2026 Poster Presentations
P474: POST-TRAUMATIC STRESS DISORDER ASSOCIATED WITH TRIGEMINAL NEURALGIA: A POST-TREATMENT SURVEY
Sri Sridhar; Adway Gopakumar, BS; Shovan Bhatia, BS; Poliana Hartung, BS; Dongwon Lee, BS; Ajay Pathakamuri, BS; William McKay, MS; Paul A Gardner, MD; Georgios A Zenonos, MD; University of Pittsburgh Medical Center
Introduction: Trigeminal neuralgia (TN) is a chronic neuropathic disorder characterized by recurrent, severe paroxysms of facial pain, often regarded as among the most debilitating pain conditions and often associated with concomitant psychopathology. When pharmacologic therapy fails, surgical interventions such as percutaneous glycerol rhizotomy and microvascular decompression (MVD) are frequently employed. While outcomes relevant to pain recurrence are well characterized, the psychosocial events subsequent to treatment remain underexplored. Emerging evidence suggests that post-traumatic stress disorder (PTSD) may represent an important long-term sequela in patients exposed to recurrent severe pain. This study aimed to evaluate the prevalence of PTSD associated with patients with TN who had undergone glycerol rhizotomy or MVD.
Methods: A telephone-based survey was conducted in which patients with a prior diagnosis of trigeminal neuralgia were contacted and administered a questionnaire based on the PTSD Checklist for DSM-5 (PCL-5). A total of 103 patients were contacted, of whom 32 elected to participate in the survey, yielding a participation rate of 31%. Patients were characterized as ‘probable PTSD’ with a PCL-5 score greater than 30. Descriptive statistics were analyzed, and group comparisons were performed using t-tests for continuous variables and Fisher’s exact test with odds ratios for categorical outcomes.
Results: Among the 32 patients recruited (71.9% female; mean age: 63.9 ± 10.6), 11 (34.4%) underwent MVD, and the rest underwent glycerol rhizotomy. Fifteen (46.9%) patients reported purely paroxysmal pain at the time of the survey. No patients had a previous diagnosis of PTSD. Eleven (34.4%) patients were taking PTSD medication at the time of the survey. Interestingly, there was a significant difference in the number of patients who were taking SSRIs when stratifying between probable and improbable PTSD diagnoses (100% vs. 22.2%, p=0.002). Mean PTSD symptom severity, as measured by PCL-5, was comparable between patients undergoing glycerol rhizotomy and those undergoing MVD (16.5 ± 12.7 vs. 16.0 ± 8.9, p=0.96). Across the total cohort, 5 (15.6%) patients met criteria as probable PTSD cases (PCL-5 > 30). The incidence of PTSD did not differ significantly between patients undergoing glycerol rhizotomy and MVD (14.3% vs. 18.2%, p>0.99). The odds of PTSD were comparable following MVD compared to glycerol rhizotomy (OR: 0.75, 95% CI [0.13–4.85], p>0.99). No additional demographic or clinical predictors of PTSD were identified in this cohort.
Conclusion: Our findings indicate that while PTSD symptoms are reported among patients following both percutaneous glycerol rhizotomy and MVD for TN, there was no significant difference in prevalence between the two groups. Despite these findings, the presence of PTSD in a subset of patients with TN underscores the importance of incorporating psychological and psychiatric assessment into long-term follow-up care.