Retrospective Analysis of Clinical Feature in Trigeminal Neuralgia.

BACKGROUND: Trigeminal neuralgia (TN) is usually established using characteristic clinical features such as sudden, severe, and unilateral facial pain. Studies about diverse clinical features and epidemiologic data of TN have been reported previously; however, most of the previous studies have evaluated in and focused on Caucasian and Western populations. OBJECTIVES: The purpose of this study was to evaluate diverse clinical features, currently applied types of treatment, and brain imaging studies in patients with TN in a Korean population. STUDY DESIGN: Retrospective analysis. SETTING: An interventional pain management practice in South Korea. METHODS: Patients with a primary diagnosis of TN were identified using Clinical Data Warehouse v 2.5 (CDW, Planit Healthcare, Seoul, Korea) using the key words "trigeminal neuralgia and G50.0 (International classification of disease 10 code)." RESULTS: TN occurred predominantly between the fifth and seventh decades of life, with female predominance. The V3 division and unilateral right-side involvement were the most common affected region. An electric shock like sensation and the intraoral side (teeth and gingiva) were the most common pain description and location, respectively. Normal brain imaging studies and vascular compression on the trigeminal nerve were observed in 92 (64.7%) and 36 (25%) patients, respectively. The superior cerebellar artery was the most common offending vessel (19;13.3%). Monotherapy with carbamazepine alone was the most common (91;37.7%), whereas radiofrequency thermoablation was the most common invasive treatment. LIMITATIONS: The results of this study were based on data on TN patients from a single center. The generalizability of the findings to the Korean population is thus limited. CONCLUSION: There is little difference between Korean and other Asian patients with TN in their demographic and clinical characteristics.

Aspirin Cessation Before Interventional Procedures: Not Blindly Following Guidelines but Making Test-based Decisions.

BACKGROUND: Deciding whether to continue or discontinue aspirin prior to interventional procedures is a major concern for pain physicians. Many guidelines have been published on the discontinuation of aspirin before invasive procedures; however, the recommendations are inconsistent and do not consider individual platelet function. Furthermore, many studies have shown a high prevalence of aspirin resistance  in patients taking this medication. OBJECTIVES: To determine the necessity of discontinuing aspirin prior to interventional pain procedures in relation to individual platelet function. STUDY DESIGN: Multicenter, cross-sectional study. SETTING: University-affiliated hospitals. METHODS: We examined platelet function among patients scheduled for an interventional pain procedure by measuring their closure time using collagen/epinephrine cartridges in a commercial platelet-function analyzer. The patients were categorized into either an aspirin-taking or nonaspirin-taking group (Group A or Group N, respectively). The proportion of patients who showed normal/abnormal platelet function was calculated and compared between the groups. RESULTS: A total of 1,111 patients were included in this study. In Group A, 56.4% (102/181) showed normal platelet function, whereas 43.6% (79/181) showed abnormal platelet function. In Group N, 85.8% (798/930) and 14.2% (132/930) showed normal and abnormal platelet function, respectively. LIMITATION: The proportion of laboratory, not clinical aspirin resistance was evaluated. Factors affecting platelet function were not investigated exhaustively. CONCLUSION: The high prevalence of normal platelet function in patients taking aspirin suggests no necessity of discontinuation before procedures in such patients. Abnormal platelet function can occur even in patients who are not taking aspirin. Therefore, platelet function should be measured and considered on a case-by-case basis prior to interventional procedures, and discontinuation of aspirin should be decided based on these factors.