Predictive factors associated with success and failure for radiofrequency thermocoagulation in patients with trigeminal neuralgia

Abstract

Background: Radiofrequency thermocoagulation (RFT) has been widely used to manage trigeminal neuralgia (TN) refractory to oral medication. Careful selection of patients for managing TN with RFT can decrease morbidity and improve treatment efficacy. Objectives: The goal of this study was to determine clinical variables related to the treatment outcome in patients with TN undergoing RFT. Study Design: Retrospective analysis. Setting: University hospital in Korea. Methods: Demographic and clinical data were garnered by billing records for patients with TN who received RFT by one pain physician between January 2005 and August 2014. A successful outcome was pre-defined as at least 50% pain relief on a 0 – 10 NRS pain score for longer than 6 months after RFT. Variables evaluated for their association with outcome included age, gender, baseline pain score, etiology, type of pain, co-existing psychopathology, and history of previous intervention. Results: Among 90 patients who underwent RFT for managing TN, 75 patients (83.3%) reported a successful outcome (> 50% pain relief at 6 months after RFT procedure). Pain characteristics was the most significant predictor associated with successful outcomes of RFT in both univariate and multivariate logistic analysis; odds ratio of provoked paroxysmal pain was 131.516 and mixed type of pain was 20.602 in multivariate analysis. Limitations: Prospective studies are recommended to confirm our findings and ascertain which additional variables can be taken into account to improve the likelihood of a successful outcome for RFT in patients with TN. Conclusion: A provoked paroxysmal pain or mixed pain condition was associated with a positive outcome for RFT in patients with TN. In addition, bilateral TN, high baseline NRS pain score, or co-morbid psychiatric condition was related with negative outcomes in univariate analysis. Pain clinicians should consider these findings when selecting patients for managing TN to increase the efficacy of RFT.