Evaluating the impact of trigeminal neuralgia

There is a lack of prospective systematic studies on the clinical characteristics of pain in trigeminal neuralgia (TN) as well as its 'psychosocial burden'. Patients with idiopathic TN were categorised into three sub-types (n = 225). Group 1 (n= 155, 68.9%) had TN without concomitant pain, Group 2 (n=32, 14.2%) had TN with intermittent concomitant pain and Group 3 (n=39, 16.9%) had TN with autonomic symptoms. We tested two hypotheses: (i) that different pain profiles would be associated with the different groups; (2) that the severe pain associated with TN would impact negatively on activities of daily living and thereby result in disability as defined by the World Health Organisation. A different pain profile was found across the groups. We obtained unequivocal evidence that TN causes disability with up to 45% of patients being absent from usual daily activities 15 days or more in the past 6 months. On the Hospital Anxiety and Depression Scale, 35.7% patients had mild to severe depression and over 50% were anxious. The Pain Catastrophizing Scale showed that 78% of patients had considerable negative thoughts with scores > 20 and a mean score of 36.4. Prior to referral only 54% had been prescribed carbamazepine whilst opioids had been prescribed in 14.6% of the patients. Prior to referral over 80% had already been to one specialist centre which had not provided appropriate management. Patients with TN report varied characteristics but all result in some degree of psychosocial disability especially before adequate therapy is attained