436 Colored Pain Drawing in Patients With Trigeminal Neuralgia and Its Impact on Gamma Knife Radiosurgery Outcomes

Abstract

INTRODUCTION: Trigeminal neuralgia (TN) is one of the most common causes of facial pain and Gamma Knife radiosurgery (GKRS) has been used for a long time with high pain relief rates. However, psychological processes can influence the pain perception and adversely affect treatment outcome. Colored pain drawing (CPD) is a simple,powerful tool for capturing essential aspects of the subjective pain. METHODS: Fifty consecutive patients with medically intractable, ICHD-3 beta-confirmed TN were included. A numerical pain rate scale (NPRS) was used to assess usual level of pain experienced by the patient. Patients were asked to draw the distribution of usual pain pattern with a colored pen of their choice on two standardized face charts. The patients then underwent GKRS. Follow-up data were obtained by clinical examination and/or telephone questionnaire postoperatively at 1, 3 and 6 months. Outcome results were categorized based on the Barrow Neurological Institute (BNI) pain scale (BNI I–III:good outcomes and BNI IV–V:treatment failure). BNI facial numbness score was used to assess complications. All CPDs were classified as “expected” or “unexpected” based on the patient’s description of pain. RESULTS: The median age was 64 years (range, 27-88) years and the male/female ratio was 3:2. 86% of the patients experienced immediate pain relief within the first 3 months. Of those patients, 39 (90.7%) did not have any pain recurrence (BNI I). At last follow-up, 39 (78%) patients had good treatment outcome and 11 patients (22%) had treatment failure. 96% of the patients did not experience any facial numbness. There were 35 patients with “expected” and 15 patients with “unexpected” CPDs. NPRS scores were not significantly different between groups (p = 0.985). The preference of association of pain with black or red color was distinct and did not differ between two groups (p = 0.08). Patients with “expected” CPDs reported significantly better freedom from pain compared with those with “unexpected” CPDs (p < 0.0001). CONCLUSION: CPDs could serve as clinical acumen for outcomes of GKRS treatment for TN.