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Effects of microvascular decompression on depression and anxiety in trigeminal neuralgia: A prospective cohort study focused on risk factors and prognosis

https://doi.org/10.1016/j.clineuro.2017.08.011Get rights and content

Highlights

  • A prospective cohort study is conducted, and 128 patients with TN who underwent MVD in our department are included.

  • Depression and anxiety are prevalent in patients with idiopathic TN.

  • Female gender, high pain intensity and ineffective medicine treatment are risk factors.

  • MVD leads to significant improvements in the depression and anxiety symptoms.

Abstract

Objective

Patients with trigeminal neuralgia (TN) often develop a terrible fear of triggering pain, which may lead to depression and anxiety, exerting a negative effect on their quality of life. This study aimed to investigate the prevalence and risk factors of depression and anxiety in TN patients, and further to investigate the effects of microvascular decompression (MVD) on these psychiatric disorders.

Patients and methods

A prospective cohort study was conducted, patients with TN who underwent MVD in our department between 2013 and 2015 were included. Visual analogue scale (VAS) score was used to measure the severity of pain. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were used to evaluate depression and anxiety disorders before and 6-month after MVD. The clinical data of these patients were collected prospectively and statistically analyzed.

Results

A total of 128 study subjects comprising 70 women and 58 men with a mean age of 47.5 ± 11.2 years were included in this study. The mean VAS score was 7.7 ± 1.5. Eighty-three patients (64.8%) had depression and 24 patients (18.8%) suffered anxiety. Multivariate logistic regression analysis revealed that female gender (OR = 2.4, P = 0.036), high pain intensity (OR = 3.25, P = 0.027) and ineffective medicine treatment (OR = 1.89, P = 0.041) were associated with depression, and female gender (OR = 3.45, P = 0.034) and high pain intensity (OR = 2.88, P = 0.022) were also associated with anxiety. There were significant improvements in depression and anxiety symptoms between pre- and postoperative responses.

Conclusions

Depression and anxiety are prevalent in patients with idiopathic TN. Female gender, high pain intensity and ineffective medicine treatment are risk factors. MVD not only provides high pain-relief rate, but also leads to significant improvements in the depression and anxiety symptoms.

Introduction

Trigeminal neuralgia (TN) is reputed to be one of the most painful conditions characterized by short, unilateral paroxysms of unbearable electric shock-like pain in the distribution of fifth cranial nerve, resulting in significant impairment of the quality of life, and is even known historically as the “suicide disease” [5], [1], [16]. To date, the precise mechanism for TN remains unclear, and it has been widely accepted that neurovascular conflict (NVC) at the nerve’s root entry zone plays a major role in the etiology of TN [5], [14], [11], [13]. Microvascular decompression (MVD) leads to NVC elimination and successful pain relief, strongly supporting this theory, which is widely regarded as a logical and valuable method for curing the disease [18], [27].

Although not a common disorder, the impact on the lives of patients is profound [26], [23], [25]. Psychiatric disorders such as depression and anxiety are highly prevalent in patients suffering from TN. Zakrzewska et al. evaluated the impact of pain on patient functioning in 225 patients with TN, and they found that 35.7% patients had mild-to-severe depression and over 50% were anxious [26]. In addition, Macianskyte et al. reported that patients with TN presented a higher level for anxiety and depression than those with atypical facial pain, and there was a significant positive correlation between pain intensity and depression level [15]. Diagnosis and treatment of depression and anxiety disorders that related to TN are very important, as they can be associated with significant morbidity and mortality [22], [25]. However, the psychological consequences of TN rarely receive attention.

To facilitate the development of effective intervention strategies, it’s very important to identify the risk factors for psychiatric disorders associated with TN. In addition, despite the known efficiency of MVD on TN symptoms, no studies have been performed so far to evaluate the influence of MVD on related depression and anxiety in patients with TN, as successful functional improvement after surgery does not necessarily mean that patients have improved psychological consequences. To address these questions, we conducted a prospective study to determine the prevalence and risk factors of depression and anxiety in patients with TN, and further to investigate the effects of MVD on these psychiatric disorders.

Section snippets

Study subjects

The study included patients clinically diagnosed with idiopathic TN, who received MVD treatment at the neurosurgery department of West China Hospital, from September 2013 to March 2015. Idiopathic TN was diagnosed according to the criteria of the second edition of the International Classification of Headache Disorders [19]. The exclusion criteria included: (1) Diagnosed with secondary TN or bilateral symptoms; (2) Unable to understand and answer the questionnaires; (3) Patients with chronic

Patient characteristics

A total of 128 study subjects comprising 70 women (54.7%) and 58 men (45.3%) with a mean age of 47.5 ± 11.2 years (range, 20–71 years) were included in this study. The left side was affected in 59 patients (46.1%) and right in 69 patients (53.9%). The mean duration of TN before surgery was 5.2 ± 4.6 years (range, 0.5–28 years). Seventy-three percent had been educated for fewer than 9 years. Eighty percent were married, and 27.3% were not employed. The demographic and clinical characteristics of the

Discussion

Previous studies have confirmed that patients affected by chronic pain are at a higher risk of developing depression and anxiety than the general population [7], [3], [15]. In addition, existence of pain-related psychiatric disorders is often considered as a predictor of poorer treatment outcome in patients with chronic pain [15]. As one of the most painful conditions, TN pain plays a significant role in incapacitating the individual and places a substantial burden on patients' quality of life,

Conclusions

In conclusion, our study highlighted the high prevalence of anxiety and depression in patients with idiopathic TN. Furthermore, the results suggested that female gender, high pain intensity and ineffective medicine treatment were significant risk factors for depression or anxiety in patients with TN. MVD not only provides high pain-relief rate, but also leads to significant improvements in the depression and anxiety symptoms.

Conflicts of interest

None.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgment

We would like to thank all the patients for their participation.

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    These authors contributed equally to the study as the co-first authors.

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