Treatment outcomes in trigeminal neuralgia–a systematic review of domains, dimensions and measures

Background Trigeminal neuralgia (TN) is a painful disorder characterized by sudden electric shock–like pain. It is a rare condition for which multiple treatments are available, including medical and surgical. The best treatment option is yet to be defined, and this is related to the lack of definition in the treatment outcomes and outcome measures. The aim of this systematic review was to summarize all the outcomes and outcomes measures that have been published to date and highlight variability in their use. Methods We have conducted a literature search using a wide range of databases (1946–2019 for medical and 2008–2019 for surgical treatment), for all intervention studies in TN. Four hundred and sixty-seven studies were selected for data extraction on TN classification, data collection method, intervention, and treatment outcomes mapped to the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT guidelines). Results Most studies collected data on pain (n = 459) and side effects (n = 386) domains; however, very few collected data on the impact of treatment on physical (n = 46) and emotional functioning (n = 17) and on patient satisfaction (n = 35). There was high variability on outcome measures used for pain relief (n = 10), pain intensity (n = 9), and frequency of pain episodes (n = 3). Conclusions A clear definition of what are the important outcomes for patients with TN is essential. The choice of standardized outcome measures allowing for consistent reporting in TN treatment will allow for comparison of studies and facilitate treatment choice for patients and clinicians thus, improving health outcomes and reducing health care cost

An international Delphi survey and consensus meeting to define the core outcome set for trigeminal neuralgia clinical trials

Background Trigeminal neuralgia (TN) is an excruciating unilateral facial pain, which negatively affects patient's quality of life. Historically, it has been difficult to compare treatment efficacy due to the lack of standardized outcomes. In addition, patients' perspective has seldomly been acknowledged. The aim of this study was to reach consensus on what outcomes of treatment are important to different TN stakeholders (patients, clinicians and researchers), to identify the TN Core Outcome Set (TRINCOS). Methods A list of outcomes identified through a systematic review and focus group work was used to develop the survey questionnaire. A three-round Delphi was conducted. Participants were asked to score the outcomes on scale from 1 to 9 (1–3 not important;4–6 important but not critical;7–9 critical). Outcomes scored as critical by ≥70% and not important by <15% were retained, and those for which no consensus was reached were discussed at a consensus meeting. Results Of the 70 participants who completed the Delphi, 26 were patients, 38 were clinicians and six were researchers. Of the 40 outcomes presented, 17 were scored as critical and no consensus was met for 23 outcomes. Agreement was reached during a consensus meeting on 10 outcomes across six domains (pain, side effects, social impact, quality of life, global improvement, and satisfaction with treatment). Conclusion Implementation of TRINCOS in future clinical trials will improve homogeneity of studies' results, reduce the redundancy in the outcome assessment and effectively allow comparison of different treatments to better inform researchers, clinicians and most importantly patients, about the efficacy of the different treatments. Significance Implementation of a 10-item core outcome set in trigeminal neuralgia will improve comparability between studies allowing patients to have faster access to better treatments

Patient reported outcome measures in trigeminal neuralgia - a systematic review of psychometric performance.

Background Trigeminal neuralgia (TN) is a rare condition for which there are multiple treatment options available. To date, there has been difficulty in comparing the outcomes of treatment due to the variety of patient-reported outcome measures (PROMs) and their inadequate psychometric testing. The aim of this review was to assess the psychometric properties of PROMs used to date in TN and make recommendations for their use in future studies. Methods Five electronic databases (MEDLINE, EMBASE, CINAHL Plus, PsycINFO, Health and Psychosocial Instruments) were searched for studies assessing the development of PROMs or their psychometric properties in TN studies. The records obtained were assessed independently by two reviewers for their methodological quality, following guidance from the Consensus-based Standards for the selection of Health Measurement Instruments (COSMIN). Results Six studies were identified and information on five PROMs (Brief Pain Inventory Facial (BPI-F), Visual Analogue Scale (VAS), Barrow Neurology Institute Pain Scale (BNI-PS), Penn Facial Pain Scale-Revised (Penn-FPS-R) and Trigeminal Neuralgia Quality of Life Score) were retrieved. The Penn-FPS-R demonstrated moderate quality evidence for sufficient content validity. The BPI-F showed moderate evidence for sufficient internal consistency and structural validity but low evidence for inconsistent content validity. The Trigeminal Neuralgia Quality of Life score showed very low-quality evidence for insufficient content validity, structure validity and responsiveness. No evidence was found on the assessment of any psychometric properties of the VAS and BNI-PS in TN. Conclusion There is limited evidence of the psychometric performance of patient-reported outcomes for TN and recommendations for their inclusion in future studies cannot be made. The validation of PROMs in TN studies should be a priority in this field of research. Significance This review highlights the knowledge gap in the field of psychometrics of patient reported outcomes measures in the field of TN. Given the unavailability of an objective outcome measure for pain or health related quality of life, psychometrically sound PROMs are essential for assessing medical and surgical treatment outcomes in TN

Matrix metalloproteinase 9 modulates collagen matrices and wound repair

Animal science

Development of a Novel Cathodic Plasma/Electrolytic Deposition Technique Part 1: Production of Titanium Dioxide Coatings

A new atmospheric pressure plasma electrolytic deposition process has been developed for the production of crystalline titanium dioxide films on metal substrates. The process occurs in a liquid precursor composed of titanium tetraisopropoxide and absolute ethanol. A plasma discharge is created and confined around the cathode in a superheated vapour sheath surrounded by the liquid phase, inducing the production of a nano-crystalline TiO2 coating at the surface of the cathode. The analysis of the structure and composition of these TiO2 coatings have been carried out by Scanning Electron Microscopy, Transmission Electron Microscopy, Raman and X-Ray Photoelectron Spectroscopies and X-Ray Diffraction. The plasma discharge has been analyzed by emission spectroscopy in order to study its composition and evaluate the electron temperature. The produced crystalline titanium dioxide coatings are very adherent to the substrate and present a dendritic-like structure. We have moreover demonstrated that it is possible to adjust easily its composition by a post-processing calcination. Such characteristics make these films very interesting for photocatalysis, solar cells and gas sensing applications, and promise therefore some useful industrial benefits

Unexplained orofacial pain - is an early diagnosis possible?

Aim: to identify distinct characteristics of unexplained orofacial pain that could be used by dental practitioners in making an early diagnosis.Methods: subjects reporting orofacial pain in a postal questionnaire-based cross-sectional survey were invited for clinical examination. The interviewer was blinded to the questionnaire responses of the subjects. A diagnosis was made following the examination and subjects were assigned into two groups: unexplained pain and dental pain. The questionnaire responses of subjects who had consulted a healthcare professional within these two groups were then compared with particular attention to demographics, orofacial pain characteristics, consultation behaviour and relationship with other unexplained syndromes.Results: subjects who had consulted for their pain and were assigned to the unexplained orofacial pain group were significantly (p &lt;0.05) more likely to report the following characteristics: pain descriptors (nagging, aching, tingling), pain pattern (worse with stress), site (poorly localised), duration (persistent/chronic), high disability, multiple consultations and co-morbidities (teeth grinding, reporting of other unexplained syndromes).Conclusion: this study has shown that unexplained orofacial pain has distinct characteristics that differentiate it from other common dental conditions. This provides a good evidence base which can reduce uncertainty among dental practitioners, allowing them to make an early diagnosis

Treatment options in trigeminal neuralgia

The incidence of trigeminal neuralgia (TN) is 4.3 per 100,000 persons per year, with a slightly higher incidence for women (5.9/100,000) compared with men (3.4/100,000). There is a lack of certainty regarding the aetiology and pathophysiology of TN. The treatment of TN can be very challenging despite the numerous options patients and physicians can choose from. This multitude of treatment options poses the question as to which treatment fits which patient best. The preferred medical treatment for TN consists of anticonvulsant drugs, muscle relaxants and neuroleptic agents. Large-scale placebo-controlled clinical trials are scarce. For patients refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma knife surgery and microvascular decompression are the most promising invasive treatment options