Racial disparities in the diagnosis and management of trigeminal neuralgia

Abstract

OBJECTIVE A number of studies have documented inequalities in care and outcomes for a variety of clinical conditions. The authors sought to identify racial and socioeconomic disparities in the diagnosis and treatment of trigeminal neuralgia (TN), as well as the potential underlying reasons for those disparities, which could serve as areas of focus for future quality improvement initiatives. METHODS The medical records of patients with an ICD-9 code of 350.1, signifying a diagnosis of TN, at the Henry Ford Medical Group (HFMG) in the period from 2006 to 2012 were searched, and clinical and socioeconomic data were retrospectively reviewed. Analyses were conducted to assess potential racial differences in subspecialty referral patterns and the specific type of treatment modality undertaken for patients with TN. RESULTS The authors identified 652 patients eligible for analysis. Compared with white patients, black patients were less likely to undergo percutaneous ablative procedures, stereotactic radiosurgery, or microvascular decompression (p < 0.001). However, there was no difference in the likelihood of blacks and whites undergoing a procedure once they had seen a neurosurgeon (67% vs 70%, respectively; p = 0.712). Blacks and whites were equally likely to be seen by a neurologist or neurosurgeon if they were initially seen in either the emergency room (38% vs 37%, p = 0.879) or internal medicine (48% vs 50%, p = 0.806). Among patients diagnosed (268 patients) after the 2008 publication of the European Federation of Neurological Societies and the American Academy of Neurology guidelines for medical therapy for TN, fewer than 50% were on medications sanctioned by the guidelines, and there were no statistically significant racial disparities between white and black patients (p = 0.060). CONCLUSIONS According to data from a large database from one of the nation's largest comprehensive health care systems, there were significant racial disparities in the likelihood of a patient undergoing a procedure for TN. This appeared to stem from outside HFMG from a difference in referral patterns to the neurologists and neurosurgeons.

Dialectical Pain Management: Feasibility of a Hybrid Third-Wave Cognitive Behavioral Therapy Approach for Adults Receiving Opioids for Chronic Pain

“…This is even more problematic when it comes to race. It is well documented, for example, that African Americans with chronic pain are at greater risk of undertreatment [106,107] and invalidation by providers [108,109]. African Americans with chronic pain also report greater pain intensity, distress, and interference with functioning [110,111], especially those who are living in poorer urban areas [112].…”

Small Posterior Cranial Fossa and Cerebellopontine Cistern Volumes Are Associated With Bilateral Trigeminal Neuralgia

“…Regarding the pathogenesis of TN, it is believed that the trigeminal nerve becomes chronically compressed by abnormal twisted microvessels in the REZ area, resulting in inflammation and demyelination changes in the root of the trigeminal nerve and thus in a “short circuit” of membrane potential and neuropathic pain in the trigeminal nerve distribution area ( 14 ). One study ( 4 ) showed that the size, shape, and structure of the skull varies according to race and sex. Asians, especially women, have a higher incidence of TN and more crowding in the posterior fossa.…”

“…By eliminating NVC, microsurgical vascular decompression (MVD) can successfully relieve pain. Several studies have shown that the small space of the posterior cranial fossa is associated with NVC, suggesting a correlation between overcrowding of the posterior cranial fossa and TN (3,4).…”

Radiofrequency thermocoagulation in cases of atypical trigeminal neuralgia: a retrospective study

“…In our study population, the right side was more affected than the left (13 patients, 68.5% versus 6 patients, 31.5%, respectively). This may be attributed to the anatomical fact that foramen rotundum and foramen ovale are usually narrower on the right side [16,[23][24][25]. The mandibular and/or maxillary branches were equally affected.…”