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Complementary Therapies in Clinical... Aug 2023Few systematic reviews have examined the effects of acupuncture on trigeminal neuralgia. This review aims to provide up-to-date evidence on the efficacy of acupuncture... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND PURPOSE
Few systematic reviews have examined the effects of acupuncture on trigeminal neuralgia. This review aims to provide up-to-date evidence on the efficacy of acupuncture for managing pain in patients with trigeminal neuralgia.
METHODS
Eleven databases were searched from inception until November 2022 for relevant articles Two researchers independently conducted study selection, data extraction, and evaluation. The present review solely targeted randomized controlled trials (RCTs). The Cochrane risk of bias assessment tool 2.0 was employed to assess the risk of bias. Data were compiled using RevMan 5.4.1 software, and the quality of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
RESULTS
Thirty studies involving 2295 patients were included in this review. Compared with carbamazepine, acupuncture led to improvements in pain scores (15 RCTs, mean difference (MD) - 1.40, 95% confidence interval (CI)-1.82 to -0.98 [95% prediction interval, -3.137,0.343], p < 0.00001, low certainty of evidence (CoE)), response rates (29 RCTs, risk ratio (RR) 1.20, 95% CI 1.15 to 1.25 [95% prediction interval, 1.067, 1.346], p < 0.00001, low CoE), frequency of pain attacks (2 RCTs, MD -2.53, 95% CI -4.11 to -0.96, P = 0.002, low CoE), and adverse effects (13 RCTs, risk difference (RD) -0.15, 95% CI -0.19 to -0.11 [95% prediction interval, -0.193, -0.108], P < 0.00001, very low CoE).
CONCLUSION
Although the quality of evidence is low, compared with carbamazepine, acupuncture may improve trigeminal neuralgia-related pain. Further rigorously designed studies are warranted to confirm the effects of acupuncture on patients with trigeminal neuralgia.
Topics: Humans; Trigeminal Neuralgia; Acupuncture Therapy; Carbamazepine; Pain Management; Pain
PubMed: 37159979
DOI: 10.1016/j.ctcp.2023.101763 -
Molecular Pain 2021Trigeminal neuralgia (TN) is a severe facial pain disease of unknown cause and unclear genetic background. To examine the existing knowledge about genetics in TN, we...
Trigeminal neuralgia (TN) is a severe facial pain disease of unknown cause and unclear genetic background. To examine the existing knowledge about genetics in TN, we performed a systematic study asking about the prevalence of familial trigeminal neuralgia, and which genes that have been identified in human TN studies and in animal models of trigeminal pain. MedLine, Embase, Cochrane Library and Web of Science were searched from inception to January 2021. 71 studies were included in the systematic review. Currently, few studies provide information about the prevalence of familial TN; the available evidence indicates that about 1-2% of TN cases have the familial form. The available human studies propose the following genes to be possible contributors to development of TN: CACNA1A, CACNA1H, CACNA1F, KCNK1, TRAK1, SCN9A, SCN8A, SCN3A, SCN10A, SCN5A, NTRK1, GABRG1, MPZ gene, MAOA gene and SLC6A4. Their role in familial TN still needs to be addressed. The experimental animal studies suggest an emerging role of genetics in trigeminal pain, though the animal models may be more relevant for trigeminal neuropathic pain than TN per se. In summary, this systematic review suggests a more important role of genetic factors in TN pathogenesis than previously assumed.
Topics: Animals; Facial Pain; Humans; NAV1.7 Voltage-Gated Sodium Channel; Serotonin Plasma Membrane Transport Proteins; Trigeminal Neuralgia
PubMed: 34000891
DOI: 10.1177/17448069211016139 -
Pain Physician Dec 2022Conventional radiofrequency (CRF), pulsed radiofrequency (PRF), and pulsed com-bined conventional radiofrequency (PCRF) are widely used in the clinical treatment of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Conventional radiofrequency (CRF), pulsed radiofrequency (PRF), and pulsed com-bined conventional radiofrequency (PCRF) are widely used in the clinical treatment of trigeminal neuralgia (TN), collective evidence comparing the efficacy and safety of these radiofrequency therapies is still controversial.
OBJECTIVES
To provide additional evidence for the efficacy and safety of different radiofrequency therapies in the management of TN to update this section of the systematic review of Wu et al 2019.
STUDY DESIGN
A secondary systematic review and meta-analysis was conducted.
METHODS
Systematic database research about double-blind, randomized controlled trials (RCTs) was conducted based on PubMed, Embase, and Web of Science. Literature on TN in adults under different radiofrequency therapies was collected to evaluate pain scores, excellent pain relief, and occurrence of adverse effects after corresponding therapies.
RESULTS
A total of 11 studies, including 570 patients, were involved in our systematic review. Two studies from the same research team and one study with a completely different pain assessment tool were excluded from the meta-analysis. Ultimately, 8 studies, including 412 samples, were included in the quantitative synthesis. In secondary analyses, as with the report of Wu and colleagues, we also observed a safer outcome in PRF than CRF when regarding the occurrence of adverse effects. Nevertheless, unlike the last meta-analysis, despite no statistical difference in pain scores between CRF and PRF one week after surgery, a positive impact was observed in the CRF group one month and 3 months after surgery. A meta-analysis of 6 studies comparing PCRF and CRF was conducted and revealed no evidence to prove excellent pain relief of PCRF and CRF groups at 6 months, one year, and 2 years after surgery. However, a positive influence in reducing pain scores was observed in the PCRF group. Subgroup analysis further exhibited that PCRF positively affected TN when the temperature was lower than 70°C.
LIMITATIONS
(1) A small overall sample of included trials; (2) the diversity of tools used for pain assessment across trials, such as VAS, BNI, and NRS, limits the evaluation of outcomes; (3) a high risk exists for most studies in the meta-analysis for at least one domain, which may affect the reliability of results; (4) the short follow-up period of a few studies in the meta-analysis while the long-term efficacy of different radiofrequency treatments may require longer follow-up data to enhance the accuracy of the assessment.
CONCLUSIONS
PCRF provides better long-term efficacy and fewer adverse effects for treating TN. Yet, it is hard to draw definitive conclusions about excellent pain relief comparisons due to the moderate quality of evidence, high heterogeneity, and scarcity of available data.
Topics: Adult; Humans; Trigeminal Neuralgia; Pulsed Radiofrequency Treatment; Radiofrequency Therapy; Pain Management; Pain; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 36608005
DOI: No ID Found -
BMJ Clinical Evidence Oct 2014Trigeminal neuralgia is a sudden, unilateral, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve. Pain occurs in... (Review)
Review
INTRODUCTION
Trigeminal neuralgia is a sudden, unilateral, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve. Pain occurs in paroxysms, which can last from a few seconds to several minutes. The frequency of the paroxysms ranges from a few to hundreds of attacks a day. Periods of remission can last for months to years, but tend to shorten over time. The condition can impair activities of daily living and lead to depression.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of ongoing treatments in people with trigeminal neuralgia? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found seven studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: baclofen; carbamazepine; gabapentin; lamotrigine; oxcarbazepine; microvascular decompression; and destructive neurosurgical techniques (radiofrequency thermocoagulation, glycerol rhizolysis, balloon compression, and stereotactic radiosurgery).
Topics: Anticonvulsants; Humans; Neurosurgery; Trigeminal Neuralgia
PubMed: 25299564
DOI: No ID Found -
Neurology India 2022The culprit of trigeminal neuralgia (TGN) may occur at any point between the nerve's root entry zone (REZ) and Meckel's cave. Meckel's cave meningoencephaloceles are... (Review)
Review
BACKGROUND
The culprit of trigeminal neuralgia (TGN) may occur at any point between the nerve's root entry zone (REZ) and Meckel's cave. Meckel's cave meningoencephaloceles are rare middle cranial fossa defects that usually remain asymptomatic but may contain prolapsed trigeminal nerve rootlets and result in TGN. Their management and surgical outcomes remain poorly understood.
OBJECTIVES
To perform a systematic review of clinical presentation and surgical outcomes of middle fossa defects presenting with trigeminal nerve-related symptoms.
MATERIALS AND METHODS
A systematic review was conducted in accordance with the PRISMA guidelines for all reports of middle cranial fossa defects causing trigeminal nerve-related symptoms. The pathophysiology, presentation, surgical management, and outcomes are discussed and illustrated with a case.
RESULTS
Initial search from inception to March 2021 identified 33 articles for screening. After applying inclusion and exclusion criteria, 6 articles were included representing a total of 8 cases in addition to our case (n = 9). All 9 patients were females and 33.3% (n = 3) presented with classic trigeminal neuralgia. "Empty sella" syndrome and radiologic signs of intracranial hypertension were present in 40%-62%. No patient presented with cerebrospinal fluid leak. The preferred treatment modality was surgical with subtemporal extradural repairs using combinations of autologous fat and muscle grafts and synthetic dura. Postoperative outcomes were only available in 55.5% (n = 5) of the cases, and nearly all reported complete symptom resolution, except for one case in which the meningoencephalocele wall was incised, along with trigeminal rootlets adhered to it. Our patient had immediate and durable symptom relief after a 4-year follow-up.
CONCLUSIONS
MEC containing prolapsed trigeminal nerve rootlets can cause typical trigeminal neuralgia from chronic pulsatile stress. This supports the hypothesis that the compressive or demyelinating culprit can locate more ventrally on the course of the trigeminal nerve. Subtemporal extradural surgical repairs can be safe, effective, and durable. Incising the MEC wall should be avoided as it may have trigeminal rootlets adhered to it.
Topics: Cranial Fossa, Middle; Dura Mater; Encephalocele; Female; Humans; Male; Meningocele; Trigeminal Nerve; Trigeminal Neuralgia
PubMed: 35864609
DOI: 10.4103/0028-3886.349629 -
World Neurosurgery: X Apr 2020Trigeminal neuralgia (TN) is a painful disorder characterized by sudden electric shock-like pain. It is a rare condition for which multiple treatments are available,... (Review)
Review
BACKGROUND
Trigeminal neuralgia (TN) is a painful disorder characterized by sudden electric shock-like pain. It is a rare condition for which multiple treatments are available, including medical and surgical. The best treatment option is yet to be defined, and this is related to the lack of definition in the treatment outcomes and outcome measures. The aim of this systematic review was to summarize all the outcomes and outcomes measures that have been published to date and highlight variability in their use.
METHODS
We have conducted a literature search using a wide range of databases (1946-2019 for medical and 2008-2019 for surgical treatment), for all intervention studies in TN. Four hundred and sixty-seven studies were selected for data extraction on TN classification, data collection method, intervention, and treatment outcomes mapped to the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT guidelines).
RESULTS
Most studies collected data on pain ( = 459) and side effects ( = 386) domains; however, very few collected data on the impact of treatment on physical ( = 46) and emotional functioning ( = 17) and on patient satisfaction ( = 35). There was high variability on outcome measures used for pain relief ( = 10), pain intensity ( = 9), and frequency of pain episodes ( = 3).
CONCLUSIONS
A clear definition of what are the important outcomes for patients with TN is essential. The choice of standardized outcome measures allowing for consistent reporting in TN treatment will allow for comparison of studies and facilitate treatment choice for patients and clinicians thus, improving health outcomes and reducing health care cost.
PubMed: 32123867
DOI: 10.1016/j.wnsx.2020.100070 -
Evidence-based Complementary and... 2022Primary trigeminal neuralgia (PTN) is a clinical refractory disorder characterized by excruciating pain that severely impacts the quality of life. Several studies have... (Review)
Review
BACKGROUND
Primary trigeminal neuralgia (PTN) is a clinical refractory disorder characterized by excruciating pain that severely impacts the quality of life. Several studies have shown that acupuncture can improve PTN pain. However, the comparative efficacy and safety of acupuncture are unknown. Herein, a systematic review was conducted to compare the efficacy and safety of various acupuncture methods for PTN treatment.
METHODS
Relevant randomized controlled trials (RCTs) published up to 1 August 2021 were obtained from PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, CQVIP Database, Wanfang Database, Allied and Alternative Medicine Database, and related registration platforms. Two authors independently selected the studies and obtained data. Cochrane Handbook was used to assess the methodological quality. We put the pain relief as the primary outcome and the response rate and adverse events as the secondary outcomes. Review Manager v5.3, ADDIS v1.16.8, and STATA v15.0 software were used for data analysis. The intraclass correlation coefficient was used to assess the consistency of the two investigators.
RESULTS
A total of 58 RCTs with 4,126 participants were obtained. The meta-analysis indicated that five acupuncture methods were superior to conventional medicine (carbamazepine) in pain reduction intensity and response rate. Meanwhile, electronic acupuncture plus manual acupuncture was the most effective therapy since it reduced pain intensity in 11 methods and improved the response rate in 10 interventions. Moreover, six interventions had acceptable adverse events, and none of the included studies reported severe adverse events. However, most pieces of evidence were ranked as critically low.
CONCLUSION
These findings show that acupuncture methods can be effective and safe for PTN. Moreover, electronic acupuncture plus manual acupuncture maybe the best acupuncture treatment for PTN and should be administered to PTN patients. However, additional well-designed and high-quality RCTs should be conducted to verify the above findings in the future. The systematic review is registered with CRD42020221456.
PubMed: 35237333
DOI: 10.1155/2022/3178154 -
BMJ Clinical Evidence Mar 2009Trigeminal neuralgia is a sudden, unilateral, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve. Pain occurs in... (Review)
Review
INTRODUCTION
Trigeminal neuralgia is a sudden, unilateral, brief, stabbing, recurrent pain in the distribution of one or more branches of the fifth cranial nerve. Pain occurs in paroxysms which last from a few seconds to 2 minutes. The frequency of the paroxysms ranges from a few to hundreds of attacks a day. Periods of remission can last for months to years, but tend to shorten over time.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments in people with trigeminal neuralgia? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 14 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: ablative neurosurgical techniques to the Gasserian ganglion, baclofen, carbamazepine, clonazepam, cryotherapy of peripheral nerves, gabapentin, lamotrigine, microvascular decompression, nerve block, oxcarbazepine, peripheral acupuncture, phenytoin, proparacaine eye drops, sodium valproate, stereotactic radiosurgery, tizanidine, and topiramate.
Topics: Humans; Ophthalmic Solutions; Pain; Pain Measurement; Phenytoin; Radiosurgery; Trigeminal Ganglion; Trigeminal Neuralgia
PubMed: 19445753
DOI: No ID Found -
Biomedicines Sep 2023This umbrella review aimed to determine the various drugs used to treat trigeminal neuralgia (TN) and to evaluate their efficacies as well as side effects by surveying... (Review)
Review
This umbrella review aimed to determine the various drugs used to treat trigeminal neuralgia (TN) and to evaluate their efficacies as well as side effects by surveying previously published reviews. An online search was conducted using PubMed, CRD, EBSCO, Web of Science, Scopus, and the Cochrane Library with no limits on publication date or patients' gender, age, and ethnicity. Reviews and meta-analyses of randomized controlled trials pertaining to drug therapy for TN, and other relevant review articles added from their reference lists, were evaluated. Rapid reviews, reviews published in languages other than English, and reviews of laboratory studies, case reports, and series were excluded. A total of 588 articles were initially collected; 127 full-text articles were evaluated after removing the duplicates and screening the titles and abstracts, and 11 articles were finally included in this study. Except for carbamazepine, most of the drugs had been inadequately studied. Carbamazepine and oxcarbazepine continue to be the first choice for medication for classical TN. Lamotrigine and baclofen can be regarded as second-line drugs to treat patients not responding to first-line medication or for patients having intolerable side effects from carbamazepine. Drug combinations using carbamazepine, baclofen, gabapentin, ropivacaine, tizanidine, and pimozide can yield satisfactory results and improve the tolerance to the treatment. Intravenous lidocaine can be used to treat acute exaggerations and botulinum toxin-A can be used in refractory cases. Proparacaine, dextromethorphan, and tocainide were reported to be inappropriate for treating TN. Anticonvulsants are successful in managing trigeminal neuralgia; nevertheless, there have been few studies with high levels of proof, making it challenging to compare or even combine their results in a statistically useful way. New research on other drugs, combination therapies, and newer formulations, such as vixotrigine, is awaited. There is conclusive evidence for the efficacy of pharmacological drugs in the treatment of TN.
PubMed: 37892981
DOI: 10.3390/biomedicines11102606