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Wien Med Wochenschr. 1998 ; 148(19): 447-9.

[Acupuncture and ganglionic local opioid analgesia in trigeminal neuralgia]

Spacek A, Hanl G, Groiss O, Koinig H, Kress HG.

Abteilung für Allgemeine Anästhesie und Intensivmedizin B, Universitätsklinik für Anästhesie und Allgemeine Intensivmedizin, Wien.

Trigeminal neuralgia (TN) is defined as a chronic, severe, electrifying and burning pain in one side of the face. The attacks are initiated by tactile irritations in a so-called trigger area of the trigeminal nerve and are perceived within the borders of this nerve's innervation. TN is a chronic condition which initially goes into spontaneous remission but these become fewer as the condition progresses. TN is classified as symptomatic when the etiology is known and as idiopathic when the etiology is unknown. There are various forms of treatment: drugs such as anticonvulsants, local ganglionic opioid analgesia (GLOA) at the superior cervical ganglion or sphenopalatine ganglion, percutaneous intervention at the trigeminal ganglion as well as neurosurgery. None of these various procedures has been found to be the most suited and best method. A retrospective analysis of the data of 39 patients who had sought treatment for TN at our pain and acupuncture outpatients' department from 1993 to 1994 was undertaken. Group A (n = 17) had received carbamazepine and acupuncture therapy, group B (n = 11) carbamazepine and GLOA + acupuncture, whereas group C (n = 11) had received carbamazepine and GLOA without acupuncture. All subjects had taken carbamazepine for at least 4 weeks and their plasma levels were within the therapeutic range. Acupuncture therapy was carried out once a week and the number recorded. GLOA was carried out with 0.045 mg buprenorphine at the superior cervical ganglion or the sphenopalatine ganglion as a series of at least 5 injections. The number of attacks of pain and the degree of pain (visual analogue scale [VAS]) were documented. The reduction in pain was categorized in 4 groups: I = pain free, II = reduction of at least 50% on the VAS, III = reduction of less than 50% on the VAS, and IV = no improvement. The statistical analysis was carried out using the chi 2-text, p < 0.05 was considered as significant. Of the groups who received acupuncture as an additive, 8 of the 17 subjects of group A, and 5 of the 11 subjects of group B were pain free, but only 2 of the 11 subjects of group C (no acupuncture). The results of the patients with marked pain reduction (category II) were similar. The most patients with no improvement were from the group which did not receive acupuncture (C). The statistical analysis showed significant differences in the categories I, II, and IV between groups A and C. These results show that the combined use of acupuncture and carbamazepine with/without GLOA achieves an additional therapeutic effect in the treatment of trigeminal neuralgia. The addition of acupuncture seems to have a superior effect to the addition of GLOA. These results support the use of acupuncture as an additional form of therapy for the treatment of trigeminal neuralgia.

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