Pathophysiology

The etiology of AFP is largely unknown, although some risk factors have been suggested.117 These risk factors include psychological factors, hormonal factors, minor nerve trauma, and infection of the sinuses or teeth.117 None of these risk factors can be considered the sole etiological factor. The high level of psychiatric comor-bidity has led to the assumption that AFP is secondary to mental illness, for example depression.111 However, whether AFP pain is secondary to mental illness, or vice versa, can be very difficult to determine. Furthermore, the large proportion of middle-aged women suffering from AFP has aroused the suspicion that AFP could be caused or worsened by a deficiency or imbalance in female sex hormones.117 At present, a widely discussed hypothesis is that AFP is neuropathic in origin, which could explain the temporal relationship between debut of AFP and the history of trauma or surgery in or near the painful region.

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