Refractory Trigeminal Neuralgia Reduced With Percutaneous Radiofrequency Ablation

Percutaneous trigeminal radiofrequency ablation was found to be associated with significantly more pain relief compared with sham treatment among patients with refractory trigeminal neuralgia, according to the results of a study published in Pain Medicine.

Patients (N=30) who had been experiencing trigeminal neuralgia for more than 6 months were recruited in Brazil for this sham-controlled, double-blind, randomized trial. Patients underwent either thermal radiofrequency ablation of the trigeminal nerve delivered inside Meckel’s cave using a coaxial approach at 75°C for 60 seconds (n=15) or sham treatment (n=15). Changes in scores on the numeric rating scale for pain and the 36-Item Short-Form Health Survey questionnaire (SF-36) were evaluated up to 1 year after the procedure.

The intervention and control arms consisted of 80% and 66.7% women with a mean age of 66.9 (standard deviation [SD], 10.7) and 62.5 (SD, 10.50) years, 28.5% and 40% had both V2 and V3 trigeminal branch involvement, 57.1% and 60.0% reported suicidal ideation, and numeric rating sale for pain scores were 9.6 (SD, 0.7) and 9.8 (SD, 0.4) points, respectively.

Recipients of the active intervention experienced a significant reduction in pain scores (from 9.2 to 0.7 points) compared with those receiving the sham intervention (8.9 to 5.8 points). This decrease in pain scores was observed as early as 1 day following treatment. The change in pain scores was maintained throughout the 12-month follow-up. At 1 month, the patients assigned to the sham treatment were allowed to switch to active treatment. After the patients switched treatments, the reductions in pain scores were similar between groups.

Initially, recipients of radiofrequency ablation experienced greater improvements in all SF-36 scales, except for general health perception.

At 1 month following treatment, participants in the ablation cohort decreased consumption of carbamazepine or oxcarbazepine by 84.75% compared with a decrease of 16.46% among participants in the sham group.

Adverse events included numbness (40%), paresthesia (13.3%), and labial herpes reactivation (n=6).

Study authors concluded that percutaneous trigeminal radiofrequency ablation caused a clinically significant reduction in pain compared with sham treatment among patients with trigeminal neuralgia. Although additional study is needed to compare outcomes of this treatment with surgical decompression, the authors conclude that “[t]hese results support using radiofrequency nerve ablation as a treatment for refractory trigeminal neuralgia.”