Abstract
ICOP-1 was launched in 2020 and is now due for an update (1). This announcement from the ICOP-2 Steering Committee informs clinicians and researchers regarding ongoing activities towards the update and highlights several issues of special importance to be discussed.
ICOP-1 has been well received as the first comprehensive classification of all acute and chronic types of orofacial pain (OFP). It was designed to mirror and meet the same scientific and clinical rigor as ICHD-3 and was prepared in close coordination with the ICHD committee members (2).
More than 400 publications have since used and cited ICOP-1, and it is now internationally regarded as the gold standard for OFP diagnosis and a reference source for future guidelines on OFP management. We are also delighted that ICOP-1 has been translated into several languages.
Firstly, during the initial years of use, minor mistakes and omissions were noted in ICOP-1; these will be rectified in ICOP-2. Just as with ICOP-1 we will publish a final draft for ICOP-2 on the IHS website for maximal transparency and input from the clinical community. We emphatically invite the OFP and headache clinical communities to submit their observations to the Steering Committee.
Secondly, the revision will continue following the same guidelines as ICHD-3, where introduction of new entities and criteria must be data-supported and adhere to the same general structure as ICOP-1. As such, inclusion of neck pain and ocular pain is not deemed appropriate at this time whereas midfacial pain conditions linked to sinus pathology must be considered. Discussion is ongoing regarding the validity of idiopathic pain conditions, with or without somatosensory abnormalities; and this will be clarified. This is important, not least because the evolving concept of nociplastic pain may be linked to somatosensory abnormalities within the painful area. Differentiating between discrete/localized and regional/widespread pain in the orofacial region and head is of paramount importance.
Thirdly, the distinction between primary and secondary OFP—one of the hallmarks of ICHD-3 for headaches—will be further elaborated for myofascial pain and temporomandibular joint (TMJ) disorders, as well as for lesions or diseases of the cranial nerves. We note that open questions remain which need to be discussed such as improving the delineation between persistent idiopathic facial or dentoalveolar pains (PIFP, PIDAP) and neuropathic pain, and rare entities such as orofacial migraine and constant unilateral facial pain with additional attacks (CUFPA).
Fourthly, the chapter on facial presentation of primary headaches will need careful reassessment. The question of whether tension-type orofacial pain, indeed, exists needs researching. This can only be done with tentative inclusion criteria. Additionally, considering recent publications the relationship between neurovascular orofacial pain and orofacial migraine needs reassessing.
Lastly, ICOP-2 will retain a chapter on the assessment of psychosocial and biobehavioral aspects of OFP, even though this is not in line with ICHD-3. The roadmap for ICOP-2 will be aligned with ICHD-4, with tentative publication in Cephalalgia in 2029. This timeline will allow clinical research to address ambiguities, arbitrarily decided criteria, and coordination between pain diagnostic systems. ICOP-2 aims for optimized clinical utility and user-friendliness to maximize impact.
Footnotes
Author contributions
PS drafted the editorial and all co-authors provided input and agreed on the final draft.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
