Long term evaluation of a multidisciplinary trigeminal neuralgia service

Sanjeet Singhota; Nana Tchantchaleishvili; Jianhua Wu; Ludvic Zrinzo; Lewis Thorne; Harith Akram; Joanna M Zakrzewska

doi:10.1186/s10194-022-01489-7

Long term evaluation of a multidisciplinary trigeminal neuralgia service

J Headache Pain. 2022 Sep 3;23(1):114. doi: 10.1186/s10194-022-01489-7.

Authors

Sanjeet Singhota^{1

2

3}, Nana Tchantchaleishvili^{4

5}, Jianhua Wu⁶, Ludvic Zrinzo⁴, Lewis Thorne⁴, Harith Akram⁴, Joanna M Zakrzewska^{7

8}

Affiliations

¹ Medical School, University of Birmingham, Birmingham, B15 2GW, UK.
² Current address: The Royal London Hospital, London, E1 1FR, UK.
³ Facial Pain Department, Royal National ENT & Eastman Dental Hospitals, London, WC1E 6DG, UK.
⁴ Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Victor Horsley, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK.
⁵ Bordeaux Neurocampus, University of Bordeaux, Bordeaux, France.
⁶ School of Dentistry, University of Leeds, Leeds, LS2 9LU, UK.
⁷ Facial Pain Department, Royal National ENT & Eastman Dental Hospitals, London, WC1E 6DG, UK. j.zakrzewska@ucl.ac.uk.
⁸ Pain Management Centre, The National Hospital for Neurology and Neurosurgery, London, W1T 3BF, UK. j.zakrzewska@ucl.ac.uk.

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.

Keywords: Care-pathways; Medications; Multi-disciplinary management; Neurosurgery; Personalised medicine; Trigeminal neuralgia.

MeSH terms

Facial Pain
Follow-Up Studies
Humans
Pain Clinics
Radiosurgery*
Treatment Outcome
Trigeminal Neuralgia* / diagnosis
Trigeminal Neuralgia* / surgery