Efficacy and safety of different acupuncture-related therapies for primary trigeminal neuralgia: a systematic review and network meta-analysis
In brief
Bloodletting therapy doubles response rate for primary trigeminal neuralgia
In a network meta-analysis of 58 trials, bloodletting achieved roughly twice the total effective rate compared with control and modestly lowered pain scores, while acupuncture added to conventional medicine cut attack frequency and adverse-event risk. Evidence certainty was low to moderate and heterogeneity high, so larger rigorous trials are needed.
- Journal
- Frontiers in pain research (Lausanne, Switzerland) (Q1)
- Published
- 14 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Guanxi Ren, Yinsu Chen, Xinyu Zhang, Yaqing Guo, Weijia Peng, Kunping Jia, et al.
- PMID
- 42524199
- DOI
- 10.3389/fpain.2026.1854738
Why clinicians should know about it
- Picked for Complementary and Alternative Medicine (top studies of the week, 2 August 2026): Network meta-analysis of acupuncture for trigeminal neuralgia
Abstract
BACKGROUND: Primary trigeminal neuralgia (PTN) is a debilitating neuropathic pain disorder with limited long-term treatment options. Although acupuncture is widely used, the comparative effectiveness of different acupuncture modalities remains unclear. OBJECTIVE: To compare the efficacy and safety of various acupuncture therapies for PTN using a network meta-analysis (NMA). METHODS: Randomized controlled trials were identified through a systematic search of seven databases from database inception to 2 March 2026. Outcomes included total effective rate (TER), visual analogue scale (VAS), attack frequency (AF), traditional Chinese medicine syndrome score (TCMSS), and adverse events (AEs). A network meta-analysis was conducted, and treatments were ranked using SUCRA. RESULTS: This network meta-analysis included 58 randomized controlled trials. The results showed that bloodletting therapy was identified as a potentially effective intervention for improving TER (RR = 2.00, 95% CI: 1.15-3.47; SUCRA = 95.6%; CINeMA: low certainty) and reducing VAS scores (MD = 0.07, 95% CI: 0.01-0.61; SUCRA = 87.4%; CINeMA: very low certainty). In contrast, acupuncture combined with conventional Western medicine performed better in reducing AF (MD = 0.05, 95% CI: 0.02-0.14; SUCRA = 100%; CINeMA: very low certainty), improving TCMSS (SMD = 0.15, 95% CI: 0.07-0.34; SUCRA = 90.7%; CINeMA: very low certainty), and decreasing the risk of AEs (OR=0.18, 95% CI: 0.12-0.28; SUCRA = 73.8%; CINeMA: moderate certainty). CONCLUSIONS: Different acupuncture modalities may offer distinct therapeutic benefits for PTN. Bloodletting therapy showed potential advantages in improving TER and reducing VAS, whereas acupuncture combined with conventional Western medicine appeared to perform better in reducing AF, improving TCMSS, and lowering the risk of AEs. However, these findings should be interpreted cautiously because of moderate-to-high heterogeneity across some outcomes and the generally low certainty of the evidence. Further large-scale, multicenter, high-quality randomized controlled trials are warranted to confirm these findings. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, PROSPERO (CRD420261339021).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.