The association of frailty with worse pain outcomes in older patients with trigeminal neuralgia treated using primary percutaneous glycerin rhizotomy.

Abstract

Objective: Trigeminal neuralgia (TN) is a neurological disorder that typically manifests as excruciating orofacial pain along the branches of the trigeminal nerve. Percutaneous treatments for TN have been shown to provide short-term pain relief, but they are often associated with the recurrence of pain. In this study, the authors assessed the role of frailty status in postoperative pain and numbness outcomes for patients treated with primary percutaneous glycerin rhizotomy.

Methods: At the authors' institution, 231 older patients (age ≥ 60 years) who underwent primary glycerin rhizotomy between 2011 and 2022 were reviewed. These patients were dichotomized by the presence or absence of frailty using the modified 5-item Frailty Index. Demographic data, comorbidity information, clinical characteristics, intraoperative complications, and postoperative outcomes were collected. Kaplan-Meier analysis, multivariable ordinal regression, and Cox proportional hazards analysis were used to compare Barrow Neurological Institute (BNI) pain and numbness index outcomes between frail and nonfrail patients.

Results: Frail patients (n = 87) had significantly higher rates of hypertension, diabetes, history of cerebrovascular accidents, chronic kidney disease, hyperlipidemia, chronic obstructive pulmonary disease, and congestive heart failure compared to nonfrail patients (n = 144, p < 0.05). Frail patients had significantly worse pain at final follow-up compared to nonfrail patients (p < 0.01). They also experienced significantly higher rates of pain recurrence (p < 0.01) and rhizotomy failure (p < 0.01), defined as a BNI pain index score > 3 within 3 months after surgery. Multivariable ordinal regression determined that frailty was significantly associated with higher BNI pain index scores at final follow-up (p < 0.01). Cox proportional hazards models indicated that while male sex was associated with greater pain recurrence (p < 0.01), frailty was associated with a higher likelihood of rhizotomy failure (p < 0.01).

Conclusions: In this study, frail older patients who underwent primary glycerin rhizotomy experienced greater pain levels postoperatively and had a higher incidence of rhizotomy failure relative to their nonfrail counterparts. Therefore, frailty status should be considered during preoperative counseling prior to percutaneous glycerin rhizotomy to guide clinical decision-making and inform patient expectations following the procedure.