Favourable prognosis of trigeminal neuralgia when enrolled in a multidisciplinary management program - a two-year prospective real-life study.
BACKGROUND
Prognosis of medically treated trigeminal neuralgia patients is assumed to be poor, but the evidence is lacking. Thus, prospective real-life studies of medical management of trigeminal neuralgia are warranted.


METHODS
This was an observational study. Patients were consecutively enrolled in a structured management program at a specialist centre for facial pain. Optimisation of medical treatment, physiotherapy, psychotherapy, and advice from trained nurses, were parts of the program. Medically intractable patients were referred for neurosurgery. Data-collection was prospective using standardised schemes and patient surveys. The aim was to describe the two-year outcome of medical treatment at the specialist centre. The primary outcome was a 50% reduction in the overall burden of pain according to a Numerical Rating Scale (NRS) after two years.


RESULTS
A total of 186 primary TN patients were enrolled in the program of which 103 patients remained medically managed and completed the two-year follow-up. Fifty patients were treated surgically within the first two years of follow-up. Half of the medically managed patients (53 (51%)), had more than a 50% reduction in the overall burden of pain over the two-year period. The overall burden of pain on NRS decreased from mean 5.34 to 3.00, p < 0.01. There was no significant association between primary outcome and sex, depression and/or anxiety, concomitant persistent pain, or neurovascular contact with morphological changes of the trigeminal nerve.


CONCLUSIONS
Patients with trigeminal neuralgia improve over a two-year period when enrolled in a structured medical management program. Optimisation of drug treatment, continuous advice and education and support by the multidisciplinary team, referral of the medically intractable patients for surgery or the natural history of the disease, can be some of the reasons for the improvement. The favourable prognosis provides hope and optimism for medically managed TN patients.


TRIAL REGISTRATION
Current study was observational, and patients were offered standard clinical care and laboratory workups according to current American Academy of Neurology and European Federation of Neurological Societies treatment guidelines. The study has been registered at ClincalTrials.gov. ID: NCT03838393 .
['Heinskou|Tone Bruvik|TB|http://orcid.org/0000-0002-1318-4262', 'Maarbjerg|Stine|S|', 'Wolfram|Frauke|F|', 'Rochat|Per|P|', 'Brennum|Jannick|J|', 'Olesen|Jes|J|', 'Bendtsen|Lars|L|']
D000328:Adult D000368:Aged D005157:Facial Pain D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D019635:Neurosurgical Procedures D018710:Pain Clinics D059408:Pain Management D011379:Prognosis D011446:Prospective Studies D012017:Referral and Consultation D016896:Treatment Outcome D014277:Trigeminal Neuralgia
Multidisciplinary management Real-life study Observational study Outcome Natural history Individualized drug treatment