Evaluating the impact of trigeminal neuralgia

Abstract

Patients with idiopathic trigeminal neuralgia (TN) were categorised into 3 subtypes (n = 225). Group 1 (n = 155, 68.9%) had TN without concomitant pain, group 2 (n = 32, 14.2%) had TN with intermittent concomitant pain, and group 3 (n = 39, 16.9%) had TN with autonomic symptoms. We tested 2 hypotheses: (1) that different pain profiles would be associated with the different groups; (2) that the severe pain associated with TN would impact negatively on activities of daily living and thereby result in disability as defined by the World Health Organisation. A different pain profile was found across the groups. We obtained unequivocal evidence that TN causes disability with up to 45% of patients being absent from usual daily activities 15 days or more in the past 6 months. On the Hospital Anxiety and Depression Scale, 35.7% patients had mild-to-severe depression and over 50% were anxious. The Pain Catastrophizing Scale showed that 78% of patients had considerable negative thoughts with scores >20 and a mean score of 36.4. Prior to referral, only 54% had been prescribed carbamazepine while opioids had been prescribed in 14.6% of the patients. Prior to referral, over 80% had already been to 1 specialist centre which had not provided appropriate management. Patients with TN report varied characteristics but all result in some degree of psychosocial disability especially before adequate therapy is attained.

Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach

“…In patients with a neurovascular conflict and medically refractory TN, microvascular decompression is generally the most successful option, with about 75% of the patients being pain free up to 5 years after surgery and a relatively low recurrence rate (about 4% per year) [24][25][26]. Perioperative morbidity cannot be underestimated since it involves an open cranial operation; however, this risk has to be outweighed against the substantial impact this devastating disease has on daily life, with severe depression being present in more than 10% of the patients [27,28]. Other less invasive treatment options are radiofrequency rhizotomy, glycerol rhizotomy, balloon microcompression, and stereotactic radiosurgery (gamma knife).…”

Characterizing Treatment Utilization Patterns for Trigeminal Neuralgia in the United States

“…The severe pain experienced by patients with TN can lead to significant impairment of quality of life, 6 with outcomes for many remaining suboptimal, both because of a lack of efficacy and poor tolerability of available therapies. Few advances have been made in the treatment of TN in recent years, and at present there are no drugs that have been specifically developed for TN.…”

“…25 Similar treatment patterns, including multiple drug use and only half of patients being prescribed carbamazepine, were noted in a prospective study by Zakrzewska et al among patients with TN referred to a specialist pain center in the United Kingdom. 6 In a large UK study by Hall et al, 58% of treated patients with TN were prescribed carbamazepine as an initial treatment, while substantially fewer were prescribed analgesics and amitriptyline (note that the study predated the introduction of gabapentin and pregabalin). 5 Further, more frequent treatment changes occurred when analgesics were used versus carbamazepine.…”

“…[2][3][4][5] However, the patient burden of TN is substantial owing to the severity of the pain, which may worsen or become more prolonged over time. 6,7 In one study, almost 60% of patients scored the intensity of TN paroxysmal stabbing pain as "the worst possible pain." 8 There is evidence that TN-associated pain can lead to disability, depression, and anxiety, having a significant impact on patient's quality of life, as well as indirect costs to society resulting from work absenteeism.…”

“…8 There is evidence that TN-associated pain can lead to disability, depression, and anxiety, having a significant impact on patient's quality of life, as well as indirect costs to society resulting from work absenteeism. 6,7 Clinical guidelines recommend carbamazepine, the only medication currently approved by the US Food and Drug Administration (FDA) for TN, and oxcarbazepine (a keto-analog of carbamazepine), both anticonvulsants, as first-line treatments for TN. 9 While there is evidence to support the use of carbamazepine for pain relief in TN (number need to treat [NNT] of 2) 10 , its use must be considered in light of a poor tolerability profile and adverse effects that can include dizziness, liver damage, and cognitive impairment (number needed to harm for carbamazepine withdrawal of 24, 95% CI 14 -112).…”