Cognitive Behavioral Therapy for Patients with Trigeminal Neuralgia: A Feasibility Study

Daniel, Hilary; Poole, Jolyon Ji; Klein, Hélène; Huang, Cleo; Zakrzewska, Joanna M

doi:10.11607/ofph.2664

Cited by 13 publications

(15 citation statements)

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“…In recent 2 years, a large number of clinical studies had taken CBT as a management measure of different kinds of pain, including mixed unlocated chronic pain [ 7 – 18 ], back pain [ 19 , 20 ], low back pain [ 21 – 26 ], chronic pancreatitis [ 27 ], fibromyalgia [ 28 , 29 ], functional abdominal pain [ 30 ], trigeminal neuralgia [ 31 ], haemophilia pain [ 32 ], osteoarthritis pain [ 33 – 35 ], perioperative pain [ 36 – 39 ], orofacial pain [ 40 ], diabetic peripheral neuropathic pain [ 41 ], and provoked vestibulodynia [ 42 ]. Previous studies on structural changes in the brain of patients with chronic pain indicated the presence of neuroplasticity in areas associated with the experience and anticipation of pain [ 43 ].…”

Section: Structural and Functional Changes Of The Brain Due To Cbtmentioning

confidence: 99%

Neuroimaging Mechanism of Cognitive Behavioral Therapy in Pain Management

Bao

Qiao

et al. 2022

Pain Research and Management

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Purpose. To review the recent neuroimaging studies on cognitive-behavioral therapy (CBT) for pain management, with the aim of exploring possible mechanisms of CBT. Recent Findings. Current studies can be divided into four categories, mixed pain, fibromyalgia, migraine, and experimental pain, based on the type of disease included, with the same or different changes of brain regions after CBT intervention. According to structural and functional MRI analyses, changes of brain gray matter volume, activation and deactivation of brain regions, and intrinsic connectivity between brain regions were observed after CBT sessions. The brain regions involved mainly included some areas related to cognitive and emotional regulation. After comparison, the DLPFC, OFC, VLPFC, PCC and amygdala were found to be recurrent in multiple studies and may be key regions for CBT intervention in pain management. In the treatment of mixed chronic pain, CBT may decrease the gray matter volume of DLPFC, reduce ICN connection of OFC within the DAN network, and increase fALFF of the PCC. For FM intervention, CBT may activate the bilateral OFC and VLPFC, while in migraine, only the right OFC, VLPFC, and DLPFC were found to be more activated after CBT. In addition, the differential action of the left and right amygdala has also been shown in the latest study of migraine. In heat-evoked pain, CBT may increase the deactivation of the PCC, the connectivity between the DMN and right VLPFC, while diminishing the deactivation of VLPFC. Summary. After CBT, the brain showed stronger top-down pain control, cognitive reassessment, and altered perception of stimulus signals (chronic pain and repeated acute pain). The DLPFC, OFC, VLPFC, PCC, and amygdala may be the key brain regions in CBT intervention of pain.

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Section: Structural and Functional Changes Of The Brain Due To Cbtmentioning

confidence: 99%

Neuroimaging Mechanism of Cognitive Behavioral Therapy in Pain Management

Bao

Qiao

et al. 2022

Pain Research and Management

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“…Psychological support is crucial as low mood, anxiety and poor sleep are common in patients diagnosed with TN [4,16]. Patients were offered psychological support to facilitate them living well with pain as reported by our unit [15].…”

Section: Discussionmentioning

confidence: 99%

“…This pathway has been shown to result in significant improvement in global impression of change [13]. It includes support from clinical nurse specialists [14] and psychology support to help patients live well with pain and uncertainly [15].…”

mentioning

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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“…Patients who wished to have stereotactic radiosurgery were warned that pain relief would not be immediate, and that this was therefore potentially not suitable for those with poor pain control, but more suited to those who had manageable pain, or were pain free and had signi cant side effects with medication. All patients had access to a pain management program which included clinical psychologists and physiotherapist [10,11] as well as the doubly quali ed facial pain team as per local care pathway [9]. Patients are provided with a written information booklet produced by the Brain and Spine Foundation (https://www.brainandspine.org.uk/our-publications/booklets/face-pain/) [12]., and a comprehensive letter including all the surgical options with their pros and cons.…”

Section: Settingmentioning

confidence: 99%

Long term evaluation of a multidisciplinary trigeminal neuralgia service

Singhota

Tchantchaleishvili

et al. 2022

Preprint

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Background: Trigeminal neuralgia is an episodic severe neuralgic pain and can be managed both medically and surgically. If possible, this should be directed by a Multidisciplinary Team (MDT) of specialised surgeons, physicians, dentists, psychologists and specialist nurses with access to all treatment modalities, which enables patients to make an informed decision about their future management.Objective: The aim of this study was to review the outcomes of patients managed by an MDT clinic, in a single institute over an eleven-year period.Methods: A prospective database was used to identify patients with trigeminal neuralgia or its variants who had attended a joint MDT clinic. The electronic notes were examined for demographics, onset and duration of trigeminal neuralgia, medications history, pain scores and details of surgical procedures if any by two independent assessors. Results: 334 patients attended the MDT between 2008-2019. Forty-nine of them had surgery before being referred to the service and were included but analysed as a subgroup. Of the remaining patients, 54% opted to have surgery following the MDT either immediately or at a later date. At the last reported visit 55% of patients who opted to have surgery were pain free and off medications, compared to 15.5% of medically managed patients. Surgical complications were mostly attributable to numbness and in the majority of cases this was temporary. All patients who were not pain free, had complications after surgery or opted to remain on medical therapy were followed up in a facial pain clinic which has access to pain physicians, clinical nurse specialists and a tailored pain management program. Regular patient related outcome measures are collected to evaluate outcomes.Conclusion: An MDT clinic offers an opportunity for shared decision making with patients deciding on their personal care pathway which is valued by patients. Not all patients opt for surgery, and some continue to attend a multidisciplinary follow up program. Providing a full range of services including psychological support, improves outcomes.

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Cognitive Behavioral Therapy for Patients with Trigeminal Neuralgia: A Feasibility Study

Cited by 13 publications

References 0 publications

Neuroimaging Mechanism of Cognitive Behavioral Therapy in Pain Management

Neuroimaging Mechanism of Cognitive Behavioral Therapy in Pain Management

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

Long term evaluation of a multidisciplinary trigeminal neuralgia service

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