Background/Aims: Constant pain, especially if prominent, is sometimes considered incompatible with a diagnosis of typical idiopathic trigeminal neuralgia. This study aims to clarify the frequency of patient-reported constant pain in patients with medically intractable, typical, idiopathic trigeminal neuralgia as diagnosed with standard clinical parameters and confirmed by the response to a modified McGill questionnaire, a ‘hold-still’ test that eliminated triggers and the response to Gamma Knife radiosurgery. Method: Forty consecutive patients with typical trigeminal neuralgia were given questionnaires prior to Gamma Knife radiosurgery. Those with constant pain were further tested by being advised to hold completely still for up to 3 min. Final pain relief was evaluated after Gamma Knife radiosurgery. Results: Twenty of forty patients indicated on a questionnaire that they had constant face pain. Pain decreased on the ‘hold-still’ test on all 12 patients who were tested. Following Gamma Knife radiosurgery, there was no significant difference in pain relief in those without or with constant pain. Conclusion: Patients with typical idiopathic trigeminal neuralgia frequently report that 50% or more of their pain is constant. This constant pain is markedly decreased if the patient holds completely still for a few minutes and does not affect the outcome of Gamma Knife radiosurgery.

Keywords:
Trigeminal neuralgia, Constant face pain, Gamma Knife radiosurgery, Typical trigeminal neuralgia, Face pain
1.
Barker FG II, Jannetta PJ, Bissonette DJ, Larkins MV, Jho HD: The long-term outcome of microvascular decompression for trigeminal neuralgia. N Engl J Med 1996;334:1077–1084.
2.
Brisman R: Gamma knife surgery with a dose of 75 to 76.8 Gray for trigeminal neuralgia. J Neurosurg 2004;100:848–854.
3.
Brisman R: Trigeminal neuralgia: diagnosis and treatment. World Neurosurg 2011;76:533–534.
4.
Burchiel KJ: A new classification for facial pain. Neurosurgery 2003;53:1164–1167.
5.
Burchiel KJ, Slavin KV: On the natural history of trigeminal neuralgia. Neurosurgery 2000;46:152–155.
6.
Eller JL, Raslan AM, Burchiel KJ: Trigeminal neuralgia: definition and classification. Neurosurg Focus 2005;18(5):E3.
7.
Hakanson S: Trigeminal neuralgia treated by the injection of glycerol into the trigeminal cistern. Neurosurgery 1981;9:638–646.
8.
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders, ed 2. Cephalalgia 2004;24(suppl 1):9–160.
9.
Kondziolka D, Lunsford LD, Flickinger JC, Young RF, Vermeulen S, Duma CM, et al: Stereotactic radiosurgery for trigeminal neuralgia: a multiinstitutional study using the gamma unit. J Neurosurg 1996;84:940–945.
10.
Latchaw JP Jr, Hardy RW Jr, Forsythe SB, Cook AF: Trigeminal neuralgia treated by radiofrequency coagulation. J Neurosurg 1983;59:479–484.
11.
Lesse SE: Atypical facial pain syndrome. Arch Neurol 1960;3:122–123.
12.
Lichtor T, Mullan JF: A 10-year follow-up review of percutaneous microcompression of the trigeminal ganglion. J Neurosurg 1960;72:49–54.
13.
Maesawa S, Salame C, Flickinger JC, Pirris S, Kondziolka D, Lunsford LD: Clinical outcomes after stereotactic radiosurgery for idiopathic trigeminal neuralgia. J Neurosurg 2001;94:14–20.
14.
Merskey H, Bogduk N (eds): Classification of Chronic Pain, ed 2. Seattle, IASP Press, 1994.
15.
Miller JP, Acar F, Burchiel KJ: Classification of trigeminal neuralgia: clinical, therapeutic, and prognostic implications in a series of 144 patients undergoing microvascular decompression. J Neurosurg 2009;111:1231–1234.
16.
Sandell T, Eide PK: Effect of microvascular decompression in trigeminal neuralgia patients with or without constant pain. Neurosurgery 2008;63:93–99.
17.
Sharav Y, Singer E, Schmidt E, Dionne RA, Dubner R: The analgesic effect of amitriptyline on chronic facial pain. Pain 1987;31:199–209.
18.
Sindou M, Leston J, Howeidy T, Decullier E, Chapuis F: Micro-vascular decompression for primary trigeminal neuralgia (typical or atypical). Long-term effectiveness on pain; prospective study with survival analysis in a consecutive series of 362 patients. Acta Neurochir (Wien) 2006;148:1235–1245.
19.
Solomon S, Lipton RB: Atypical facial pain: a review. Semin Neurol 1988;8:332–338.
20.
Sweet WH, Wepsic JG: Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers. 1. Trigeminal neuralgia. J Neurosurg 1974;39:143–156.
21.
Szapiro J Jr, Sindou M, Szapiro J: Prognostic factors in microvascular decompression for trigeminal neuralgia. Neurosurgery 1985;17:920–929.
22.
Verheul JB, Hanssens PEJ, Lie ST, Leenstra S, Piersma H, Beute GN: Gamma knife surgery for trigeminal neuralgia: a review of 450 consecutive cases. J Neurosurg 2010;113:160–167.
23.
Taarnhoj P: Decompression of the trigeminal root. J Neurosurg 1954;11:299–305.
24.
White JC, Sweet WH: Pain and the Neurosurgeon: A Forty-Year Experience. Springfield, Thomas, 1969, p 409.
© 2013 S. Karger AG, Basel
2013
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