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

The differential impact of neuropathic, musculoskeletal and neurovascular orofacial pain on psychosocial function.

BACKGROUND: While the psychosocial morbidity of orofacial pain (OFP) is widely recognised, the differential impact of musculoskeletal, neuropathic and neurovascular symptoms on pain and psychosocial function in individuals with and without coexisting OFP conditions is unclear. MATERIALS AND METHODS: This was a comparative cross-sectional study of 350 consecutive patients attending an OFP clinic; 244 completed standardized self-report measures of pain experience, mood, and generic and oral health-related quality of life (HRQoL). The impact of musculoskeletal, neuropathic and neurovascular symptoms on measures was assessed using linear and logistic generalized linear models. RESULTS: Two-hundred patients were diagnosed with a neuropathic condition; 125 with musculoskeletal pain and 101 with (neurovascular) headache disorders. 23% of patients presented with multiple OFP conditions; this was more common in patients with neurovascular (62%) than neuropathic (21%) and/or musculoskeletal orofacial symptoms (28%). Patients with neurovascular symptoms experienced significantly higher levels of pain, evidenced less pain self-efficacy and had poorer overall health. Neuropathic OFP was significantly associated with greater psychological and social oral health disability. Multiple OFP symptoms were not linked to pain severity or psychosocial function, although health scores were worse for patients with neurovascular pain and neuropathic/musculoskeletal symptoms compared with patients with only neurovascular symptoms. CONCLUSIONS: The profile and degree of psychosocial morbidity in patients with OFP is significantly related to the types of presenting orofacial symptoms. Patients with neurovascular pain present with higher pain levels and have poorer health while those with neuropathic pain have higher oral functional morbidity; both may require more complex multidisciplinary management