Treatment-Resistant Trigeminal Neuralgia: Case Reports

Background: Trigeminal neuralgia is a painful neuropathic condition that is often resistant to conventional treatments. Case reports suggest that stimulation of acupuncture points may offer an alternative approach to treatment. Objective: To present 2 cases of treatment-resistant trigeminal neuralgia that responded dramatically to acupuncture therapy based on neuroanatomical point selection. Design, Setting, and Patients: Two patients (1 woman and 1 man, both in their 60s) with trigeminal neuralgia refractory to pharmacotherapy and surgery, treated with acupuncture in a private practice setting. Interventions: In case 1, manual acupuncture needling of BL 2, LI 20, GB 20, and Shenmen in the antihelix of the ear. The needles were inserted using a plastic guide tube and were left in place 10-15 minutes. In case 2, low-level laser therapy was applied directly over the same set of acupuncture points as described in case 1. The laser irradiation to each point was approximately 2 minutes. Main Outcome Measure: A symptoms score based on visual analog scale (VAS) rating (0-90), frequency of symptoms (1-4), and patients’ subjective level of discomfort (1-4). Results: The first patient’s pretreatment VAS scores were 85 for shooting pains and 65 for background pain. At 2 months’ follow-up, her symptom scores were 0 for shooting pain and 15 for background pain. The second patient’s pretreatment VAS scores were 80 for shooting pains and 75 for background pain. His posttreatment scores were 15 for shooting pains and 15 for background pain. This reduction in symptoms enabled the patient to eliminate his reliance on medications. Conclusions: This paper describes 2 cases of treatment-resistant trigeminal neuralgia that achieved substantial relief of signs and symptoms following acupuncture therapy. If the results of these cases can be reproduced in controlled investigations, acupuncture may play a more prominent role in the treatment of patients with trigeminal neuralgia.