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Li R, Sun J, Luo K, Luo N, Sun R, Gao F, Wang Y, Xia Y, Li X, Chen L, Ma R, Shao X, Liang Y, Fang J. Electroacupuncture and carbamazepine for patients with trigeminal neuralgia: a randomized, controlled, 2 × 2 factorial trial. J Neurol 2024:10.1007/s00415-024-12433-x. [PMID: 38816482 DOI: 10.1007/s00415-024-12433-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/04/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Trigeminal neuralgia (TN) is difficult to treat due to its severe pain intensity and recurring episodes, which significantly impact quality of life. OBJECTIVES We aimed to assess the effectiveness of electroacupuncture (EA) in alleviating the pain intensity in TN, and to determine whether EA combined with low-dosage carbamazepine (CBZ) has a synergistic effect. METHODS A multi-centre, randomized, 2 × 2 factorial trial was conducted. Participants who met the inclusion criteria received active EA or sham EA for 60 min, three times a week for four weeks; CBZ (300 mg per day) or placebo for four weeks. The primary outcome was the change in visual analog scale (VAS) score from baseline to weeks 2, 4, 16, and 28. Secondary outcomes included quality of life and adverse events. RESULTS A total of 120 participants (75 females and 45 males; mean (SD) age, 58.5 (15.3) years) were included. The main effects of EA and CBZ were significant (P < 0.001), and there was a significant interaction was identified between the interventions (P = 0.041). Participants who received EA (mean difference [MD], -0.3 [95% CI, -0.40 to -0.20] at week 2; -1.6 [-1.70 to -1.50] at week 4; -1.1 [-1.31 to -0.89] at week 16; -0.8 [-1.01 to -0.59] at week 28), CBZ (MD, -0.6 [95% CI, -0.70 to -0.50] at week 2; -0.9 [-1.03 to -0.77] at week 4, -0.2 [-0.41 to 0.01] at week 16, 0.2 [-0.01 to 0.41] at week 28), and the combination of both (MD, -1.8 [95% CI, -1.90 to -1.70] at week 2; -3.7 [-3.83 to -3.57] at week 4, -3.4 [-3.61 to -3.19] at week 16, -2.9 [-3.11 to -2.69] at week 28) had a greater reduction in VAS score over the treatment phase than their respective control groups (sham EA, placebo, and sham EA plus placebo). EA-related adverse events (6/59, 10.17%) were lower than that of CBZ (15/59, 25.42%) during the whole phases. CONCLUSIONS EA or CBZ alone are effective treatments for TN, while the combination of EA and low-dosage CBZ exerts a greater benefit. These findings in this trial demonstrate that the combination of EA and low-dosage CBZ may be clinically effective under certain circumstances. TRIAL REGISTRATION NCT03580317.
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Affiliation(s)
- Rongrong Li
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jing Sun
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Kaitao Luo
- Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Ning Luo
- The Third Clinical Medical College of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China
| | - Ruohan Sun
- The Third Clinical Medical College of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China
| | - Feng Gao
- Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Yiyi Wang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China
| | - Yunfan Xia
- The Third Clinical Medical College of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China
| | - Xiaoyu Li
- The Third Clinical Medical College of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China
| | - Lifang Chen
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Ruijie Ma
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaomei Shao
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, 219 Moganshan Road, Hangzhou, Zhejiang, China
| | - Yi Liang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, Zhejiang, China.
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, 219 Moganshan Road, Hangzhou, Zhejiang, China.
| | - Jianqiao Fang
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, 219 Moganshan Road, Hangzhou, Zhejiang, China.
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