Acupuncture in the Management of Trigeminal Neuralgia

Description

ABSTRACT

Aims To assess the standing of acupuncture as a clinical tool in the management of trigeminal neuralgia against the current first-line drug and the most effective surgery.

Methods Data regarding efficacy, side-effects, and cost were compiled for each of the three modalities from the PubMed and Cochrane Library databases. Patient stress was estimated according to Holmes and Rahe’s Social Readjustment Rating Scale (SRRS).

Results Acupuncture is not significantly more effective than its corresponding control (p=0.088), but has the greatest mean efficacy of the modalities considered (acupuncture 86.5% ±5.6% (95% confidence interval), surgery 79.3% ±7.7%, pharmacotherapy 71.7% ±2.5%). Acupuncture also had fewer mean reported side-effects (acupuncture 22.7% ±5.9%, surgery 25.3% ±12.6%, pharmacotherapy 88.8% ±25.0%) and lowest cost: after 5 years acupuncture cost £750, carbamazepine £1507.73 and microvascular decompression £4878.42. Acupuncture was the least stressful according to the SRRS (53 points), surgery the next most stressful (153 points) and pharmacotherapy was the most stressful intervention to patients (217 points).

Conclusion Acupuncture appears more effective than pharmacotherapy or surgery. Statistical analysis of side-effects was not possible due to inconsistent reporting protocols, but the data indicate acupuncture is considerably safer than pharmacotherapy or surgery. Acupuncture is also the least expensive therapeutic modality to deliver long-term (67 weeks onwards), and our analysis indicates that it is less stressful to patients than pharmacotherapy or surgery. Further study into these areas and the practicality of its availability on the NHS is recommended.