Abstract:
:Trigeminal neuralgia (TN) is a rare form of neuropathic facial pain characterised by severe, paroxysmal pains in the face. Little is known about the decision process in treatment of TN, and management with anti-epileptic drugs or surgical procedures carries risks of side effects, recurrence and complications. One hundred fifty-six previously diagnosed TN patients completed an adapted time-trade-off utility measurement questionnaire to ascertain how they valued the potential outcomes from various surgical and medical treatments. The decision analysis revealed that microvascular decompression surgery (MVD) offered the best chance of improved quality of life or highest maximum expected utility (MEU). MVD (MEU=16.08 out of a possible 20) was closely followed by balloon compression (MEU=15.97), percutaneous glycerol rhizolysis (MEU=15.61) and then radiofrequency thermocoagulation (MEU=14.93). Medication offered the least optimal chance of improved quality of life (MEU=14.61). The difference between the highest (MVD) and lowest scoring treatments (medication) was 7.3% (1.46/20). These results were sensitive to some utility values, meaning the preferred treatment is changed by the values patients assign to outcomes. As surgical techniques narrowly offer the highest chance of maximising patient quality of life, all patients with TN should consider surgery. However, surgery is not right for everyone, and patients should be informed about their full range of choices. Treatment decisions must take place after careful consideration of the values patients place on benefits and risks of treatment.
journal_name
Painjournal_title
Painauthors
Spatz AL,Zakrzewska JM,Kay EJdoi
10.1016/j.pain.2007.02.009subject
Has Abstractpub_date
2007-10-01 00:00:00pages
302-310issue
3eissn
0304-3959issn
1872-6623pii
00006396-200710000-00012journal_volume
131pub_type
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