Concomitant depression and anxiety negatively affect pain outcomes in surgically managed young patients with trigeminal neuralgia: Long-term clinical outcome

Abstract

Background:Onset of trigeminal neuralgia (TN) is uncommon in young adults with less favorable benefit from surgical interventions. The aim of this study was to evaluate the role of concomitant psychosomatic disorders in long-term surgical outcomes in this population.Methods:Twenty-one patients younger than 30 years of age were diagnosed initially as having medically refractory TN, and each patient underwent microvascular decompression (MVD) as initial surgical management. Correlation of clinical outcome and psychosomatic disorders (DSM-IV) was evaluated during a 15-year interval.Results:A total of 93 procedures were performed for the management of TN and subsequent iatrogenic craniofacial pain disorders. At a median of 81 months, 8 of 21 patients were free of facial pain. Fourteen patients with concomitant major depressive disorder (MDD) or other anxiety disorders underwent a higher median of procedures compared with 7 patients without known MDD or anxiety (4.5 versus 1 intervention, P = 0.038). Two of 14 patients who were diagnosed with MDD or other anxiety disorders were free of craniofacial pain, whereas 6 of 7 patients without mood or anxiety disorders were free of craniofacial pain (P = 0.0005). Thirteen patients developed treatment-related complications that required further surgical procedures. Presence of MDD or other anxiety disorders was associated with higher rate of complications (P = 0.026). One patient with past medical history of severe anxiety died of unknown causes.Conclusions:In young patients with TN, comorbid MDD or anxiety disorders was associated with seeking multiple invasive procedures in multiple academic centers with limited benefit and high rates of surgical induced complications.

Exome Sequencing Implicates Impaired GABA Signaling and Neuronal Ion Transport in Trigeminal Neuralgia

“…These findings are consistent with the expression of GABA A Rs along sensory axons ( Bhisitkul et al., 1990 ; Oyelese et al., 1997 ), with the well-documented role of GABA A R signaling in trigeminal pathway nociception ( Dieb and Hafidi, 2015 ; Jang et al., 2017 ; Kaushal et al., 2016 ; Martin et al., 2010 ; Wei et al., 2013 ), with the efficacy of GABA-modulating drugs in some patients with TN ( Granger et al., 1995 ; White et al., 2000 ) ( Table S6 ), and with the established importance of GABA A R disinhibition and consequent neuronal hyperexcitability in neuropathic pain ( Dieb and Hafidi, 2015 ; Jang et al., 2017 ; Martin et al., 2010 ). These observations support our speculation that frequent co-occurrence of anxiety, depression, and other psychiatric conditions with TN, especially those in younger patients ( Mousavi et al., 2016 ) (often unresponsive to MVD) ( Hamlyn, 1997a ), may reflect pleiotropy of germline variants impacting other aspects of GABA signaling.…”

Amplified parabrachial nucleus activity in a rat model of trigeminal neuropathic pain

“…Neuropathic pain affecting the trigeminal system, in particular, is frequently associated with negative affective states, including a high incidence of depression, anxiety, and sleep disorders (Wu et al, 2015, Mousavi et al, 2016, Smith et al, 2013). Patients with trigeminal neuralgia and traumatic trigeminal neuropathic pain also suffer from hypersensitivity to light touch and temperature, often accompanied by a more persistent, dull pain in the region of the face innervated by the damaged nerve (Gregg et al, 1979, Dubner et al, 1987, Love and Coakham, 2001, Elias et al, 2014).…”

Microvascular decompression in patients aged 30 years or younger

“…[ 29 ] reported that TN due to venous compression is rare (5.8%), others documented a high rate in TN patients, including young individuals [ Table 3 ]. [ 28 30 31 32 ]…”