Research: Facal Pain Relief and Surgery

EpubMallory et al. Outcomes after Percutaneous Surgery for Patients with Multiple Sclerosis Related Trigeminal Neuralgia. Neurosurgery. 2012 May 15.

BACKGROUND: Approximately 1-2 percent of patients with multiple sclerosis develop trigeminal neuralgia (TN). Percutaneous surgery is commonly performed in medically refractory cases.

OBJECTIVE: To analyze the pain outcomes and complications for patients with multiple sclerosis related trigeminal neuralgia (MS-TN) having percutaneous surgery.

METHODS: Retrospective review of patients having balloon micro-compression (BMC) (n=69) or glycerol rhizotomy (PRGR) (n=67) from 1997-2010. Patients in the two groups were similar with regard to age, gender, pain location, and pain quality. Mean pain duration was longer in the PRGR group (54.6 versus 16 months, P<0.001); more patients having BMC had prior surgery (87% versus 48%, P<0.001). Outcomes were defined as excellent (no pain, no medications), good (no pain with medications), and poor. Median follow-up was 13 months (range, 0.25-132 months).

RESULTS: Ninety-five patients initially had excellent (n=45, 33%) or good outcomes (n=50, 37%). Pain relief was maintained in 58 percent of patients at 3-months and 28 percent at 2-years. There was no difference in excellent/good outcomes between the surgical groups (HR=0.73, P=0.14). No correlation was noted between pain relief and new or increased facial numbness (HR=0.78, P=0.19). Forty-four BMC patients (64%) had additional surgery compared to 36 PRGR patients (54%) (P=0.19). Complications were more frequent after BMC (17.4% versus 3.0%, P<0.01).

CONCLUSION: Percutaneous surgery for patients with MS-TN is less likely to provide pain relief than similar operations performed for patients with idiopathic TN. New trigeminal deficits did not correlate with better facial pain outcomes, supporting the concept that many patients with MS-TN have centrally mediated pain.

Trigeminal neuralgia is a nerve disorder that causes a stabbing or electric-shock-like pain in parts of the face. This is thought to originate from the trigeminal nerve. This
nerve carries pain, feeling, and other sensations from the brain to the
skin of the face. It can affect part or all of the face, and the surface
of the eye. Sometimes the treatment is surgical which aims to cut the signal along the trigeminal nerve. The surgery could be rhizotomy which is surgical removal of the nerve roots.

Although there was a good initial response from surgery, the effectiveness diminished with time.  There was a better response to surgery in idiopathic (no lesion or obvious cause) TN than MS-TN. Ths result suggest that some of the pain is generated by misfiring of nerves within the CNS tissue that falsely trigger pain nerve pathways. This is called neuropathic pain and is particularly diffficult to treat in comparison to other types of pain.

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1 comment

  • '…is a nerve disorder that causes a stabbing or electric-shock-like pain in parts of the face.'

    So if the pain is constant and fluctuating in severity it is not TN?

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