A racial analysis of pain outcomes following microvascular decompression for trigeminal neuralgia

Abstract

OBJECTIVE Pain outcomes by race in trigeminal neuralgia (TN) are not well investigated. The authors aimed to compare microvascular decompression (MVD) outcomes in TN patients on the basis of self-identified race. METHODS The authors retrospectively reviewed all patients with TN who underwent MVD at their institution from 2007 to 2020. Each patient’s self-reported race was recorded, and Barrow Neurological Institute (BNI) scores for pain and numbness were compared. Factors associated with pain recurrence were assessed using survival analyses and multivariate regressions. RESULTS Of 1011 patients, 925 reported their racial demographic characteristics, and patients who identified as Native American or American Indian and Native Hawaiian or Pacific Islander were excluded due to small sample sizes. Of the resulting 921 patients, 697 (75.7%) patients identified as White, 108 (11.7%) as Black or African American, 39 (4.2%) as Asian, and 77 (8.4%) as other. Compared with White patients, Black TN patients were more likely to present with type 1 TN (p = 0.02). At final follow-up, the mean BNI pain score of Black patients was significantly higher (p < 0.001) compared with that of White patients, although pain scores did not differ preoperatively. The adjusted multivariate ordinal regression model showed that Black patients were associated with higher BNI pain scores at final follow-up (p = 0.01). Furthermore, compared with White patients, Black patients were at increased risk for postoperative pain recurrence (p = 0.04), which additionally occurred after a shorter median pain-free duration (p = 0.03). CONCLUSIONS TN patients who identify as Black or African American exhibit worse postoperative pain outcomes after MVD compared with White patients. Future studies investigating the factors driving these racial differences are warranted.