Introduction: Treatment for medically refractory trigeminal neuralgia (TN) ranges from conservative to neurosurgical intervention. The Brief Pain Inventory (BPI)-Facial was applied here in both short- and long-term follow-up to assess these treatments’ outcomes.
Methods: An IRB-approved retrospective chart review is planned for 576 patients evaluated by the senior author (JYL) for possible neurosurgical intervention (2006-2011). Procedures included microvascular decompression, percutaneous glycerol rhizotomy, supraorbital nerve stimulation, and gamma knife radiosurgery. To date, the BPI-Facial has been administered to and analyzed for 19 TN patients pre-operatively (baseline if no surgery), at the post-procedural visit, and at the long-term follow-up (mean 5.77 years) by telephone.
Results: Patients that underwent neurosurgical intervention (N=12) had higher preoperative mean ratings on the BPI-Facial than those who were treated conservatively (N=7) for all categories (pain intensity, 6.19 vs. 3.55, general activity interference, 6.26 vs. 4.35, facial-specific interference, 6.07 vs. 3.94). Neurosurgical intervention regardless of procedure type was associated with significant benefit in all categories (pain intensity, 2.17, general activity interference, 2.03, facial-specific interference, 1.5; p<0.01) at the post-procedural visit. This significant improvement persisted long-term (pain intensity, 1.87, general activity interference, 1.58, facial-specific interference, 1.61; p<0.01). Conservative measures provided long-term benefit only in the facial-specific interference score (1.61 vs. 1.33; p<0.04).
Conclusions: Preliminary findings indicate that neurosurgical intervention for TN is efficacious and durable. While conservative measures provided some benefit, patients undergoing surgery suffered from more severe TN. Future work encompassing the entire cohort will better delineate these relative outcomes and allow for more procedure-specific comparisons.
Patient Care: This research will improve care for patients with trigeminal neuralgia because it shows the efficacy and durability of various treatment options for trigeminal neuralgia. Because this study evaluates how different treatments (ranging from conservative to neurosurgical) affect pain intensity and interference at various time points, patients will be able to make more informed choices when it comes to choosing their treatment.
Learning Objectives: By the conclusion of the session, participants should be able to understand that neurosurgical intervention provides an effective and long-lasting treatment option for patients with medically refractory trigeminal neuralgia. The results of the BPI-Facial will show how pain intensity and interference caused by pain changes over time and also how it differs among patients with conservative therapy and those who had neurosurgical intervention.