A double burden: depression and early pain recurrence following surgical management of trigeminal neuralgia

OBJECTIVE Trigeminal neuralgia (TN) is characterized by recurrent, unilateral episodes of electric shock-like facial pain, frequently triggered by routine activities, that can significantly impair quality of life. Although interventions such as microvascular decompression, stereotactic radiosurgery, and minimally invasive percutaneous procedures often provide rapid pain relief, recurrence remains a clinical challenge. Psychological comorbidities, particularly depressive disorder, may play a role in predicting outcomes after surgical intervention. This study aimed to determine whether a preexisting diagnosis of depressive disorder was independently associated with earlier recurrence of pain after surgical intervention. METHODS This single-center retrospective study included patients with TN who underwent surgical intervention between March 30, 2017, and March 30, 2024. Exposure variables consisted of demographic data, comorbidities, preprocedural characteristics of TN, procedure type, and total number of interventions. Primary outcomes were defined as > 50% pain relief at the last follow-up and recurrence of pain during the follow-up period. RESULTS A total of 150 patients with TN who underwent 193 procedures were included in this retrospective analysis. The mean follow-up duration was 11.4 months. Among these cases, 54 patients had a clinical diagnosis or were being treated for depressive disorder. Female sex (74.1%) and comorbid migraine (44.4%) were significantly more prevalent in the depressed cohort. Patients with depressive disorder also underwent balloon compression rhizotomy (52.1%) and radiosurgery (32.4%) at higher rates compared with those without depressive disorder. No other significant differences were observed between the two groups. Postoperatively, recurrence of any level of facial pain was significantly more common in patients with depressive disorder (70.4% vs 51.6%, p = 0.011). In a multivariable mixed-effects Cox regression model, depressive disorder emerged as an independent predictor of earlier pain recurrence during follow-up, alongside type of surgical intervention received. CONCLUSIONS Depressive disorder is a common psychiatric comorbidity among patients with TN. This study demonstrated that depressive disorder also serves as an independent predictor of earlier pain recurrence after surgical intervention. Recognizing depressive disorder alongside other preexisting conditions may aid clinicians in setting realistic expectations of surgical outcomes and guiding clinical decision-making. Further studies are necessary to validate the observed associations and further clarify the impact of psychological comorbidities on pain outcomes after surgery.