{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:30:51Z","timestamp":1793716251866,"version":"4.6.1"},"reference-count":37,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Trigeminal neuralgia (TN) is an orofacial pain disorder that is more prevalent in females than males. Although an increasing number of studies point to sex differences in chronic pain, how sex impacts TN patients\u2019 journeys to care has not been previously addressed. This study sought to investigate sex differences in patients\u2019 journeys to diagnosis, referral, and treatment of TN within a large national context.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Patients with classic TN (n = 100; 50 females and 50 males) were randomly selected through chart reviews at the largest surgical treatment center for TN in Canada for a cross-sectional study. Statistical tests, including Welch\u2019s t-test, the chi-square test, Pearson\u2019s correlations, and analyses of covariance, were conducted with Python.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Key discrepancies between sexes in access to care were identified. Females had a significantly longer referral time interval (average 53.2 months vs 20.4 months, median 27.5 months vs 11.0 months, p = 0.018) and total time interval (average 121.1 months vs 67.8 months, median 78.0 months vs 45.2 months, p = 0.018) than males, despite reporting higher pain intensity at referral. Although medically intolerant patients had a significantly shorter referral time interval than medically tolerant patients (average 13.0 months vs 41.0 months, median 6.0 months vs 17.0 months, p &lt; 0.001), medically tolerant females had a significantly longer referral time interval than medically tolerant males (average 59.9 months vs 21.7 months, median 30.0 months vs 12.0 months, p = 0.017). No statistically significant differences were detected between the sexes for diagnostic time interval (average 63.3 months vs 43.0 months, median 24.0 months vs 24.0 months, p = 0.263) or treatment time interval (average 4.6 months vs 4.7 months, median 4.0 months vs 3.0 months, p = 0.986).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Critical sex differences in patients\u2019 journeys to TN surgical treatment were identified, with females enduring considerably longer referral timelines and expressing significantly greater pain intensity than males at referral. Taken together, our findings suggest the presence of unconscious bias and discrimination against females and highlight the need for expediting TN treatment referral for female TN patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.11.jns221191","type":"journal-article","created":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T10:37:11Z","timestamp":1672396631000},"page":"463-471","source":"Crossref","is-referenced-by-count":9,"title":["Sex differences in patient journeys to diagnosis, referral, and surgical treatment of trigeminal neuralgia: implications for equitable care"],"prefix":"10.3171","volume":"139","author":[{"given":"Peter Shih-Ping","family":"Hung","sequence":"first","affiliation":[{"name":"Institute of Medical Science, University of Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alana G.","family":"Byeon","sequence":"additional","affiliation":[{"name":"Institute of Medical Science, University of Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alborz","family":"Noorani","sequence":"additional","affiliation":[{"name":"Institute of Medical Science, University of Toronto, Ontario, Canada;"},{"name":"MD Program, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew R.","family":"Walker","sequence":"additional","affiliation":[{"name":"Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianni R.","family":"Lorello","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Pain Management, University Health Network\u2014Toronto Western Hospital, Toronto, Ontario, Canada;"},{"name":"Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada;"},{"name":"The Wilson Centre, University Health Network\u2014Toronto General Hospital, Toronto, Ontario, Canada;"},{"name":"Women\u2019s College Research Institute, Women\u2019s College Hospital, Toronto, Ontario, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mojgan","family":"Hodaie","sequence":"additional","affiliation":[{"name":"Institute of Medical Science, University of Toronto, Ontario, Canada;"},{"name":"Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada;"},{"name":"Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; and"},{"name":"Division of Neurosurgery, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Pain Res Manag","first-page":"77","article-title":"The need for a Canadian pain strategy","volume":"16","author":"Lynch ME","year":"2011","unstructured":"Lynch ME. The need for a Canadian pain strategy. Pain Res Manag. 2011;16(2):77\u201380.21499581"},{"issue":"4","key":"b2","series-title":"Pain Res Manag","first-page":"179","article-title":"Chronic pain in Canada\u2014prevalence, treatment, impact and the role of opioid analgesia","volume":"7","author":"Moulin DE","year":"2002","unstructured":"Moulin DE, Clark AJ, Speechley M, Morley-Forster PK. Chronic pain in Canada\u2014prevalence, treatment, impact and the role of opioid analgesia. Pain Res Manag. 2002;7(4):179\u2013184.12518174"},{"key":"b3","series-title":"Clinicoecon Outcomes Res","first-page":"483","article-title":"Pain severity and the economic burden of neuropathic pain in the United States: BEAT Neuropathic Pain Observational Study","volume":"6","author":"Schaefer C","year":"2014","unstructured":"Schaefer C, Sadosky A, Mann R,  Pain severity and the economic burden of neuropathic pain in the United States: BEAT Neuropathic Pain Observational Study. Clinicoecon Outcomes Res. 2014;6:483\u2013496.25378940"},{"issue":"1","key":"b4","series-title":"Pain Pract","first-page":"79","article-title":"The costs and consequences of adequately managed chronic non-cancer pain and chronic neuropathic pain","volume":"14","author":"Andrew R","year":"2014","unstructured":"Andrew R, Derry S, Taylor RS, Straube S, Phillips CJ. The costs and consequences of adequately managed chronic non-cancer pain and chronic neuropathic pain. Pain Pract. 2014;14(1):79\u201394.23464879"},{"issue":"5","key":"b5","series-title":"J Pain","first-page":"447","article-title":"Sex, gender, and pain: a review of recent clinical and experimental findings","volume":"10","author":"Fillingim RB","year":"2009","unstructured":"Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL III. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. 2009;10(5):447\u2013485."},{"issue":"12","key":"b6","series-title":"Nat Rev Neurosci","first-page":"859","article-title":"Sex differences in pain and pain inhibition: multiple explanations of a controversial phenomenon","volume":"13","author":"Mogil JS","year":"2012","unstructured":"Mogil JS. Sex differences in pain and pain inhibition: multiple explanations of a controversial phenomenon. Nat Rev Neurosci. 2012;13(12):859\u2013866.23165262"},{"issue":"10","key":"b7","series-title":"Headache","first-page":"1574","article-title":"Trigeminal neuralgia\u2014a prospective systematic study of clinical characteristics in 158 patients","volume":"54","author":"Maarbjerg S","year":"2014","unstructured":"Maarbjerg S, Gozalov A, Olesen J, Bendtsen L. Trigeminal neuralgia\u2014a prospective systematic study of clinical characteristics in 158 patients. Headache. 2014;54(10):1574\u20131582.25231219"},{"issue":"1-2","key":"b8","series-title":"J Neurosci Res","first-page":"604","article-title":"Sex-based differences in brain alterations across chronic pain conditions","volume":"95","author":"Gupta A","year":"2017","unstructured":"Gupta A, Mayer EA, Fling C,  Sex-based differences in brain alterations across chronic pain conditions. J Neurosci Res. 2017;95(1-2):604\u2013616.27870423"},{"issue":"11","key":"b9","series-title":"Acta Neurochir (Wien)","first-page":"1925","article-title":"Diagnosis, medication, and surgical management for patients with trigeminal neuralgia: a qualitative study","volume":"157","author":"Allsop MJ","year":"2015","unstructured":"Allsop MJ, Twiddy M, Grant H,  Diagnosis, medication, and surgical management for patients with trigeminal neuralgia: a qualitative study. Acta Neurochir (Wien). 2015;157(11):1925\u20131933.26329729"},{"issue":"9","key":"b10","series-title":"Lancet Neurol","first-page":"784","article-title":"Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia","volume":"19","author":"Bendtsen L","year":"2020","unstructured":"Bendtsen L, Zakrzewska JM, Heinskou TB,  Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia. Lancet Neurol. 2020;19(9):784\u2013796.32822636"},{"issue":"9","key":"b11","series-title":"Pain","first-page":"1905","article-title":"Diffusion imaging in trigeminal neuralgia reveals abnormal trigeminal nerve and brain white matter","volume":"155","author":"DeSouza DD","year":"2014","unstructured":"DeSouza DD, Hodaie M, Davis KD. Diffusion imaging in trigeminal neuralgia reveals abnormal trigeminal nerve and brain white matter. Pain. 2014;155(9):1905\u20131906.24880116"},{"key":"b12","series-title":"Neuroimage Clin","first-page":"710","article-title":"Predicting pain relief: use of pre-surgical trigeminal nerve diffusion metrics in trigeminal neuralgia","volume":"15","author":"Hung PSP","year":"2017","unstructured":"Hung PSP, Chen DQ, Davis KD, Zhong J, Hodaie M. Predicting pain relief: use of pre-surgical trigeminal nerve diffusion metrics in trigeminal neuralgia. Neuroimage Clin. 2017;15:710\u2013718.28702348"},{"issue":"3","key":"b13","series-title":"J Neurosurg","first-page":"727","article-title":"Temporal disconnection between pain relief and trigeminal nerve microstructural changes after Gamma Knife radiosurgery for trigeminal neuralgia","volume":"133","author":"Hung PSP","year":"2020","unstructured":"Hung PSP, Tohyama S, Zhang JY, Hodaie M. Temporal disconnection between pain relief and trigeminal nerve microstructural changes after Gamma Knife radiosurgery for trigeminal neuralgia. J Neurosurg. 2020;133(3):727\u2013735."},{"key":"b14","series-title":"Neuroimage Clin","first-page":"102706","article-title":"Regional brain morphology predicts pain relief in trigeminal neuralgia","volume":"31","author":"Hung PSP","year":"2021","unstructured":"Hung PSP, Noorani A, Zhang JY,  Regional brain morphology predicts pain relief in trigeminal neuralgia. Neuroimage Clin. 2021;31:102706.34087549"},{"issue":"1","key":"b15","series-title":"J Pain","first-page":"141","article-title":"Pain relief reverses hippocampal abnormalities in trigeminal neuralgia","volume":"23","author":"Noorani A","year":"2022","unstructured":"Noorani A, Hung PSP, Zhang JY,  Pain relief reverses hippocampal abnormalities in trigeminal neuralgia. J Pain. 2022;23(1):141\u2013155.34380093"},{"key":"b16","series-title":"Neuroimage Clin","first-page":"101911","article-title":"Selective hippocampal subfield volume reductions in classic trigeminal neuralgia","volume":"23","author":"Vaculik MF","year":"2019","unstructured":"Vaculik MF, Noorani A, Hung PSP, Hodaie M. Selective hippocampal subfield volume reductions in classic trigeminal neuralgia. Neuroimage Clin. 2019;23:101911.31491821"},{"issue":"8","key":"b17","series-title":"Pain","first-page":"1468","article-title":"Differential expression of a brain aging biomarker across discrete chronic pain disorders","volume":"163","author":"Hung PSP","year":"2022","unstructured":"Hung PSP, Zhang JY, Noorani A,  Differential expression of a brain aging biomarker across discrete chronic pain disorders. Pain. 2022;163(8):1468\u20131478.35202044"},{"issue":"2","key":"b18","series-title":"Pain","first-page":"261","article-title":"Pain in persons who are marginalized by social conditions","volume":"161","author":"Craig KD","year":"2020","unstructured":"Craig KD, Holmes C, Hudspith M,  Pain in persons who are marginalized by social conditions. Pain. 2020;161(2):261\u2013265.31651578"},{"issue":"2","key":"b19","series-title":"J Neurosurg","first-page":"368","article-title":"Racial disparities in the diagnosis and management of trigeminal neuralgia","volume":"126","author":"Reinard K","year":"2017","unstructured":"Reinard K, Nerenz DR, Basheer A,  Racial disparities in the diagnosis and management of trigeminal neuralgia. J Neurosurg. 2017;126(2):368\u2013374.26967783"},{"issue":"16","key":"b20","series-title":"Proc Natl Acad Sci U S A","first-page":"4296","article-title":"Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites","volume":"113","author":"Hoffman KM","year":"2016","unstructured":"Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A. 2016;113(16):4296\u20134301.27044069"},{"issue":"2","key":"b21","series-title":"Pain Med","first-page":"150","article-title":"Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States","volume":"13","author":"Meghani SH","year":"2012","unstructured":"Meghani SH, Byun E, Gallagher RM. Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States. Pain Med. 2012;13(2):150\u2013174."},{"issue":"11","key":"b22","series-title":"JAMA Pediatr","first-page":"996","article-title":"Racial disparities in pain management of children with appendicitis in emergency departments","volume":"169","author":"Goyal MK","year":"2015","unstructured":"Goyal MK, Kuppermann N, Cleary SD, Teach SJ, Chamberlain JM. Racial disparities in pain management of children with appendicitis in emergency departments. JAMA Pediatr. 2015;169(11):996\u20131002.26366984"},{"issue":"2","key":"b23","series-title":"Pain Med","first-page":"364","article-title":"Impact of physician and patient gender on pain management in the emergency department\u2014a multicenter study","volume":"10","author":"Safdar B","year":"2009","unstructured":"Safdar B, Heins A, Homel P,  Impact of physician and patient gender on pain management in the emergency department\u2014a multicenter study. Pain Med. 2009;10(2):364\u2013372.18992042"},{"issue":"5","key":"b24","series-title":"Acad Emerg Med","first-page":"414","article-title":"Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain","volume":"15","author":"Chen EH","year":"2008","unstructured":"Chen EH, Shofer FS, Dean AJ,  Gender disparity in analgesic treatment of emergency department patients with acute abdominal pain. Acad Emerg Med. 2008;15(5):414\u2013418.18439195"},{"issue":"1","key":"b25","series-title":"Cephalalgia","first-page":"1","article-title":"Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition","volume":"38","year":"2018","unstructured":"Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1\u2013211.29368949"},{"issue":"2","key":"b26","series-title":"Neurology","first-page":"220","article-title":"Trigeminal neuralgia: new classification and diagnostic grading for practice and research","volume":"87","author":"Cruccu G","year":"2016","unstructured":"Cruccu G, Finnerup NB, Jensen TS,  Trigeminal neuralgia: new classification and diagnostic grading for practice and research. Neurology. 2016;87(2):220\u2013228.27306631"},{"issue":"6","key":"b27","series-title":"J Neurosurg","first-page":"1231","article-title":"Classification of trigeminal neuralgia: clinical, therapeutic, and prognostic implications in a series of 144 patients undergoing microvascular decompression","volume":"111","author":"Miller JP","year":"2009","unstructured":"Miller JP, Acar F, Burchiel KJ. Classification of trigeminal neuralgia: clinical, therapeutic, and prognostic implications in a series of 144 patients undergoing microvascular decompression. J Neurosurg. 2009;111(6):1231\u20131234."},{"issue":"1","key":"b28","series-title":"J R Stat Soc B","first-page":"289","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini Y","year":"1995","unstructured":"Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc B. 1995;57(1):289\u2013300."},{"issue":"8","key":"b29","series-title":"Pain","first-page":"1618","article-title":"Health care providers\u2019 judgments in chronic pain: the influence of gender and trustworthiness","volume":"157","author":"Sch\u00e4fer G","year":"2016","unstructured":"Sch\u00e4fer G, Prkachin KM, Kaseweter KA, Williams ACDC. Health care providers\u2019 judgments in chronic pain: the influence of gender and trustworthiness. Pain. 2016;157(8):1618\u20131625.26934512"},{"key":"b30","series-title":"Pain Res Manag","first-page":"6358624","article-title":"\"Brave men\" and \"emotional women\": a theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain","volume":"2018","author":"Samulowitz A","year":"2018","unstructured":"Samulowitz A, Gremyr I, Eriksson E, Hensing G. \"Brave men\" and \"emotional women\": a theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain. Pain Res Manag. 2018;2018:6358624.29682130"},{"key":"b31","article-title":"Epistemic Injustice: Power and the Ethics of Knowing","author":"Fricker M","year":"2007","unstructured":"Fricker M. Epistemic Injustice: Power and the Ethics of Knowing. Oxford University Press;2007."},{"issue":"5","key":"b32","series-title":"J Pain","first-page":"551","article-title":"The influence of patient sex, provider sex, and sexist attitudes on pain treatment decisions","volume":"15","author":"Hirsh AT","year":"2014","unstructured":"Hirsh AT, Hollingshead NA, Matthias MS, Bair MJ, Kroenke K. The influence of patient sex, provider sex, and sexist attitudes on pain treatment decisions. J Pain. 2014;15(5):551\u2013559.24576430"},{"key":"b33","article-title":"Privilege: A Reader","author":"Kimmel MS","year":"2017","unstructured":"Kimmel MS, Ferber AL. Privilege: A Reader. 4th ed. Westview Press;2017."},{"issue":"2","key":"b34","series-title":"Health Rep","first-page":"125","article-title":"Gender inequalities in care-giving in Canada","volume":"4","author":"Dowler JM","year":"1992","unstructured":"Dowler JM, Jordan-Simpson DA, Adams O. Gender inequalities in care-giving in Canada. Health Rep. 1992;4(2):125\u2013136.1421017"},{"issue":"1","key":"b35","series-title":"J Neurosurg Sci","first-page":"13","article-title":"Advances in the management of trigeminal neuralgia","volume":"57","author":"Hodaie M","year":"2013","unstructured":"Hodaie M, Coello AF. Advances in the management of trigeminal neuralgia. J Neurosurg Sci. 2013;57(1):13\u201321.23584217"},{"key":"b36","series-title":"Ther Clin Risk Manag","first-page":"289","article-title":"Advances in diagnosis and treatment of trigeminal neuralgia","volume":"11","author":"Montano N","year":"2015","unstructured":"Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag. 2015;11:289\u2013299.25750533"},{"issue":"12","key":"b37","series-title":"Arch Neurol","first-page":"1524","article-title":"Gamma knife radiosurgery for trigeminal neuralgia: results and expectations","volume":"55","author":"Kondziolka D","year":"1998","unstructured":"Kondziolka D, Perez B, Flickinger JC, Habeck M, Lunsford LD. Gamma knife radiosurgery for trigeminal neuralgia: results and expectations. Arch Neurol. 1998;55(12):1524\u20131529.9865796"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/139\/2\/article-p463.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/139\/2\/article-p463.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/139\/2\/article-p463.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,18]],"date-time":"2024-05-18T10:46:10Z","timestamp":1716029170000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/139\/2\/article-p463.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,1]]},"references-count":37,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2022.11.jns221191","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,1]]}}}