Treatment Outcomes in Trigeminal Neuralgia–A Systematic Review of Domains, Dimensions and Measures

Nova, Carolina Venda; Zakrzewska, Joanna M; Baker, Sarah R.; Ríordáin, Rícheal Ní

doi:10.1016/j.wnsx.2020.100070

Cited by 35 publications

(35 citation statements)

References 466 publications

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“…These measures often only capture the mood and pain of the patient at a set time point of 1 week, and this can be very readily influenced by how the patient's pain has been in the few days leading up to their appointment. We also know that few of these measures have been psychometrically tested in this population [22]. Comparatively, a global summary of improvement in their pain is more reflective of the patient's perspective on how well they feel their pain is managed overall.…”

Section: Discussionmentioning

confidence: 99%

The Journeys of Patients with Trigeminal Neuralgia on a Background of Multiple Sclerosis

Patel

Godazandeh

et al. 2021

Pain Manag.

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Aim: Multiple sclerosis (MS) is well recognized as a secondary cause for trigeminal neuralgia (TN). In this case series, we detail the management of all the patients with TN and MS (pwTNMS) presenting to a specialist unit. Materials & methods: A prospective patient database was used to extract key clinical data on pharmacological, psychometric and surgical management of 20 pwTNMS. Results: 65% of pwTNMS underwent surgical interventions for management of their pain.12/20 achieved remission periods, through surgery and/or medication. Significant improvement was noted on the global impression of change illustrated by a p < 0.001. Conclusion: pwTNMS require a multifaceted approach combining polypharmacy, surgical interventions and psychological support. Developing self-management skills is crucial if patients are to live well with pain.

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Section: Discussionmentioning

confidence: 99%

The Journeys of Patients with Trigeminal Neuralgia on a Background of Multiple Sclerosis

Patel

Godazandeh

et al. 2021

Pain Manag.

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“…This approach is recommended in the updated guidelines [ 8 ]. A recent systematic review of outcomes used in 467 TN studies highlights how few studies report on domains such as physical ( n = 46) and emotional functioning ( n = 17) and only 35 studies collected data on patient satisfaction [ 33 ]. This study adds a breadth of information to the relatively limited prior research on these topics.…”

Section: Discussionmentioning

confidence: 99%

Burden of illness of trigeminal neuralgia among patients managed in a specialist center in England

et al. 2020

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Background Trigeminal neuralgia (TN) causes severe episodic, unilateral facial pain and is initially treated with antiepileptic medications. For patients not responding or intolerant to medications, surgery is an option. Methods In order to expand understanding of the pain-related burden of illness associated with TN, a cross-sectional survey was conducted of patients at a specialist center that utilizes a multidisciplinary care pathway. Participants provided information regarding their pain experience and treatment history, and completed several patient-reported outcome (PRO) measures. Results Of 129 respondents, 69/128 (54%; 1 missing) reported no pain in the past 4 weeks. However, 84 (65%) respondents were on medications, including 49 (38%) on monotherapy and 35 (27%) on polytherapy. A proportion of patients had discontinued at least one medication in the past, mostly due to lack of efficacy (n = 62, 48%) and side effects (n = 51, 40%). A total of 52 (40%) patients had undergone surgery, of whom 30 had microvascular decompression (MVD). Although surgery, especially MVD, provided satisfactory pain control in many patients, 29% of post-surgical patients reported complications, 19% had pain worsen or stay the same, 48% were still taking pain medications for TN, and 33% reported new and different facial pain. Conclusions In most PRO measures, respondents with current pain interference had poorer scores than those without pain interference. In the Patient Global Impression of Change, 79% expressed improvement since beginning of treatment at this clinic. These results indicate that while the multidisciplinary approach can substantially alleviate the impact of TN, there remains an unmet medical need for additional treatment options.

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“…The goal of treatment of trigeminal neuralgia is to reduce the frequency and intensity of the paroxysms of facial pain or eliminate them altogether. Most management studies used pain relief as the major outcome measure, though there is no consensus about outcome measures [ 39 ]. Pain intensity is not the same as the degree of pain relief.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies of treatment of TN used either the visual analogue scale (VAS) for pain or the Barrow Neurological Institute Pain Intensity Scale to measure pain intensity. A smaller number used attack frequency, measures of daily functioning, emotional impact of TN, or satisfaction with treatment [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Chronic Facial Pain: Trigeminal Neuralgia, Persistent Idiopathic Facial Pain, and Myofascial Pain Syndrome—An Evidence-Based Narrative Review and Etiological Hypothesis

Gerwin

2020

IJERPH

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Trigeminal neuralgia (TN), the most common form of severe facial pain, may be confused with an ill-defined persistent idiopathic facial pain (PIFP). Facial pain is reviewed and a detailed discussion of TN and PIFP is presented. A possible cause for PIFP is proposed. (1) Methods: Databases were searched for articles related to facial pain, TN, and PIFP. Relevant articles were selected, and all systematic reviews and meta-analyses were included. (2) Discussion: The lifetime prevalence for TN is approximately 0.3% and for PIFP approximately 0.03%. TN is 15–20 times more common in persons with multiple sclerosis. Most cases of TN are caused by neurovascular compression, but a significant number are secondary to inflammation, tumor or trauma. The cause of PIFP remains unknown. Well-established TN treatment protocols include pharmacotherapy, neurotoxin denervation, peripheral nerve ablation, focused radiation, and microvascular decompression, with high rates of relief and varying degrees of adverse outcomes. No such protocols exist for PIFP. (3) Conclusion: PIFP may be confused with TN, but treatment possibilities differ greatly. Head and neck muscle myofascial pain syndrome is suggested as a possible cause of PIFP, a consideration that could open new approaches to treatment.

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Treatment Outcomes in Trigeminal Neuralgia–A Systematic Review of Domains, Dimensions and Measures

Cited by 35 publications

References 466 publications

The Journeys of Patients with Trigeminal Neuralgia on a Background of Multiple Sclerosis

The Journeys of Patients with Trigeminal Neuralgia on a Background of Multiple Sclerosis

Burden of illness of trigeminal neuralgia among patients managed in a specialist center in England

Chronic Facial Pain: Trigeminal Neuralgia, Persistent Idiopathic Facial Pain, and Myofascial Pain Syndrome—An Evidence-Based Narrative Review and Etiological Hypothesis

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