Neuropathic pain is nerve pain may occur following mechanical, chemical, metabolic or thermal injury of a sensory nerve. Microneurosurgery of the trigeminal nerve is an elective injury of a sensory nerve to treat sensory deficits, and sometime to treat neuropathic pain. The risk of developing neuropathic pain following trigeminal nerve repair has never been examined. The objective of this study was to determine which risk factors might be associated with the development of neuropathic pain following trigeminal nerve microneurosurgery. A retrospective review and prospective evaluation of 44 patients who underwent trigeminal nerve repair, including both the inferior alveolar nerve (IAN) and lingual nerve (LN), was performed. Each record was reviewed to account for age, gender, presence of neuropathic pain, site of nerve injury, etiology of the nerve injury, classification of the nerve injury, duration of the nerve injury, and type of repair performed. The primary end point was the presence or absence of neuropathic pain at 3, 6, and 12 months after surgery. The presence of neuropathic pain prior to microneurosurgery was the significant risk factor associated with the presence of neuropathic pain after trigeminal nerve surgery ( p < 0.0001). Pain prior to surgery had the following: sensitivity 72.7%, specificity 100%, positive predictive value 100%, negative predictive value 91%. In 100% of patients, if there was no neuropathic pain prior to surgery, there was none after surgery. The presence of neuropathic pain prior to trigeminal microneurosurgery is the major risk factor for developing postoperative neuropathic pain. These findings suggest that trigeminal nerve surgery is not a risk factor for developing neuropathic pain in the absence of neuropathic pain before surgery.
Risk factors associated with neuropathic pain following trigeminal nerve repair
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