Comparison of the Neuropathic Pain Symptoms and Psychosocial Impacts of Trigeminal Neuralgia and Painful Posttraumatic Trigeminal Neuropathy

Aims: To compare the impacts of trigeminal neuralgia (TN) and painful posttraumatic trigeminal neuropathy (PPTTN) on psychologic function and health-related quality of life (HRQoL) using a comprehensive quantitative assessment. Methods: This was a comparative cross-sectional study. A total of 97 patients diagnosed with PPTTN and 40 patients diagnosed with TN who sought treatment at an orofacial pain clinic completed standardized self-report measures of pain intensity, neuropathic symptoms, pain self-efficacy, mood, and indicators of general and oral HRQoL. Differences between the PPTTN and TN groups were tested, and associations of each condition with pain severity, psychologic function, and HRQoL were examined. Results: The majority of PPTTN (66%) and TN patients (80%) were affected by orofacial pain. Pain attacks were more frequent in TN (71%) than PPTTN (28%) patients, while numbness was more common in PPTTN (51%) than TN (12%) patients. Pain intensity was higher in TN for intermittent and affective pain dimensions. Both PPTTN and TN had a significant, but comparable, impact on patients’ oral HRQoL. The burden of condition on overall health was significantly more pronounced in patients with TN than PPTTN, with evident differences in the mobility and self-care domains. There was a trend showing that more TN (54%) than PPTTN (36%) patients reported signs of depression, but clinically significant anxiety was comparably high in both groups (34% to 39%). Anxiety and pain-self efficacy were closely related to oral and general health statuses in both groups. Conclusions: Both TN and PPTTN are associated with significant psychosocial burden and reduced HRQoL, indicating a need to develop effective treatments for neuropathic orofacial pain that target functional restoration.

orofacial pain;posttraumatic trigeminal neuropathy;psychosocial;trigeminal nerve injuries;trigeminal neuralgia

1.Vaegter HB, Andersen PG, Madsen MF, Handberg G, Enggaard TP. Prevalence of neuropathic pain according to the IASP grading system in patients with chronic non-malignant pain. Pain Med 2014;15:120–127.

2.Gustin SM, Wilcox SL, Peck CC, Murray GM, Henderson LA. Similarity of suffering: Equivalence of psychological and psychosocial factors in neuropathic and non-neuropathic orofacial pain patients. Pain 2011;152:825–832.

3.Smith JG, Elias LA, Yilmaz Z, et al. The psychosocial and affective burden of posttraumatic neuropathy following injuries to the trigeminal nerve. J Orofac Pain 2013;27:293–303.

4.Merskey H. Classification of Chronic Pain: Descriptors of Chronic Pain Syndromes and Definitions of Pain Terms, ed 2. Seattle: IASP, 1994.
5.MacDonald BK, Cockerell OC, Sander JW, Shorvon SD. The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. Brain 2000;123:665–676.

6.Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629–808.

7.Brisman R. Trigeminal neuralgia and multiple sclerosis. Arch Neurol 1987;44:379–381.

8.Sato M, Kondo A, Otsuka S, et al. Trigeminal neuralgia: Association with tentorial meningioma and persistent primitive trigeminal artery. Fukushima J Med Sci 1995;41:87–93.

9.Castro AR, Siqueira SR, Perissinotti DM, Siqueira JT. Psychological evaluation and cope with trigeminal neuralgia and temporomandibular disorder. Arq Neuropsiquiatr 2008;66:716–719.

10.Tölle T, Dukes E, Sadosky A. Patient burden of trigeminal neuralgia: Results from a cross-sectional survey of health state impairment and treatment patterns in six European countries. Pain Pract 2006;6:153–160.

11.Zakrzewska JM, Wu J, Mon-Williams M, Phillips N, Pavitt SH. Evaluating the impact of trigeminal neuralgia. Pain 2017;158:1166–1174.

12.Macˇianskyté D, Janužis G, Kubilius R, Adomaitiené V, Šcˇiupokas A. Associations between chronic pain and depressive symptoms in patients with trigeminal neuralgia. Medicina (Kaunas) 2011;47:386–392.

13.Benoliel R, Eliav E. Neuropathic orofacial pain. Oral Maxillofac Surg Clin North Am 2008;20:237–254.

14.Bennetto L, Patel NK, Fuller G. Trigeminal neuralgia and its management. BMJ 2007;334:201–205.

15.Allsop MJ, Twiddy M, Grant H, et al. Diagnosis, medication, and surgical management for patients with trigeminal neuralgia: A qualitative study. Acta Neurochir (Wien) 2015;157: 1925–1933.

16.Renton T. Prevention of iatrogenic inferior alveolar nerve injuries in relation to dental procedures. Dent Update 2010;37: 350–352.

17.International Association for the Study of Pain. Painful post-Traumatic Trigeminal Neuropathy (PTTN). Orofacial pain Fact Sheets, September 2016. https://s3.amazonaws.com/rdcms-iasp/files/production/public/Content/ContentFolders/GlobalYearAgainstPain2/20132014OrofacialPain/FactSheets/PTTN_2016.pdf. Accessed January 9, 2019.

18.Benoliel R, Zadik Y, Eliav E, Sharav Y. Peripheral painful traumatic trigeminal neuropathy: Clinical features in 91 cases and proposal of novel diagnostic criteria. J Orofac Pain 2012; 26:49–58.

19.Renton T, Yilmaz Z. Profiling of patients presenting with posttraumatic neuropathy of the trigeminal nerve. J Orofac Pain 2011;25:333–344.

20.Turk DC, Fillingim RB, Ohrbach R, Patel KV. Assessment of psychosocial and functional impact of chronic pain. J Pain 2016;17(suppl 9):T21–T49.

21.Velly AM, Look JO, Carlson C, et al. The effect of catastrophizing and depression on chronic pain—A prospective cohort study of temporomandibular muscle and joint pain disorders. Pain 2011;152:2377–2383.

22.Carlson CR. Psychological factors associated with orofacial pains. Dent Clin North Am 2007;51:145–160.

23.Haviv Y, Zini A, Etzioni Y, et al. The impact of chronic orofacial pain on daily life: The vulnerable patient and disruptive pain. Oral Surg Oral Med Oral Pathol Oral Radiol 2017;123:58–66.

24.Komiyama O, Obara R, Uchida T, et al. Pain intensity and psychosocial characteristics of patients with burning mouth syndrome and trigeminal neuralgia. J Oral Sci 2012;54:321–327.

25.Carter E, Yilmaz Z, Devine M, Renton T. An update on the causes, assessment and management of third division sensory trigeminal neuropathies. Br Dent J 2016;220:627–635.

26.Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001; 16:606–613.

27.Choi Y, Mayer TG, Williams MJ, Gatchel RJ. What is the best screening test for depression in chronic spinal pain patients? Spine J 2014;14:1175–1182.

28.Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med 2006;166:1092–1097.

29.Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for clinical and research applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28:6–27.

30.Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997; 25:284–290.

31.Robinson PG, Gibson B, Khan FA, Birnbaum W. Validity of two oral health-related quality of life measures. Community Dent Oral Epidemiol 2003;31:90–99.

32.Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B. Valuing health-related quality of life: An EQ-5D-5L value set for England. Health Econ 2018;27:7–22.

33.Herdman M, Gudex C, Lloyd A, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D5L). Qual Life Res 2011;20:1727–1736.

34.Durham J, Steele JG, Breckons M, Story W, Vale L. DEEP Study: Does EQ-5D-5L measure the impacts of persistent orofacial pain? J Oral Rehabil 2015;42:643–650.

35.Dworkin RH, Turk DC, Revicki DA, et al. Development and initial validation of an expanded and revised version of the Shortform McGill Pain Questionnaire (SF-MPQ-2). Pain 2009; 144:35–42.

36.Lovejoy TI, Turk DC, Morasco BJ. Evaluation of the psychometric properties of the revised short-form McGill Pain Questionnaire. J Pain 2012;13:1250–1257.

37.Freynhagen R, Baron R, Gockel U, Tölle TR. painDETECT: A new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin 2006; 22:1911–1920.

38.Nicholas MK. The pain self-efficacy questionnaire: Taking pain into account. Eur J Pain 2007;11:153–163.

39.Asghari A, Nicholas MK. Pain self-efficacy beliefs and pain behaviour. A prospective study. Pain 2001;94:85–100.

40.Slade GD, Nuttall N, Sanders AE, Steele JG, Allen PF, Lahti S. Impacts of oral disorders in the United Kingdom and Australia. Br Dent J 2005;198:489–493.

41.McGrath C, Comfort MB, Lo EC, Luo Y. Changes in life quality following third molar surgery--The immediate postoperative period. Br Dent J 2003;194:265–268.

42.Kind P, Hardman G, Macran S. UK Population Norms for EQ5D. York: Centre for Health Economics, University of York, 1999.

43.Zelman DC, Dukes E, Brandenburg N, Bostrom A, Gore M. Identification of cut-points for mild, moderate and severe pain due to diabetic peripheral neuropathy. Pain 2005;115:29–36.

44.De Toledo IP, Conti Réus J, Fernandes M, et al. Prevalence of trigeminal neuralgia: A systematic review. J Am Dent Assoc 2016;147:570–576.e2.

45.Maarbjerg S, Gozalov A, Olesen J, Bendtsen L. Trigeminal neuralgia—A prospective systematic study of clinical characteristics in 158 patients. Headache 2014;54:1574–1582.

46.Hillerup S. Iatrogenic injury to oral branches of the trigeminal nerve: Records of 449 cases. Clin Oral Investig 2007; 11:133–142.

47.Girard-Tremblay L, Auclair V, Daigle K, Léonard G, Whittingstall K, Goffaux P. Sex differences in the neural representation of pain unpleasantness. J Pain 2014;15:867–877.

48.Renton T, Yilmaz Z. Managing iatrogenic trigeminal nerve injury: A case series and review of the literature. Int J Oral Maxillofac Surg 2012;41:629–637.

49.Cruccu G, Finnerup NB, Jensen TS, et al. Trigeminal neuralgia: New classification and diagnostic grading for practice and research. Neurology 2016;87:220–228.

50.Lin KH, Chen YT, Fuh JL, Wang SJ. Increased risk of trigeminal neuralgia in patients with migraine: A nationwide population-based study. Cephalalgia 2016;36:1218–1227.

51.Katusic S, Beard CM, Bergstralh E, Kurland LT. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945–1984. Ann Neurol 1990;27:89–95.

52.Siqueira SR, Teixeira MJ, Siqueira JT. Clinical characteristics of patients with trigeminal neuralgia referred to neurosurgery. Eur J Dent 2009;3:207–212.

53.Bowsher D. Trigeminal neuralgia: A symptomatic study of 126 successive patients with and without previous interventions. Pain Clinic (Utrecht) 2000;12:93–101.

54.Cheshire WP. Trigeminal neuralgia: For one nerve a multitude of treatments. Expert Rev Neurother 2007;7:1565–1579.

55.Ziccardi VB, Assael LA. Mechanisms of trigeminal nerve injuries. Atlas Oral Maxillofac Surg Clin North Am 2001;9:1–11.

56.Renton T, Dawood A, Shah A, Searson L, Yilmaz Z. Postimplant neuropathy of the trigeminal nerve. A case series. Br Dent J 2012;212:E17.

57.Carlson CR. Psychological considerations for chronic orofacial pain. Oral Maxillofac Surg Clin North Am 2008;20:185–195.

58.Patel N, Ali S, Yates JM. Quality of life following injury to the inferior dental or lingual nerve—A cross-sectional mixed-methods study. Oral Surg 2018;11:9–16.

59.Nurmikko TJ, Eldridge PR. Trigeminal neuralgia—Pathophysiology, diagnosis and current treatment. Br J Anaesth 2001;87:117–132.

60.Pogrel MA, Jergensen R, Burgon E, Hulme D. Long-term outcome of trigeminal nerve injuries related to dental treatment.J Oral Maxillofac Surg 2011;69:2284–2288.

61.Zuniga JR, Yates DM. Factors determining outcome after trigeminal nerve surgery for neuropathic pain. J Oral Maxillofac Surg 2016;74:1323–1329.

62.Galli U, Ettlin DA, Palla S, Ehlert U, Gaab J. Do illness perceptions predict pain-related disability and mood in chronic orofacial pain patients? A 6-month follow-up study. Eur J Pain 2010;14:550–558.

63.Ochsner KN, Ludlow DH, Knierim K, et al. Neural correlates of individual differences in pain-related fear and anxiety. Pain 2006;120:69–77.

64.Dieb W, Moreau N, Chemla I, Descroix V, Boucher Y. Neuropathic pain in the orofacial region: The role of pain history. A retrospective study. J Stomatol Oral Maxillofac Surg 2017; 118:147–150.