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Updated: Aug 13, 2026
Subcutaneous Trigeminal Nerve Field Stimulation for Refractory Facial Pain
Published on: May 10, 2017
A clinical comparison of trigeminal neuralgic pain in patients with and without underlying multiple sclerosis
R De Simone1, E Marano, V Brescia Morra
1Headache Centre, Department of Neurological Sciences, Federico II University of Naples, Via Pansini 5, I-80131, Naples, Italy. rodesimo@unina.it
Abstract:
Despite clinical similitude, there is a tendency to consider trigeminal pain in multiple sclerosis (MS) as a distinct condition. To evaluate clinical differences in trigeminal pain presentation in patients with and without underlying MS, we compared clinical characteristics of facial pain found in 15 consecutive MS patients with those reported by 13 consecutive subjects diagnosed with classical trigeminal neuralgia. The only significant difference between MS and non-MS neuralgic patients was the age of onset of pain (43.4+/-10.5 in MS vs. 59.6+/-11.50 in non-MS patients, p=0.000629, unpaired Student's t-test). No differences were observed for side, duration and quality of pain, trigeminal branches involved, presence of trigger areas or factors, pain refractive period, remitting-relapsing or chronic course. There was only a trend without statistical significance in interval pain and trigeminal hypoesthesia, more frequent in MS population. Only one patient in the MS group presented with long-lasting episodes (45-60 min) of atypical odontalgia. Our findings support the view of a common pathogenetic mechanism underlying TN in the two groups, possibly related to demyelination of the trigeminal entry root in the pons. Typical TN in MS patients should be considered as "symptomatic trigeminal neuralgia".
Insights
Facial pain in multiple sclerosis (MS) and classical trigeminal neuralgia (TN) share many clinical features. The primary difference is an earlier age of onset for MS-related trigeminal pain, suggesting a common cause.
Area of Science:
- Neurology
- Neuroscience
- Pain Medicine
Background:
- Trigeminal pain in multiple sclerosis (MS) is often clinically similar to classical trigeminal neuralgia (TN).
- Distinguishing between MS-related and non-MS trigeminal pain is crucial for accurate diagnosis and management.
- A common underlying pathogenetic mechanism is suspected due to clinical similarities.
Purpose of the Study:
- To evaluate clinical differences in trigeminal pain presentation between patients with and without MS.
- To determine if MS-related trigeminal pain represents a distinct clinical entity.
- To investigate potential shared mechanisms in trigeminal neuralgia.
Main Methods:
- Comparative clinical analysis of facial pain characteristics.
- Inclusion of 15 consecutive MS patients with trigeminal pain.
- Comparison with 13 consecutive patients diagnosed with classical trigeminal neuralgia.
Main Results:
- The only significant difference was an earlier age of onset in MS patients (43.4 years) compared to non-MS patients (59.6 years).
- No significant differences were found in pain side, duration, quality, involved branches, trigger factors, or pain course.
- A trend towards interval pain and trigeminal hypoesthesia was observed more frequently in the MS population.
Conclusions:
- Trigeminal neuralgia in MS patients shares significant clinical characteristics with classical TN.
- The earlier age of onset in MS patients suggests a specific etiological factor, possibly demyelination.
- Trigeminal pain in MS should be regarded as symptomatic trigeminal neuralgia, indicating a common pathophysiological basis.
