Long term evaluation of a multidisciplinary trigeminal neuralgia service

Abstract

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 Three hundred thirty-four 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.

Guidelines for the management of trigeminal neuralgia

“…A review of outcomes over an 11-year period in 285 patients without prior surgery for TN reported that 54% (153 of 285) had a surgical procedure and 46% (132 of 285) were medically managed. 13 Of the 334 patients included in the study, 93 (28%) were pain-free and off medication. The largest group that was pain-free and off medication were those who had undergone fi rst-time surgery (84 patients, or 55%).…”

“…Of the 49 patients undergoing surgery for a second time, only 11 (22%) were pain-free and off medication, and the 132 who remained on medication alone (18 patients, or 16%) were pain-free and off medication due to remissions. 13…”

Management of trigeminal neuralgia: A multi-centre case study in general practice

“…5 Data from a London specialist centre shows that the mean delay in referral to secondary care can be between four to 7 years and that this can be significantly extended further in patients who receive multiple referrals. 13 GPs refer to general neurologists in contrast to dental surgeons who refer to oral and maxillofacial surgical teams and this results in further delays. However, collaboration with a dental surgeon may be appropriate prior to medical management of TN as dental pain is very common and can present with similar symptoms Patients are aware of this problem and in a recent TN focus group study highlighted the need for faster referral to specialist centres.…”

Clinical characteristics of pain in patients with trigeminal neuralgia: data from a neurosurgical clinic

“…S. Singhota та співавт. [9], проаналізувавши дані 334 пацієнтів з діагнозом «невралгія трійчастого нерва», визначили, що середній вік першого візиту в заклад -58,8 року, переважання патології серед жінок (64,4 %), середня тривалість болю -(7,5 ± 7,7) року, 60,5 % пацієнтів отримували монотерапію (40,9 % -карбамазепін).…”