EFFECTS OF ACUPUNCTURE AND ELECTROACUPUNCTURE FOR TRIGEMINAL NEURALGIA AND ATYPICAL TRIGEMINAL NEURALGIA CARE, IN NON-RESPONDERS TO PHARMACOLOGICAL THERAPY

Trigeminal neuralgia (TN, or TGN), is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve. The Atypical Trigeminal Neuralgia (ATN), or Type 2 Trigeminal Neuralgia, is a rare form of Trigeminal neuralgia, a disorder of the fifth cranial nerve. This form of neuralgia is difficult to diagnose, as it is rare and the symptoms overlap with several other disorders (1). The symptoms can occur in addition to having migraine headache, or can be mistaken for migraine alone, or dental problems such as Temporomandibular joint disorder, musculoskeletal issues, or Hypochondriasis. ATN can have a wide range of symptoms and the pain can fluctuate in intensity from mild aching to a crushing or burning sensation, and also to the extreme pain experienced with the more common trigeminal neuralgia. The forms of facial neuralgia are relatively rare, with an incidence recently estimated between 12 and 24 new cases per hundred thousand population per year (2,3). ATN pain can be described as heavy, aching, stabbing and burning. Some sufferers have a constant migraine-like headache. Others may experience intense pain in one or in all three trigeminal nerve branches, including teeth, ears, sinuses, cheeks, forehead, upper and lower jaws, "behind" the eyes, and scalp. In addition, those with ATN may also experience the shocks or stabs found in type 1 TN. Many TN and ATN patients have pain that is "triggered" by light touch on shifting trigger zones. ATN pain tends to worsen with talking, smiling, chewing, or in response to sensations such as a cool breeze. The pain from ATN is often continuous, and periods of remission are rare. Both TN and ATN can be bilateral, though the character of pain is usually different on the two sides at any one time (4). Acupuncture and electroacupuncture are widely used in medicine and dentistry pain relief. Thus, a systematic review was conducted to assess the effects of acupuncture and electroacupuncture for atypical trigeminal neuralgia, to consider a different approach in patients non-responders to the pharmacological therapy. This review and the results from the studies on acupuncture and electroacupuncture, demonstrated the effectiveness that acupuncture and electroacupuncture may be beneficial to reduce symptomatic TN and ATN pain in patients. However, the poor quality of some clinical studies and the multiplicity of evaluation outcomes, limit the level of evidence. It is therefore, necessary to conduct further clinical studies to confirm the effects of acupuncture and electroacupuncture for the treatment of typical and atypical trigeminal neuralgia.