Research Submission

Concomitant Persistent Pain in Classical Trigeminal Neuralgia – Evidence for Different Subtypes

Stine Maarbjerg MD

Stine Maarbjerg MD

Danish Headache Center, Department of Neurology, Glostrup University Hospital, Glostrup, Denmark

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Aydin Gozalov MD, PhD

Aydin Gozalov MD, PhD

Danish Headache Center, Department of Neurology, Glostrup University Hospital, Glostrup, Denmark

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Jes Olesen MD, PhD

Jes Olesen MD, PhD

Danish Headache Center, Department of Neurology, Glostrup University Hospital, Glostrup, Denmark

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Lars Bendtsen MD, PhD, Dr, MS

Corresponding Author

Lars Bendtsen MD, PhD, Dr, MS

Danish Headache Center, Department of Neurology, Glostrup University Hospital, Glostrup, Denmark

Address all correspondence to L. Bendtsen, Danish Headache Center, Department of Neurology, Glostrup Hospital, Nordre Ringvej 67, 2600 Glostrup, Denmark, email: [email protected]Search for more papers by this author
First published: 20 May 2014
Citations: 88
Conflict of Interest: None.
Funding: In 2010, the Capital Region of Denmark awarded the prize Global Excellence in Health to DHC and a part of the prize has financed this study. The work was also supported by the Lundbeck Foundation (grant number R118-A11531) and the Danish patient society “Trigeminus Foreningen.” Lars Bendtsen is principal investigator for Convergence study 1014802/202 and has received research grants from Convergence Pharmaceuticals. The funding sources had no role in the study.

Abstract

Objective

To describe the clinical characteristics in classical trigeminal neuralgia (TN) with concomitant persistent pain and to investigate whether TN with concomitant persistent pain represents a distinct phenotype.

Background

There has been much debate about the possible pathophysiological and clinical importance of concomitant persistent pain in TN. This has led to subgrouping of TN into forms with and without concomitant persistent pain in the recent 3rd International Classification of Headache Disorders beta classification.

Methods

In this cross-sectional study, data on the clinical characteristics were systematically and prospectively collected from consecutive TN patients.

Results

A total of 158 consecutive TN patients were included. Concomitant persistent pain was present in 78 patients (49%). The average intensity of concomitant persistent pain was 4.6 (verbal numerical rating scale). The concomitant persistent pain was present at onset or early in the disease course. Patients with concomitant persistent pain were on average 6.2 (P = .008) years younger at onset, but the 2 groups had the same duration of disease (P = .174). There was a preponderance of women in TN with (P < .001) but not in TN without concomitant persistent pain (P = .820). Right-sided pain was more prevalent than left-sided in TN without (P = .007) but not in TN with concomitant persistent pain (P = .907). TN with concomitant persistent pain more frequently had sensory abnormalities (P < .001) and less frequently responded to sodium channel blockers (P = .001). There were no significant differences in other clinical characteristics.

Conclusions

Concomitant persistent pain is very prevalent in TN and is not a consequence of paroxysmal pain. Findings support that the 3rd International Classification of Headache Disorders beta division of TN with and without concomitant persistent pain is clinically and scientifically important.