Does Acupuncture Produce Durable Analgesia in Trigeminal Neuralgia? An Updated Systematic Review and Meta-Analysis

Area of Science:

• Neurology
• Integrative Medicine
• Evidence-Based Medicine

Background:

• Trigeminal neuralgia (TN) is a chronic pain condition often managed with carbamazepine.
• Previous reviews suggest acupuncture benefits, but lack detailed risk of bias and outcome quality assessment.
• This systematic review critically evaluates acupuncture's efficacy and safety in TN management.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) of acupuncture for trigeminal neuralgia.
• To assess acupuncture's efficacy, including pain reduction and recurrence rates, considering risk of bias.
• To evaluate the persistence of analgesic effects and safety compared to non-acupuncture controls.

Main Methods:

• Searched seven databases for RCTs comparing acupuncture to non-acupuncture controls in adults with TN.
• Analyzed end-of-treatment and follow-up pain intensity (VAS), attack frequency, recurrence, and adverse events.
• Assessed risk of bias using Cochrane RoB 2 and audited pain outcome recall period specification.

Main Results:

• Twenty-three trials (1774 participants), all from China, were included; only one used a sham control.
• End-of-treatment pain reduction favored acupuncture but was dependent on high-risk studies and lacked recall periods.
• Follow-up pain reduction showed a consistent trend but was statistically fragile; acupuncture had fewer adverse events than carbamazepine.

Conclusions:

• Current evidence for acupuncture's end-of-treatment efficacy in TN is compromised by study quality and reporting issues.
• Acupuncture demonstrates a potentially persistent but statistically fragile analgesic effect beyond treatment.
• High-quality, sham-controlled trials with standardized pain outcome reporting and prospective follow-up are essential.