Acupuncture for Trigeminal Neuralgia

Acupuncture for Trigeminal Neuralgia

            Acupuncture has been shown to be greatly effective in the treatment of trigeminal neuralgia also known as tic douloureux. It is a chronic pain condition in which the patient has episodes of shock-type pains affecting the trigeminal nerve, and characterized by facial pain as the trigeminal nerve carries sensation from the face to the brain. Something as simple as brushing teeth, shaving, or even talking can set off a burst of severe pain. Trigeminal neuralgia affects 4-13 per 100,000 people annually, and while this may not seem like a lot, it can also be a warning of something more going on in the patient’s body, such as Multiple Sclerosis. It is vital for us as providers to stay in the know of the latest research and treatment protocols for trigeminal neuralgia so that we can address the patient’s concerns..

Acupuncture Research for Trigeminal Neuralgia

A Systemic Review on Acupuncture for Trigeminal Neuralgia – 2010:

  • The goal of this systemic review was to verify the efficiency of acupuncture for Trigeminal Neuralgia treatment. Both Chinese and English databases were searched for randomized controlled studies, and these studies were evaluated for quality.

  • Twelve studies met the criteria which included a total 920 people; 506 in the acupuncture group, and 414 in the control group. The control treatment was Carbamazepine (CBZ). Four of the trials reported that acupuncture was better than CBZ, while the others showed no difference between the 2 groups. However, the adverse effects of acupuncture were much milder.

  • This study concluded that acupuncture is similarly efficient to CBZ, but with a decreased amount of adverse effects. Additional studies will need to be done with improved methodologies.

Efficiency on Primary Trigeminal Neuralgia Treated with Triple Puncture Technique and Electroacupuncture at Trigger Points – 2017:

  • The goal of this study is to compare the efficiency of combined therapy of electroacupuncture and triple puncture technique, and electroacupuncture alone. Patients with primary trigeminal neuralgia were separated into two groups with a total of 36 patients. Group A, the combination of electroacupuncture and triple puncture technique, and group B, electroacupuncture alone, containing 18 patients each. Treatment was provided for 10 days, and given once every two days. Symptoms were evaluated before treatment, at the end of the first session, and at the end of the second session.

  • When looking at the visual analogue scale (VAS) scores before and after treatment, all reduced after treatment in both groups; more so in group A. Group A had a total effective rate of 88.9%, and group B had a total effective rate of 66.7%.

  • This study concluded that the combination therapy of electroacupuncture and triple puncture technique at the trigger points was more effective than electroacupuncture alone in the treatment of primary trigeminal neuralgia.

Treatment of Facial Pain with I Ching Balance Acupuncture – 2017:

  • The goal of this study was to determine the efficiency of I Ching Balance Acupuncture (ICBA) on trigeminal neuralgia (TN) and persistent idiopathic facial pain (PIFP). One 65-year-old female with TN diagnosed 2.5 years before having acupuncture treatment, and one 42-year-old female with PIFP diagnosed 3 years before having acupuncture treatment. They were both treated in 60-minute sessions twice a week, and effects of the previous session were recorded prior to each session.

  • In both patients, pain was completely diminished after 60 and 29 acupuncture sessions in the PIFP and TN patient, respectively.  This study demonstrated the efficiency of ICBA, and its successful treatment of TN and PIFP. Additional studies with a larger population group are needed to validate these findings.

Acupuncture for Primary Trigeminal Neuralgia: A Systemic Review and PRISMA-Compliant Meta-Analysis – 2019:

  • The goal of this study was to determine the safety and efficiency of trigeminal neuralgia. There were 7 databases searched, risk of bias was assessed, and meta-analysis was conducted. Evidence was reviewed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

  • Of the 33 random controlled trials included, the meta-analysis results showed that both manual acupuncture and electroacupuncture achieved an improved response that was considerably better compared to carbamazepine. Additionally, manual acupuncture showed an increased effect at decreasing pain intensity. Furthermore, a combination of acupuncture and carbamazepine proved to have a more positive effect than carbamazepine alone. This study concluded that acupuncture may have positive effects on primary trigeminal neuralgia.

Acupuncture in the Management of Trigeminal Neuralgia – 2020:

  • The goal of this study was to compare acupuncture, carbamazepine (CBZ), and microvascular decompression (MVD) in the clinical treatment of trigeminal neuralgia. For each of these modalities, data regarding efficiency, side effects, and cost were assembled from reputable databases PubMed and Cochrane Library.

  • Acupuncture was shown to have the greatest efficiency, least reported side effects, and lowest cost of the three modalities. Additionally, according to the Holmes and Rahe’s Social Readjustment Rating Scale (SRRS) that was used to measure patient stress, acupuncture was proved to be the least stressful followed by surgery, and the most stressful being carbamazepine.

  • This study concluded that based on these findings, acupuncture appears to be more effective than MVD and CBZ. Additionally, according the data, acupuncture appears to also be safer, less expensive, and less stressful than the other two modalities.

Acupuncture Points & Protocol for Trigeminal Neuralgia

            There are a multitude of possible underlying and contributing patterns in those who develop trigeminal neuralgia, and each one will determine which series of points could be used.

Possible Underlying Patterns:

  • Blood Stagnation

  • Liver Fire

  • Liver Yin Deficiency

  • Liver and Gallbladder Damp Heat

  • Lung Damp-Phlegm Cold

  • Lung Damp-Phlegm Heat

  • Lung Wind Invasion-Wind Cold

  • Lung Wind Invasion-Wind Heat

  • Stomach Fire

Local and distal points used can also depend on where the pain is located in the face as the trigeminal nerve has three branches; the mandibular region, the maxillary region, and the ophthalmic region.

General Trigeminal Neuralgia Acupuncture Points:

  • Local Points: Xinming1, Xinming2, SI18, ST2, ST3, ST4, ST7, TH17, TH21, GV26, LI20

  • Distal Points: TH5, LI4, LV3, ST36, ST44, ST45

  • Auricular Points: Neuro, Face, Lung, Shen Men

Mandibular Region:

  • Local Points: ST6, ST7, Extra point 1 cun lateral CV24

  • Distal Point: LI4

Maxillary Region:

  • Local Points: LI20, SI18, ST2

  • Distal Point: LI4

Ophthalmic Region:

  • Local Points: UB2, GB14, Taiyang

  • Distal Points: LI4, TH5

Treating Trigeminal Neuralgia with Acupuncture

            Acupuncture for the treatment of trigeminal neuralgia has been shown to be effective, and even outperform and/or enhance current western medicine treatments. It is important to note, however, that it may take several sessions to achieve full pain relief.

Proper patient education in this arena is essential so that patients do not consider discontinuing treatment, and deeming acupuncture ineffective amongst their peers. It is vital for them to understand that although in modern day we want everything “right now”, full recovery is a process. Acupuncture as a standalone or complimentary treatment for trigeminal neuralgia is continuously getting more praise for it’s positive effects. More studies on a larger scale in the coming years will hopefully prove acupuncture to be one of the top treatment options for trigeminal neuralgia.


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