Triple Puncture for Primary Trigeminal Neuralgia: A Randomized Clinical Trial

Abstract

To evaluate the effect of triple puncture on primary trigeminal neuralgia (pTN), 64 patients with pTN were randomly assigned to two groups: treatment group and control group. The participants in the treatment group received triple puncture treatment of 6 times per week for 4 weeks, and those in control group were given carbamazepine (300–600 mg per day) for at least 1 month. Before and after treatment, the primary outcomes including the total efficiency rate and the VAS pain scores, and the secondary outcomes including the frequency of pain attack and adverse events were observed. Sixty-two participants finished the study (33 in treatment group and 29 in control group individually). After treatment, the symptoms (mainly pain) of the two groups were alleviated. The total efficiency rate in the treatment group and control group was 90.9% and 75.9% respectively. The VAS pain scores and frequency of pain attack were significantly reduced in the treatment group as compared with the control group (P<0.05). The incidence of adverse events in the treatment group and control group was 9.1% and 24.1% respectively. It can be inferred that triple puncture can effectively improve the quality of life of patients with pTN and has less side effects.

Keywords

triple puncture / primary trigeminal neuralgia / randomized clinical trial

References

[1] Headache Classification Committee of the International Headache Society IHS. The International Classification of Headache Disorders. Cephalalgia, 2013, 33(9): 629-808

[2] SathasivamHP, IsmailS, AhmadAR, et al.. Trigeminal neuralgia: a retrospective multicentre study of 320 Asian patients. Oral Surg Oral Med Oral Pathol Oral Radiol, 2017, 123(1): 51-57

[3] De ToledoIP, Conti ReusJ, FernandesM, et al.. Prevalence of trigeminal neuralgia: A systematic review. J Am Dent Assoc, 2016, 147(7): 570-576

[4] MorraME, ElgebalyA, ElmaraezyA, et al.. Therapeutic efficacy and safety of botulinum toxin A therapy in trigeminal neuralgia: a systematic review and meta-analysis of randomized controlled trials. J Headache Pain, 2016, 17(1): 63

[5] HallerS, EtienneL, KovariE, et al.. Imaging of Neurovascular Compression Syndromes: Trigeminal Neuralgia, Hemifacial Spasm, Vestibular Paroxysmia, and Glossopharyngeal Neuralgia. AJNR Am J Neuroradiol, 2016, 37(8): 1384-1392

[6] KoAL, OzpinarA, LeeA, et al.. Long-term efficacy and safety of internal neurolysis for trigeminal neuralgia without neurovascular compression. J Neurosurg, 2015, 122(5): 1048-1057

[7] AsplundP, BlomstedtP, BergenheimAT. Percutaneous Balloon Compression vs Percutaneous Retrogasserian Glycerol Rhizotomy for the Primary Treatment of Trigeminal Neuralgia. Neurosurgery, 2016, 78(3): 421-428

[8] HuangY, NiJ, WuB, et al.. Percutaneous radiofrequency thermocoagulation for the treatment of different types of trigeminal neuralgia: evaluation of quality of life and outcomes. J Huazhong Univ Sci Technolog Med Sci, 2010, 30(3): 403-407

[9] RegisJ, TuleascaC, ResseguierN, et al.. Long-term safety and efficacy of Gamma Knife surgery in classical trigeminal neuralgia: a 497-patient historical cohort study. J Neurosurg, 2016, 124(4): 1079-1087

[10] WangQP, BaiM. Topiramate versus carbamazepine for the treatment of classical trigeminal neuralgia: a meta-analysis. CNS Drugs, 2011, 25(10): 847-857

[11] Di StefanoG, La CesaS, TruiniA, et al.. Natural history and outcome of 200 outpatients with classical trigeminal neuralgia treated with carbamazepine or oxcarbazepine in a tertiary centre for neuropathic pain. J Headache Pain, 2014, 9(15): 34

[12] Al-QulitiKW. Update on neuropathic pain treatment for trigeminal neuralgia. The pharmacological and surgical options. Neurosciences (Riyadh), 2015, 20(2): 107-114

[13] CruccuG. Trigeminal Neuralgia. Continuum, 2017, 23(2): 396-420

[14] BesiE, BonifaceDR, CreggR, et al.. Comparison of tolerability and adverse symptoms in oxcarbazepine and carbamazepine in the treatment of trigeminal neuralgia and neuralgiform headaches using the Liverpool Adverse Events Profile (AEP). J Headache Pain, 2015, 16: 563

[15] XieYH, ChaiXQ, WangYL, et al.. Effect of electro-acupuncture stimulation of Ximen (PC4) and Neiguan (PC6) on remifentanil-induced breakthrough pain following thoracal esophagectomy. J Huazhong Univ Sci Technolog Med Sci, 2014, 34(4): 569-574

[16] JuZY, WangK, CuiHS, et al.. Acupuncture for neuropathic pain in adults. Cochrane Database Syst Rev, 2017, 12: CD012057

[17] ShuaiP Z X-H, LaoL, et al.. Issues of design and statistical analysis in controlled clinical acupuncture trials: an analysis of English-language reports from Western journals. Stat Med, 2012, 31(7): 606-618

[18] IchidaMC, ZemunerM, HosomiJ, et al.. Acupuncture treatment for idiopathic trigeminal neuralgia: A longitudinal case-control double blinded study. Chin J Integr Med, 2017, 23(11): 829-836

[19] ZhangYP, SongAQ, LiJK, et al.. 40 Cases of trigeminal neuralgia treated by triple puncture. Hunan J Trad Chin Med (Chinese), 2006, 22(2): 69-70

[20] JMZ. WallPD, MelzackR. Trigeminal, eye and ear pain. Textbook of pain, 20004th

[21] MacPhersonH, AltmanDG, HammerschlagR, et al.. Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. J Altern Complement Med, 2010, 16(10): ST1-14

[22] McQuayH, MooreA. An evidence-based resource for pain relief, 2000, Oxford, New York, Oxford University Press: 14

[23] Sanchez-LarsenA, SopelanaD, Diaz-MarotoI, et al.. Assessment of efficacy and safety of eslicarbazepine acetate for the treatment of trigeminal neuralgia. Eur J Pain, 2018, 22(6): 1080-1087

[24] GronsethG, CruccuG, AlksneJ, et al.. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology, 2008, 71(15): 1183-1190

[25] YangJX, ZhangJP, YuJC, et al.. Clinical research of primary trigeminal neuralgia treated with electroacupuncture at qi streets acupoints combined with spinal regulation therapy. Zhongguo Zhen Jiu (Chinese), 2014, 34(8): 763-768

[26] KaratayS, OkurSC, UzkeserH, et al.. Effects of Acupuncture Treatment on Fibromyalgia Symptoms, Serotonin, and Substance P Levels: A Randomized Sham and Placebo-Controlled Clinical Trial. Pain Med, 2018, 19(3): 615-628

[27] WangY, TangQ, ZhuL, et al.. Effects of Treatment of Treadmill Combined with Electro-Acupuncture on Tibia Bone Mass and Substance P Expression of Rabbits with Sciatic Nerve Injury. PLoS One, 2016, 11(11): e0164652

[28] JoungJY, LeeNH, SonCG. An Evolutionary Theory to Explain the Mechanism of Pain Control by Acupuncture Therapy. J Altern Complement Med, 2018, 24(7): 743-744

[29] SunR, YangY, LiZ, et al.. Connectomics: a new direction in research to understand the mechanism of acupuncture. Evid Based Complement Alternat Med, 2014, 2014: 568429