Multimodal Treatment Approaches for Facial Pain: A Comprehensive Evaluation of Outcomes

Background: Trigeminal neuralgia (TN) and other forms of facial pain pose significant challenges in clinical management due to their debilitating nature and varied etiologies. Despite advancements in treatment modalities, achieving long-term pain relief while minimizing adverse effects remains a paramount concern. Hence, this study was conducted to comprehensively evaluate the efficacy and outcomes of multimodal treatment approaches in patients with facial pain, aiming to optimize therapeutic strategies and enhance patient care. Objective: To assess the results of multimodal treatment in patients with facial pain. Methods: A total of 91 patients with facial pain treated at the Center of Neurosurgery in Tashkent were included in the study. Among them, 10 had posterior cranial fossa tumors compressing the trigeminal nerve, 77 had cases of trigeminal neuralgia (TN), and 4 experienced TN recurrence after microvascular decompression (MVD). Out of the 77 TN cases, 53 were classified as classic TN, 22 as idiopathic, and 2 as postherpetic TN. Results: All patients with tumors underwent tumor resection surgery. Pain immediately relieved in 9 cases after the operation, while 1 case experienced anesthesia dolorosa post-operation, which was subsequently managed with medication and botulinum toxin injections. MVD was performed in 53 cases of classic TN, resulting in total pain relief without any neurological complications. Among the 22 idiopathic cases, 12 showed vessel contact in MRI and underwent MVD combined with internal neurolysis of the trigeminal nerve. Pain relief was achieved in all cases post-operation, with all patients experiencing mild hypoesthesia on the face. Ten cases without vessel contact on MRI underwent percutaneous radiofrequency thermocoagulation (RT) under fluoroscopic image-guidance, with pain alleviating during the operation. Moderate hypoesthesia was aimed for during the operation, and the degree of numbness in the affected area served as the main indicator of procedure effectiveness. Three cases with recurrence were treated with RT, while MVD was attempted in one case where complete excision of adhesions from the nerve was not possible during the operation. After the operation, the patient underwent RT, resulting in complete pain relief. Two cases of postherpetic TN were treated with local injections of Lidocaine 1% - 0.1ml with 1 mg of dexamethasone, administered three times with a 5-7-day interval. All three cases experienced significant pain relief after the procedure and were further managed with medication. Conclusion: Microvascular decompression (MVD), owing to its curative nature and minimal tissue damage, is considered the preferred treatment for trigeminal neuralgia in otherwise healthy individuals. Our findings suggest that treatment planning should consider the type of facial pain. Prolonged pain relief was observed in patients without postoperative sensory deficits following MVD, which was found to be more effective for classic TN cases. In cases without nerve compression, RT is preferable and also allows for complete pain relief. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany