Different Scale, Different Pain? Discordant Pain Measurements After Surgery for Trigeminal Neuralgia

Area of Science:

• Neurosurgery
• Pain Medicine
• Clinical Outcomes Research

Background:

• Trigeminal neuralgia (TN) is a debilitating condition characterized by severe facial pain.
• Current pain assessment in TN lacks standardization, hindering comparisons of treatment efficacy and patient outcomes.
• Evaluating pain severity is crucial for understanding the burden of illness and response to surgical interventions.

Purpose of the Study:

• To assess the concordance between three common pain measurement scales in patients undergoing surgery for trigeminal neuralgia.
• To identify discrepancies in pain severity classification among surgical TN patients.
• To advocate for standardized pain reporting in TN research.

Main Methods:

• A cross-sectional study involving 39 surgical TN patients.
• Pain severity was measured using the Visual Analog Pain Scale (VAS), Brief Pain Inventory-Facial (BPI-F), and Barrow Neurological Institute (BNI) Pain Intensity Score.
• Scores were converted to a 0-10 scale and categorized; agreement was assessed using the intraclass correlation coefficient (ICC).

Main Results:

• Nearly 50% of patients (18/39) showed at least one categorical discordance across the three scales.
• Discordance rates between scales ranged from 30% to 35%.
• Moderate agreement was observed across all three scores (ICC = 0.72), with higher discordance in moderate pain categories (BNI IIIb).

Conclusions:

• Discrepancies in pain classification are common among TN patients with residual mild-moderate postoperative pain.
• The findings underscore the need for a unified, standardized approach to reporting postoperative pain outcomes in trigeminal neuralgia studies.
• Standardization will improve the comparability of research and clinical decision-making in TN management.