Catastrophizing in patients with trigeminal neuralgia is associated with pain intensity, anxiety, and neuropathic characteristics

Lima, Guilherme Machado Alvares de; Pereira, Vinicius Gonçalves Gomes; Sampaio, Nilo Souza; Hildebrandt, Fernanda Pereira; Villela, Nivaldo Ribeiro; Parise, Maud

doi:10.63231/2595-0118.e202551-pt

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ORIGINAL ARTICLE • BrJP 8 • 2025 • https://doi.org/10.63231/2595-0118.e202551-en linkcopy

Catastrophizing in patients with trigeminal neuralgia is associated with pain intensity, anxiety, and neuropathic characteristics

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES Trigeminal neuralgia (TN) is an intense, paroxysmal facial pain, triggered by innocuous stimuli. Although it is relatively rare, the impact on patients’ lives is profound. Pain catastrophizing in TN was investigated in a few studies. This study aimed to collect detailed clinical characteristics of patients with TN and examine the relationship between pain catastrophizing (PC), pain intensity, anxiety, depression, and sleep quality.

METHODS Patients with a diagnosis of TN (according to the International Classification of Orofacial Pain criteria) were evaluated through the following scales: Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), Pittsburgh sleep quality index (PSQI), painDETECT and visual analog scale.

RESULTS The study included 38 patients (26 women), with mean age of 64.4 ± 8 years. 28.9% had scores for anxiety (HAD_A ≥ 9), 34.2% had scores for depression (HAD_D ≥9), 86.8% had poor sleep quality (PSQI≥6) and 73.7% had scores for catastrophizing (PCS>20). Average pain intensity was correlated with depression (p=0,01), anxiety (p=0,04), and catastrophizing (p=0,03), especially helplessness (p<0,05). PC was also associated with anxiety (p=0,001) and neuropathic features (p=0,03). Moreover, magnification and helplessness were correlated with anxiety and depression. Rumination was correlated with poor sleep quality (p<0,05) and neuropathic features (p<0,05).

CONCLUSION This study found high levels of catastrophizing and poor sleep quality in most patients with TN. Pain catastrophizing was related to pain intensity, anxiety, and neuropathic features while poor sleep quality was associated with rumination.

Keywords:
Catastrophizing; Depression; Sleep initiation and maintenance disorders; Trigeminal neuralgia; Anxiety disorders

HIGHLIGHTS

Pain catastrophizing and poor sleep quality were common in patients with trigeminal neuralgia

Pain catastrophizing was related to pain intensity, anxiety, and neuropathic features

Poor sleep quality was associated with rumination

Pain catastrophizing could be an important element to be addressed in the search for better control of this type of pain

Age, (range)	66.2 (39-84)
Gender, n (%)
Female	54 (69.2%)
Male	24 (30.8%)
Pain characteristic, n (%)
Typical	31 (81.6%)
Atypical	7 (18.4%)
Trigeminal Branches, n (%)
V1	1 (2.6%)
V1+V2	3 (7.9%)
V1+V2+V3	3 (7.9%)
V2	2 (5.3%)
V2+V3	20 (52.6%)
V3	9 (23.7%)
Average Pain Intensity, median [P25-P75]	3.5 [0-6]
HADS-A, median [P25-P75]	6.5 [3-10]
HADS-D, median [P25-P75]	7 [3-10]
Pain Catastrophizing Scale, median [P25-P75]	32.5 [18- 42]
Pain Catastrophizing Subscale, median [P25-P75]
Magnification	7 [4-9]
Rumination	12 [9-12]
Helplessness	13 [7-19]
Pittsburgh Sleep Quality Index, median [P25-P75]	8 [7-12]
PainDETECT	20 [17-23]
Drugs
Carbamazepine, n(%)	33 (86.1%)
Phenytoin, n(%)	1 (2.6%)
Tricyclic, n(%)	8 (21.0%)
Clonazepam, n(%)	8 (21.0%)
Duloxetine, n(%)	1 (2.6%)
Baclofen, n(%)	4 (10.5%)
Gabapentinoid, n(%)	5 (13.2%)
No drugs	4 (10.5%)

	Age	Pain Intensity	HADS_A	HADS_D	PCS_M	PCS_R	PCS_H	PSQI
Pain Intensity	-0.4852**
HADS_A	0.1361	0.3672*
HADS_D	-0.1354	0.4415**	0.5871***
PCS_M	-0.2167	0.3094	0.5605***	0.3571*
PCS_R	-0.1327	0.2560	0.3022	0.0450	0.5765***
PCS_H	-0.1705	0.3678*	0.4970**	0.3519*	0.7292***	0.5419***
PSQI	0.0392	0.2311	0.2843	0.2394	0.2858	0.3335*	0.2791
PainDETECT	-0.3740	0.3287*	0.1461	0.1713	0.1636	0.3776*	0.2998	0.2827

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[1] Type 1: classical trigeminal neuralgia, purely paroxysmal; Type 2: classical trigeminal neuralgia with concomitant continuous pain; PCS: Pain Catastrophizing Scale; PSQI: Pittsburgh Sleeps Quality Index; PD-Q: PainDETECT Questionnaire; HADS: Hospital Anxiety and Depression Scale.