Assessing the Impact of a Humanistic Care-Based Nursing Model on the Psychological Well-being of Trigeminal Neuralgia Outpatients in Pain Clinics.

Objective: This study aims to assess the impact of a humanistic care-based nursing model on the psychological well-being of individuals diagnosed with primary trigeminal neuralgia (TN) and attending a pain clinic. Methods: A prospective cohort study was conducted, including 166 patients diagnosed with primary trigeminal neuralgia who sought treatment at our hospital's Pain Clinic between March 2022 and December 2022. Among them, 88 patients receiving care based on a humanistic care-based nursing model constituted the observation group, while 78 patients receiving standard nursing care comprised the control group. The Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were employed to evaluate patients' psychological states. Additionally, changes in systolic and diastolic blood pressure, along with nursing satisfaction levels, were recorded. A three-month follow-up was conducted, during which the recovery quality was assessed using the Questions of Reality-155 (QOR-15). Results: Following the nursing intervention, the observation group displayed lower SAS/SDS scores and reduced diastolic and systolic blood pressure compared to the control group (P < .05). Moreover, nursing satisfaction in the observation group was significantly higher than in the control group (P < .05). The follow-up results demonstrated that the recovery quality of the observation group was higher compared to the control group (P < .05). Conclusions: Implementing a humanistic care-based nursing model effectively enhances the psychological well-being and recovery quality of trigeminal neuralgia outpatients attending pain clinics.

Potential Molecular Mechanisms of Electroacupuncture With Spatial Learning and Memory Impairment Induced by Chronic Pain on a Rat Model.

BACKGROUND: It is frequently reported that neuropathic pain is associated with abnormalities in brain function and structure as well as cognitive deficits. However, the contributing mechanisms have remained elusive. OBJECTIVES: We aimed to investigate the systemic ultrastructural changes of the peripheral nervous system (PNS) and central nervous system (CNS) in rats with trigeminal neuralgia (TN) induced by cobra venom, as well as the effects and mechanisms of electroacupuncture (EA) and pregabalin (PGB) on TN. STUDY DESIGN: This study used an experimental design in rats. SETTING: The research took place in the laboratory at the Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine. METHODS: Male Sprague-Dawley rats were randomly divided into 4 groups (n = 12/group): cobra venom (CV), PGB, EA, and sham-operated (SHAM). The development of pain-related behaviors and spatial learning and memory abilities were measured using video recordings and Morris water maze tests, respectively. The ultrastructural changes of the PNS and CNS were examined using transmission electron microscopy. We also screened the differentially expressed genes and proteins in the prefrontal cortex  and hippocampus using  ribonucleic acid sequencing and isobaric tag for relative and absolute quantitation techniques, respectively. Data for the behavioral tests and molecular biology were analyzed with a one-way analysis of variance. RESULTS: The rats in the CV group exhibited long-lasting pain-like behaviors, cognitive deficits, and systemic ultrastructural changes. Both EA and PGB alleviated the chronic pain syndrome, but EA also inhibited the chronic pain-induced cognitive dysfunction and restored normal cellular structures, while PGB was associated with no improvements. Transcriptomic and proteomic analyses revealed marcks, pak2 and acat1 were altered in rats with TN but were adjusted back to baseline by EA but not by PGB. LIMITATIONS: We examined systemic ultrastructural alterations at different levels of the nervous system; however, the detailed timeline of the damage process was not explicitly delineated.  Moreover, the current study provides only preliminary evidence for the neurobiological mechanisms of cognitive impairment resulting from chronic pain.  Further research is still necessary (using models such as gene knockout rats and cell cultures) before a detailed mechanism can be postulated. CONCLUSIONS: EA treatment may offer significant advantages when compared to PGB for the treatment of cognitive impairment associated with chronic pain. Moreover, marcks, pak2 and acat1 may be the potential therapeutic targets of EA.

Cognitive and sensorimotor function in participants being treated for trigeminal neuralgia pain.

BACKGROUND: Trigeminal neuralgia (TN) is an orofacial condition defined by reoccurring, spontaneous, short-lived but excruciating stabbing pain. Pharmacological interventions constitute the first-line treatment for TN, with antiepileptic drugs commonly prescribed. People treated for TN pain with antiepileptic drugs describe cognitive and motor difficulties affecting activities of daily living, and report poorer quality of life. We undertook the first comprehensive objective evaluation of sensorimotor and cognitive performance in participants being treated for TN pain with antiepileptic drugs relative to age-matched controls. METHODS: Participants (43 TN, 41 control) completed a battery of sensorimotor (steering, aiming and tracking) and cognitive (working memory, processing speed, inhibition) tasks. RESULTS: The TN group performed significantly worse than controls on the sensorimotor tracking and aiming tasks and across all cognitive measures. CONCLUSIONS: The data explain why patients treated with antiepileptic drugs report impairment when conducting activities of daily living (given the need for cognitive and motor capability within most of these). The study is an important first step in: (i) ensuring there is adequate information on the impact of pharmacological treatment; (ii) identifying measures to determine optimal medication dosage and track change over time; (iii) creating an evidence base that could allow scientific justification of alternative pain treatment options for TN (e.g. the costs/benefits of surgery).

Trigeminal Neuralgia: Toward a Multimodal Approach.

OBJECTIVES: Trigeminal neuralgia (TN) is the most common cranial neuralgia in adults, with a slight prevalence in women. Antiepileptic drugs represent the mainstay of the medical treatment, whereas microvascular decompression is the best option in case of neurovascular conflict. Although these treatments showed a good rate of efficacy, they can be contraindicated in some patients and >50% of patients undergoing these treatments will present recurrence of pain in the following months. In this majority of patients, pain becomes chronic and can severely affect their quality of life and cause cognitive disturbances, such as anxiety and depression. METHODS: The purpose of this study was to review the efficacy and safety of current treatment modalities for TN, as well as to propose a multimodal approach for those patients presenting with a chronic form of TN. RESULTS: Current treatment modalities have been reviewed. Actual pain evaluation systems and the neuropsychologic features of TN have been analyzed in order to propose an alternative treatment algorithm. DISCUSSION: Chronic pain can also lead to the misperception of patients' own selves leading to enhanced pain perception and altering therapeutic outcomes. Thus, there is the need to define a personalized multimodal approach of treatment, taking into account other available TN therapies and the neuropsychologic aspect of chronic pain.

[Linear accelerator-based stereotactic radiosurgery for the treatment of trigeminal neuralgia. Nine years' experience in a single institution]. / Radiocirugia estereotactica con acelerador lineal para el tratamiento de la neuralgia trigeminal. Experiencia de nueve años en una sola institucion.

INTRODUCTION. Pharmacological treatment is the first therapeutic step towards controlling pain in trigeminal neuralgia, but 25-50% of patients become medication resistant. There are currently several surgical alternatives for treating these patients. AIM. To evaluate the effectiveness and safety of stereotactic radiosurgery for the treatment of patients with trigeminal neuralgia. PATIENTS AND METHODS. A follow-up study was conducted on 30 patients who underwent radiosurgery using a Novalis linear accelerator. Eighty per cent of the dosage was calculated at the isocentre, the entry zone of the root of the trigeminal nerve. The mean follow-up time was 27.5 months (range: 1-65 months). RESULTS. The mean age was 66 years (range: 36-87 years), with a time to progression of 7.1 years (range: 4-27 years). The distribution of the pain was from the right side (63.3%). Of the 30 patients, 27 experienced an improvement (90%) 1.6 months (range: 1 week-4 months) after the treatment; 10 patients (33.3%) scored grade I, and 17 patients (56.6%) obtained a score of grade II. During the follow-up, four patients (14.2%) suffered a relapse; two underwent re-irradiation. Time without recurrence was 62.7 months (range: 54.6-70.8 months). The rate of side effects was 76.7% and only three patients developed facial anaesthesia with loss of the corneal reflex. CONCLUSIONS. The use of the linear accelerator is an effective therapeutic option in the treatment of trigeminal neuralgia, since it provides adequate long-term control of the pain, reduces the use of medication and improves the quality of life.

TITLE: Radiocirugia estereotactica con acelerador lineal para el tratamiento de la neuralgia trigeminal. Experiencia de nueve años en una sola institucion.Introduccion. El tratamiento farmacologico constituye el primer escalon terapeutico para el control del dolor en la neuralgia del trigemino, pero entre el 25-50% de los pacientes se hace farmacorresistente. Actualmente existen varias alternativas quirurgicas para tratar a estos pacientes. Objetivo. Evaluar la efectividad y seguridad de la radiocirugia estereotactica para el tratamiento de pacientes con neuralgia del trigemino. Pacientes y metodos. Se dio seguimiento a 30 pacientes que se sometieron a radiocirugia con acelerador lineal Novalis. Se calculo el 80% de la dosis en el isocentro, la zona de raiz de entrada del nervio trigemino. El tiempo medio de seguimiento fue de 27,5 meses (rango: 1-65 meses). Resultados. La edad media fue de 66 años (rango: 36-87 años), con un tiempo de evolucion de 7,1 años (rango: 4-27 años). La distribucion del dolor fue del lado derecho (63,3%). De los 30 pacientes, 27 tuvieron mejoria (90%) 1,6 meses (rango: 1 semana-4 meses) despues del tratamiento; 10 pacientes (33,3%) tuvieron una valoracion de grado I y 17 pacientes (56,6%) una valoracion de grado II. Durante el seguimiento, cuatro pacientes (14,2%) tuvieron recidiva; dos se sometieron a reirradiacion. El tiempo sin recurrencia fue de 62,7 meses (rango: 54,6-70,8 meses). La tasa de efectos secundarios fue del 76,7%, y solo tres pacientes desarrollaron anestesia facial con perdida del reflejo corneal. Conclusiones. El uso del acelerador lineal es una opcion terapeutica efectiva en el tratamiento de la neuralgia del trigemino, proporciona a largo plazo adecuado control del dolor, reduce el uso de medicamentos y mejora la calidad de vida.

Thalamic metabolic alterations with cognitive dysfunction in idiopathic trigeminal neuralgia: a multivoxel spectroscopy study.

INTRODUCTION: Although abnormalities in metabolite compositions in the thalamus are well described in patients with idiopathic trigeminal neuralgia (ITN), differences in distinct thalamic subregions have not been measured with proton magnetic resonance spectroscopy ((1)H-MRS), and whether there are correlations between thalamic metabolites and cognitive function still remain unknown. METHODS: Multivoxel MRS was recorded to investigate the metabolic alterations in the thalamic subregions of patients with ITN. The regions of interest were localized in the anterior thalamus (A-Th), intralaminar portion of the thalamus (IL-Th), posterior lateral thalamus (PL-Th), posterior medial thalamus (PM-Th), and medial and lateral pulvinar of the thalamus (PuM-Th and PuL-Th). The N-acetylaspartate to creatine (NAA/Cr) and choline to creatine (Cho/Cr) ratios were measured in the ITN and control groups. Scores of the visual analogue scale (VAS) and the Montreal Cognitive Assessment (MoCA) were analyzed to correlate with the neuroradiological findings. RESULTS: The NAA/Cr ratio in the affected side of PM-Th and PL-Th in ITN patients was statistically lower than that in the corresponding regions of the thalamus in controls. The NAA/Cr ratio in the affected PM-Th was negatively associated with VAS and disease duration. Furthermore, decreases of NAA/Cr and Cho/Cr were detected in the affected side of IL-Th, and lower Cho/Cr was positively correlated with MoCA values in the ITN group. CONCLUSIONS: Our result of low level of NAA/Cr in the affected PM-Th probably serves as a marker of the pain-rating index, and decreased Cho/Cr in IL-Th may be an indicator of cognitive disorder in patients with ITN.

Trigeminal neuralgia: outcomes after gamma knife radiosurgery.

BACKGROUND: Trigeminal neuralgia (TN) often remains difficult to treat despite multiple available medications, and can severely impact on the quality of life of affected patients. Gamma knife radiosurgery has recently emerged as a minimally-invasive alternative to surgery for patients suffering from drug-resistant TN. The goal of this study was to report the short-term efficacy of gamma knife radiosurgery for TN and assess its impact on the quality of life of patients treated in the first 18 months of our experience. METHODS: Patients with medically-refractory TN or with unacceptable drug side effects were considered for radiosurgery. A maximum dose of 80 Gy was administered to the affected nerve using a single 4-mm isocenter. Follow-up assessments were made at 2,4 and 6 months, with evaluation of pain relief, drug reduction and quality of life. Factors impacting treatment response were assessed using Cox regression analysis. RESULTS: A total of 67 patients were treated. Significant pain relief was seen in 77.6% of patients, including 32.6% who became pain-free. Patients were able to discontinue all medications in 34.3% or reduce drug intake by more than 50% in an additional 28.4% of cases. No variable was found to predict pain relief although older age (>66 years) approached statistical significance. Sensory side effects were seen in 14.9% of patients. Quality of life improved in the majority of patients after radiosurgery. CONCLUSIONS: Gamma knife radiosurgery is a safe and effective management alternative for trigeminal neuralgia, providing good or excellent pain relief and improvement in quality of life in the majority of patients with few side effects.

Review of the treatment of trigeminal neuralgia with gamma knife radiosurgery.

BACKGROUND: Trigeminal neuralgia is a debilitating condition caused by compression of the trigeminal nerve, ganglions, or divisions. Gamma knife radiosurgery has been increasingly used in the treatment of trigeminal neuralgia as a non-invasive alternative to microvascular decompression and rhizotomies. METHODS: We reviewed the medical literature regarding outcomes, time course, and prognostic factors for successful pain control in gamma knife radiosurgery. The dosimetry, target, complications of treatment, as well as perceived quality of life in treatment were also reviewed. RESULTS AND CONCLUSION: The growing body of literature suggests that the low rates of complications of gamma knife radiosurgery, coupled with the high success rates and patient satisfaction, allow it to be increasingly used as primary intervention for trigeminal neuralgia for appropriate patients.

Gabapentin supplemented with ropivacain block of trigger points improves pain control and quality of life in trigeminal neuralgia patients when compared with gabapentin alone.

OBJECTIVE: Pain control in trigeminal neuralgia (TN) is achieved using anticonvulsivants, mainly carbamazepine. When this drug cannot be used, other drugs like gabapentin (GBP) have been used to provide adequate pain control. To improve the therapeutic effect of GBP, we evaluated the clinical efficacy of associating GBP with ropivacain (ROP) analgesic block of facial trigger points in TN patients. DESIGN: Thirty-six TN patients were randomly assigned during 4 weeks to 1 of the following protocols: Protocol I-daily oral GBP administered in a titrated dose; Protocol II-ROP applied as analgesic block to TN trigger points once a week; Protocol III-daily oral GBP plus ROP once a week. Protocol II had to be discontinued in 7/12 patients owing to insufficient pain control. Pain intensity was evaluated by the Visual Analog Scale (VAS) and disability was assessed by Sickness Impact Profile. RESULTS: When compared with Protocol I, Protocol III (GBP+ROP) patients showed (1) a reduction of VAS score after 7 and 28 days of treatment, an effect that was still present 6 and 12 months later; (2) a faster reduction of VAS score using a significantly lower dose of GBP; (3) a smaller total and daily GBP dose at the end of the treatment, which resulted in a total absence of adverse side effects; and (4) an improvement of the functional well-being measured by the Sickness Impact Profile. The number needed to treat (NNT) (GBP+ROP vs. GBP protocols) to obtain 1 GBP+ROP-treated patient with at least 50% pain relief was 1.71 (day 7) and 2.40 (day 28). CONCLUSIONS: The association of GBP and ROP is safe, without side effects and results in an important clinical benefit associated to an improvement of the functional health status of TN patients when compared with GBP alone. This may constitute a therapeutic alternative for pain control in TN patients who cannot be treated with carbamazepine.

Assessment of pain control, quality of life, and predictors of success after gamma knife surgery for the treatment of trigeminal neuralgia.

OBJECT: There are various surgical treatment alternatives for trigeminal neuralgia (TN), but there is no single scale that can be used uniformly to assess and compare one type of intervention with the others. In this study the objectives were to determine factors associated with pain control, pain-free survival, residual pain, and recurrence after gamma knife surgery (GKS) treatment for TN, and to correlate the patients' self-reported quality of life (QOL) and satisfaction with the aforementioned factors. METHODS: Between the years 2000 and 2004, the authors treated 81 patients with medically refractory TN by using GKS. Fifty-two patients responded to a questionnaire regarding pain control, activities of daily living, QOL, and patient satisfaction. The median follow-up duration was 16.5 months. Twenty-two patients (42.3%) had complete pain relief, 14 (26.9%) had partial but satisfactory pain relief, and in 16 patients (30.8%) the treatment failed. Seven patients (13.5%) reported a recurrence during the follow-up period, and 25 (48.1%) reported a significant (> 50%) decrease in their pain within the 1st month posttreatment. The mean decrease in the total dose of pain medication was 75%. Patients' self-reported QOL scores improved 90% and the overall patient satisfaction score was 80%. CONCLUSIONS: The authors found that GKS is a minimally invasive and effective procedure that yields a favorable outcome for patients with recurrent or refractory TN. It may also be offered as a first-line surgical modality for any patients with TN who are unsuited or unwilling to undergo microvascular decompression.

[Personality characteristics of patients with prosopalgias]. / Lichnostnye osobennosti bol'nykh prozopalgiiami.

The MMPI test, Hornblow and Kidson's visual-analog anxiety scale and two types of the painful "questionnaires" suggested by the authors were used to examine the status of emotional personality sphere in 61 patients with prosopalgias due to typical trigeminal neuralgia (n = 39), dental plexalgia (n = 13) and pulpitis (n = 9). It has been revealed that patients with typical trigeminal neuralgia demonstrate the predominance of the depressive syndrome, whereas dental plexalgia is mostly characterized by anxiety. Analysis of the semantic tests is very instrumental in helping the physician to deepen the idea of the structure of subjective sensations in facial pain. Meanwhile the indicators of the "daily pain scale" promote administration of the drugs from the standpoint of chronotherapy.