Short- and Long-Term Pain Relief With Radiofrequency Rhizotomy in Multiple Sclerosis Patients With Trigeminal Neuralgia: A Systematic Review.

Abstract

Trigeminal neuralgia (TN) in patients with multiple sclerosis (MS) is a debilitating condition that is often refractory to medical management. Radiofrequency rhizotomy (RFR) is a commonly used percutaneous intervention, but its outcomes in this specific population require a comprehensive synthesis. This systematic review aims to evaluate the short- and long-term pain relief, recurrence rates, and safety profile of RFR in patients with MS-associated TN (MS-TN). A systematic search of PubMed, Scopus, Web of Science, and Embase was performed up to October 2025. Eight studies meeting the inclusion criteria, all of retrospective design, were selected. Data on study characteristics, pain relief outcomes, recurrence, complications, and repeat procedures were extracted. The risk of bias was assessed using the ROBINS-I tool. The analysis of the included studies demonstrated that RFR provides high rates of short-term pain relief, with a significant majority of patients achieving favorable outcomes soon after the procedure. However, the long-term durability of pain relief was variable, showing a declining trend over time, with pain recurrence being a common feature. This pattern often necessitated repeated procedures to maintain pain control. The most frequently reported complications were facial sensory disturbances, which were generally well-tolerated, while major adverse events were rare. The methodological quality of the evidence was predominantly low risk of bias. RFR is a highly effective intervention for achieving rapid short-term pain relief in MS-TN, making it a valuable option for managing acute exacerbations. Its long-term utility is defined by its repeatability, as pain recurrence is common, necessitating a chronic disease management strategy. The procedure's favorable risk-benefit profile and procedural flexibility solidify its role as a cornerstone in the multimodal treatment arsenal for this challenging condition.