Updated Evidence of Acupuncture for Trigeminal Neuralgia: A Systematic Review and Meta-Analysis with GRADE Assessment

Trigeminal neuralgia (TN) is a clinically intractable disorder characterized by episodes of severe pain that often significantly impairs patients' quality of life. Although previous studies suggest that acupuncture may alleviate pain, it is particularly important to conduct an updated meta-analysis to confirm the effectiveness and safety of acupuncture in light of updated clinical evidence in recent years.

A systematic search was conducted across eight databases: four English-language (PubMed, Cochrane Library, Embase, and Web of Science) and four Chinese-language (Wanfang Data, China National Knowledge Infrastructure, China Science and Technology Journal Database, and China Biomedical Literature Service System). The search period for each database spans from its inception to 19 December 2025. Meta-analysis was conducted by using Stata 17.0.

A total of 38 randomized controlled trials involving 2836 patients with TN were included. Meta-analysis results showed that compared with the control group, the acupuncture group demonstrated significant differences in the following indicators: higher overall response rate (RR = 1.14, 95% CI 1.11-1.18), and lower visual analog scale scores (SMD = -1.19, 95% CI -1.62 to -0.76), frequency of pain episodes (SMD = -1.31, 95% CI -2.18 to -0.44), adverse events (RR 0.28, 95% CI: 0.16-0.50), and BPI-facial pain score (SMD = -0.53, 95% CI -0.96 to -0.09) were reduced.

Acupuncture combined with medication may improve efficacy and reduce adverse events compared with monotherapy. However, the quality of existing evidence is low due to methodological limitations. Rigorous, multicenter randomized controlled trials with standardized protocols are needed to confirm the role of acupuncture for TN management.