Medical School, University of Birmingham, Birmingham, B15 2GW, UK.
Current address: The Royal London Hospital, London, E1 1FR, UK.
J Headache Pain. 2022 Sep 3;23(1):114. doi: 10.1186/s10194-022-01489-7.
Trigeminal neuralgia is an episodic severe neuralgic pain and can be managed both medically and surgically. If possible, this should be directed by a Multidisciplinary Team (MDT) of specialised surgeons, physicians, dentists, psychologists and specialist nurses with access to all treatment modalities, which enables patients to make an informed decision about their future management.
The aim of this study was to review the outcomes of patients managed by an MDT clinic, in a single institute over an eleven-year period.
A prospective database was used to identify patients with trigeminal neuralgia or its variants who had attended a joint MDT clinic. The electronic notes were examined for demographics, onset and duration of trigeminal neuralgia, medications history, pain scores and details of surgical procedures if any by two independent assessors.
Three hundred thirty-four patients attended the MDT between 2008-2019. Forty-nine of them had surgery before being referred to the service and were included but analysed as a subgroup. Of the remaining patients, 54% opted to have surgery following the MDT either immediately or at a later date. At the last reported visit 55% of patients who opted to have surgery were pain free and off medications, compared to 15.5% of medically managed patients. Surgical complications were mostly attributable to numbness and in the majority of cases this was temporary. All patients who were not pain free, had complications after surgery or opted to remain on medical therapy were followed up in a facial pain clinic which has access to pain physicians, clinical nurse specialists and a tailored pain management program. Regular patient related outcome measures are collected to evaluate outcomes.
An MDT clinic offers an opportunity for shared decision making with patients deciding on their personal care pathway which is valued by patients. Not all patients opt for surgery, and some continue to attend a multidisciplinary follow up program. Providing a full range of services including psychological support, improves outcomes.
三叉神经痛是一种阵发性剧烈神经痛，可以通过医学和手术进行治疗。如果可能，应由专门的外科医生、内科医生、牙医、心理学家和专科护士组成的多学科团队（MDT）来指导治疗，并提供所有治疗方式，以便患者能够就其未来的治疗做出明智的决策。
本研究旨在回顾单一机构 11 年来多学科诊所管理的患者的结果。
使用前瞻性数据库来识别在联合 MDT 诊所就诊的三叉神经痛或其变体患者。两名独立评估员通过电子病历检查患者的人口统计学资料、三叉神经痛的发病和持续时间、药物治疗史、疼痛评分以及手术细节（如有）。
2008-2019 年间，334 名患者参加了 MDT。其中 49 人在转至该服务之前已接受过手术，并被包括在内，但作为亚组进行分析。在其余患者中，54%在 MDT 后选择手术，无论是立即手术还是以后手术。在最后一次随访时，选择手术的患者中有 55%无痛且停止用药，而接受药物治疗的患者仅有 15.5%。手术并发症主要与麻木有关，且在大多数情况下是暂时的。所有未缓解疼痛、手术后有并发症或选择继续药物治疗的患者都在面部疼痛诊所接受随访，该诊所可以提供疼痛医生、临床护士专家和定制的疼痛管理方案。定期收集患者相关的结果评估措施来评估结果。
MDT 诊所为患者提供了共同决策的机会，让患者决定自己的个人护理途径，这是患者所看重的。并非所有患者都选择手术，有些患者继续参加多学科随访计划。提供全方位的服务，包括心理支持，可改善结果。
