Here, we analyze the incidence, treatment and comorbidities seen in patients with Trigeminal neuralgia TN and painful TN attributed to MS plaque in a large tertiary center.

Trigeminal neuralgia (TN) is a well-recognized cause of facial pain in the general population, and multiple sclerosis (MS) accounts for some of these cases.  A recent meta-analysis reported that the prevalence of TN in MS was 3.8%. Although the occurrence of TN secondary to MS is now referred to as painful TN attributed to MS plaque, we refer to it as TN for simplicity. 

The Leaf research database was used to obtain retrospective data for all patients with ICD-10 code diagnosis for trigeminal neuralgia (ICD-10 G50.0) and for multiple sclerosis (ICD-10 G35.0) at the University of Washington.We aimed to investigate its prevalence in a large academic medical center and looked at pharmacotherapy and psychiatric comorbidities.

Our search showed that N=3,798 patients had diagnoses of multiple sclerosis (MS) at UWMC and N=1,176 patients had trigeminal neuralgia(TN). N=91 patients were found to have both diagnoses. This represents 2.3% of MS patients having TN and 7.7% of TN have painful TN attributed to MS plaque. Of the patients with both, N=63 (69%) were female. Only N=14 (15%) of these patients were working full time. Use of multiple pharmacologic therapies was common in all patients. Patients were prescribed carbamazepine, oxcarbazepine, balcofen, lamotrigine, gabapentin, pregabalin, tizanidine, topiramate, opioids, botox and surgery. All patients with TN had a high rate of opioid prescribing (over 60%) and 46% of patient had fatigue. 

The prevalence of TN in this sample is consistent with prior large study that included participants from multiple centers and reported a low prevalence of TN in only 2% in MS patients. Our analysis shows high rates of comorbid fatigue, opioid prescribing and disability.