1Department of Neurosurgery, Koç University School of Medicine, Istanbul.
3Gamma Knife Center, Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey.
J Neurosurg. 2023 Jul 28;140(2):507-514. doi: 10.3171/2023.6.JNS23834. Print 2024 Feb 1.
Gamma Knife radiosurgery (GKRS) effectively achieves high rates of pain control in trigeminal neuralgia (TN); however, psychological factors can also impact how individuals perceive pain and respond to treatment. The authors aimed to measure the effects of alexithymia and depression on GKRS outcomes, as well as the potential role of colored pain drawings (CPDs) in identifying patients who require additional psychological support.
Seventy-three medically intractable, typical patients with TN were included. Participants completed a visual analog scale (VAS), the Toronto Alexithymia Scale (TAS-20), and the Turkish version of the Beck Depression Inventory-II (BDI-II). Participants used colored pens to draw their pain patterns on standardized face charts and CPDs were categorized as expected or unexpected. Based on the Barrow Neurological Institute pain scale, patients were categorized as responders or nonresponders.
Most patients (63%) were female, and the median age was 60 (range 27-88) years. Of 73 patients, 56 (76.7%) were responders and 17 (23.3%) were nonresponders. Forty-nine patients (67.1%) had expected CPDs, whereas 24 (32.9%) had unexpected CPDs. Responder and nonresponder groups had similar ages, genders, education, comorbidities, and initial VAS scores. Both groups preferred the colors red and black to describe intense pain (79.2% vs 67.3%, p = 0.411). Significantly better pain relief was observed in patients with expected CPDs than in those with unexpected CPDs (87.8% vs 54.2%, p = 0.003). The unexpected CPD group had significantly more alexithymia (58.3% vs 32.7%, p = 0.045). The mean BDI-II score of the cohort was 26 (range 15-37) and was significantly higher in the unexpected group (28.3 vs 24.8, p = 0.028). Unexpected CPD (OR 12.540) and higher TAS-20 score (OR 3.22) increased treatment failure risk.
The outcomes of TN treatment can be influenced by psychological factors, and patients with TN with higher total TAS-20 and BDI-II scores, along with unexpected CPDs, had an increased likelihood of treatment failure. CPDs can be accessed quickly and may allow the physician to screen out most patients with unfavorable psychometrics and proceed with the necessary treatment with appropriate psychological support.
伽玛刀放射外科（GKRS）可有效控制三叉神经痛（TN）的高疼痛率；然而，心理因素也会影响个体对疼痛的感知和对治疗的反应。作者旨在测量述情障碍和抑郁对 GKRS 结果的影响，以及彩色疼痛图（CPD）在识别需要额外心理支持的患者方面的潜在作用。
纳入 73 例经医学治疗无效的典型 TN 患者。参与者完成视觉模拟量表（VAS）、多伦多述情障碍量表（TAS-20）和土耳其版贝克抑郁量表-II（BDI-II）。参与者使用彩色笔在标准面部图表上绘制疼痛模式，CPD 分为预期或非预期。根据巴罗神经研究所疼痛量表，患者被分为反应者和非反应者。
大多数患者（63%）为女性，中位年龄为 60 岁（范围 27-88 岁）。73 例患者中，56 例（76.7%）为反应者，17 例（23.3%）为非反应者。49 例（67.1%）有预期的 CPD，24 例（32.9%）有意外的 CPD。反应者组和非反应者组的年龄、性别、教育程度、合并症和初始 VAS 评分相似。两组患者均更喜欢用红色和黑色来描述剧烈疼痛（79.2%比 67.3%，p=0.411）。与意外 CPD 组相比，预期 CPD 组的疼痛缓解明显更好（87.8%比 54.2%，p=0.003）。意外 CPD 组的述情障碍明显更多（58.3%比 32.7%，p=0.045）。队列的平均 BDI-II 评分为 26 分（范围 15-37），意外组明显更高（28.3 比 24.8，p=0.028）。意外 CPD（OR 12.540）和更高的 TAS-20 评分（OR 3.22）增加了治疗失败的风险。
TN 治疗的结果可能受到心理因素的影响，TN 患者的总 TAS-20 和 BDI-II 评分较高，以及出现意外的 CPD，其治疗失败的可能性增加。CPD 可以快速获取，并且可以让医生筛选出大多数心理测量结果不佳的患者，并在必要时提供适当的心理支持进行治疗。
