Have you ever taken Tegretol, Neurontin, Baclofen, Trileptal or other anti-seizure drugs (AED’s) for your facial pain?

9) Did you ever experience any major reduction in facial pain (partial or complete) from taking any of these AEDs?

10) Have you ever had surgery for your pain? (e.g. neurectomy, radiofrequency, lesioning, glycerol injection, balloon compression, rhizotomy, microvascular decompression or radiosurgery)

11) Did your current pain start only after trigeminal nerve surgery? If this is a recurrence of your original pain after successful trigeminal nerve surgery, the answer is, “no”.

12) Did your pain start after facial herpes zoster or “shingles” rash (not merely “fever blisters” around the mouth)?

13)Do you have multiple sclerosis?

14)Did your pain start after a facial injury?

15) Did your pain start only after facial surgery (i.e. oral surgery, ear/ nose/throat surgery or plastic surgery)?

16) When you place your index finger right in front of your ears on both sides at once and feel your jaw open and close, does the area under your fingers on either side hurt?