Long-Term Pain Outcomes in Patients with Trigeminal Neuralgia and Depression Following Microvascular Decompression

Introduction: Depression is a psychiatric comorbidity often experienced by patients with trigeminal neuralgia. Beyond its psychological burden, depression has been shown to alter pain perception and impair coping mechanisms. Despite this, its impact on long-term outcomes for trigeminal neuralgia following microvascular decompression (MVD) have not been well characterized. The aim of this study was to compare long-term pain outcomes in patients with and without pre-existing depression after MVD as well as identify predictors of pain relief within each group. Methods: A retrospective analysis of patients with trigeminal neuralgia and pre-existing depression who underwent microvascular decompression from 2022–2025 at a single institution was conducted. Demographics at presentation and operative data were collected. The primary outcome was long-term pain relief, defined as absence of pain at last-follow-up. Chi-square/Fisher’s exact test assessed association between categorical variables and pain outcomes. Univariate Cox proportional hazards regression analysis and Kaplan-Meier survival analysis assessed prognostic factors for long-term pain relief. Results: A total of 163 patients underwent 175 MVD procedures for trigeminal neuralgia. Of these patients, 29 (18%) had pre-existing depression, 24 being women (83%). Among the 134 patients without depression, 77 were women (57%). Among patients with depression, 7 (24%) reported symptoms persisting ≥5 years before surgery. In contrast, among those without depression, 45 (34%) had symptoms for ≥5 years. The majority of patients (n=138, 85%) presented with purely paroxysmal pain. Seven (24%) patients with depression had evidence of residual long-term pain compared with 36 (22%) without depression. On univariate analysis, depression was not associated with long-term pain recurrence (HR: 1.04, 95% CI: 0.48–2.25; p = 0.93). Subgroup analyses were conducted on patients with depression which interestingly showed that longer baseline symptom duration (≥5 years) was associated with a higher risk of long-term pain recurrence (HR: 9.52, 95% CI: 1.57–57.9; p = 0.014). Additionally, Kaplan-Meier analysis showed that patients with depression who had ≥5 years of symptoms before undergoing MVD had a median long-term-pain relief duration of 32.9 months, whereas patients with depression had