The Journeys of Patients with Trigeminal Neuralgia on a Background of Multiple Sclerosis

Abstract

Aim: Multiple sclerosis (MS) is well recognized as a secondary cause for trigeminal neuralgia (TN). In this case series, we detail the management of all the patients with TN and MS (pwTNMS) presenting to a specialist unit. Materials & methods: A prospective patient database was used to extract key clinical data on pharmacological, psychometric and surgical management of 20 pwTNMS. Results: 65% of pwTNMS underwent surgical interventions for management of their pain.12/20 achieved remission periods, through surgery and/or medication. Significant improvement was noted on the global impression of change illustrated by a p < 0.001. Conclusion: pwTNMS require a multifaceted approach combining polypharmacy, surgical interventions and psychological support. Developing self-management skills is crucial if patients are to live well with pain.

Lay abstract

Aim: Multiple sclerosis (MS) is understood to be the leading secondary cause for the development of trigeminal neuralgia (TN). Very little is known about how this group of patients are managed, in terms of the medication and surgical treatments used. In this study we follow the journey of all the patients with TN and MS (pwTNMS) presenting to the same multidisciplinary (several specialists) unit, detailing their management and impact on the quality of life. Materials & methods: Data were collected on 20 pwTNMS on what types of medication and surgical treatments were undertaken to try and manage their pain. Results: A total of 65% of pwTNMS underwent one or more surgical treatments for management of their pain. Twelve patients achieved periods of being pain free, through surgery and/or medication. There was significant improvement noted on the global impression of change in pain. Pain catastrophizing scores remained high, suggesting many patients remained fearful and worried regarding their pain. Conclusion: TN in patients with MS can be very challenging to manage, often necessitating a more complex approach to treatment involving a combination of medication, surgery and psychological support, to achieve better management of their pain. Multiple medications are often used in an attempt to reduce adverse drug side effects. Patients, are likely to undergo frequent surgical procedures. A multidisciplinary approach encouraging self-management is crucial if patients are to live well with their pain and improve prognosis.

Keywords::

• ablative procedures
• multiple sclerosis
• pain management
• refractory pain
• trigeminal neuralgia

Acknowledgments

The authors thank the patients and AcaMedics, the medical student research group at UCL, who assigned the student to the project.

Informed consent disclosure

The authors state that informed consent has been obtained from all participants. Institutional approval was not required as the data were gathered within the scope of a service review under the Quality and Safety Department at UCLH NHS Foundation Trust.

Financial & competing interests disclosure

JM Zakrzewska undertook the work at UCL/UCLHT who received a proportion of funding from the Department of Health’s NIHR Biomedical Research Center funding scheme. The authors state that informed consent has been obtained from all participants. Institutional approval was not required as the data were gathered within the scope of a service review under the Quality and Safety Department at UCLH NHS Foundation Trust. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Additional information

Funding

JM Zakrzewska undertook the work at UCL/UCLHT who received a proportion of funding from the Department of Health’s NIHR Biomedical Research Center funding scheme. The authors state that informed consent has been obtained from all participants. Institutional approval was not required as the data were gathered within the scope of a service review under the Quality and Safety Department at UCLH NHS Foundation Trust. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.