Abstract
BackgroundTrigeminal 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.MethodsIn 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.ResultsOf 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.ConclusionsIn 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.
Highlights
Trigeminal neuralgia (TN) causes severe episodic, unilateral facial pain and is initially treated with antiepileptic medications
The results indicate that a multidisciplinary care pathway can produce substantial benefit in a majority of patients, as evidenced by 79% of patients reporting improvement in the PGIC measure since beginning of treatment at this clinic
A study by Di Stefano et al [9] found that carbamazepine and oxcarbazepine, the 2 medications commonly recommended as first-line therapy for TN, produce side effects that can lead to treatment withdrawal
Summary
Trigeminal neuralgia (TN) causes severe episodic, unilateral facial pain and is initially treated with antiepileptic medications. Trigeminal neuralgia (TN) is a rare condition that affects the trigeminal nerve, resulting in extreme, sporadic, sudden, electric shock-like unilateral facial pain [1]. The attacks typically last only for a few seconds to a maximum of 2 min and can occur in quick succession with a frequency of 1–. These episodes of TN, encompassing the duration of recurrent attacks, can last for periods of days to even months, but can go into periods of remission which can last for months [3]. The intensity and unpredictability of the pain can be physically and mentally incapacitating, and result in a severe burden of illness (BOI) and impaired patient quality of life (QoL) [5, 6]. O’Callaghan et al The Journal of Headache and Pain (2020) 21:130 diagnostic delays [7], suboptimal management strategies, complications from treatments, and resistance to treatment may contribute to the disease burden [6]
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