Divergent Associations of Pain and Anxiety with Disease Duration in Trigeminal Neuralgia: Evidence from Behavior, Spatial Gradients, and Duration-Related Patterns.

Trigeminal neuralgia (TN) patients frequently develop anxiety. We tested whether this anxiety reflects an independent dimension rather than a mere byproduct of chronic pain. We enrolled 58 TN patients-all with BNI grade V (treatment-refractory severe pain)-and 30 healthy controls. Evidence was assessed across three parallel dimensions: behavioral (HAMA anxiety levels), spatial (functional gradient architecture along the perceptual-cognitive axis, Gradient 3), and duration-related (Gradient 3 patterns with disease duration). Behaviorally, anxiety was elevated versus HC (HAMA: 9.23±6.11 vs 5.26±1.39, p=0.0006) but did not correlate with disease duration (r=-0.176, p=0.175). Spatially, Gradient 3 revealed a divergence (FDR-corrected q<0.05): the somatomotor network shifted toward the sensory pole (p=0.0028), while the limbic network shifted toward the cognitive pole (p=0.0017). Exploratory duration-related analyses showed a correlation between limbic network positioning and disease duration (r=-0.325, uncorrected p=0.013), with a trend-level early-stage association that warrants prospective validation. Pain and anxiety show divergent associations with disease duration in TN. These dissociations challenge the byproduct hypothesis and suggest that anxiety may warrant separate clinical consideration, though prospective validation is needed. PERSPECTIVE: This study identifies differing cortical network patterns in trigeminal neuralgia that may inform understanding of pain-anxiety comorbidity. The findings support further investigation of anxiety as a distinct clinical consideration, while duration-related associations remain exploratory and require longitudinal validation.