Acupuncture for Trigeminal Neuralgia
Trigeminal Neuralgia (TN) is a condition in which sudden pain is felt on part of the face, usually around the cheek or mouth. This may be sharp and perhaps like an electric shock; this usually subsides within a matter of minutes, but there may be a residual dull ache or tenderness afterwards. These attacks may come frequently or only occasionally. Sometimes attacks may be triggered by activities such as eating or talking, or by touching the face; sometimes even a draught of air across the face can be enough to trigger the pain.
TN usually affects people in their 60’s and 70’s, and is more common in women than men. It is caused by the trigeminal nerve, a nerve which is involved in transmitting sensations of touch and pain from the face and in chewing and producing saliva and tears; in most cases a blood vessel is thought to irritate the nerve by pressing on it where it emerges from the skull. Conventional medical treatment often uses a drug caused carbamazepine to treat TN, but symptoms will usually recur if the drug is stopped, and some people find it works less well as time goes on. The drug also can cause some unpleasant side effects. Surgery is also a possibility.
TN and TCM
Pain in TCM is always due to an impairment in the free flow of Qi in the area concerned, in this case the face. So treatment first of all aims to restore this free flow through the face. Acupuncture, which is well known for its ability to relieve pain in a wide range of conditions, is well suited to this task. However, it is also necessary to establish why the Qi is getting stuck in this area. In some cases this will be due to a weakness in the ‘defensive Qi’; this is a form of Qi which circulates through the skin and muscles, forming a barrier between the individual and the world around them. If the defensive Qi is weak, the individual becomes overly susceptible to external influences such as wind or cold air, which penetrate into the skin of the face and cause the Qi to stop flowing. Defensive Qi declines in old age, which is partly why TN tends to affect older people; despite this, it can be strengthened by acupuncture, perhaps supported by herbal therapy, appropriate exercise and dietary choices individualised to the patient. In other cases, TN may be related to Qi rushing upwards uncontrollably. Normally, there is a dynamic balance between this upward movement, related to warmth, activity and stimulation (what the Chinese term ‘Yang’) and the stabilising, grounding and cooling energy (‘Yin’). Yin can tend to be depleted by the ageing process, especially in a person who has perhaps ignored the need to balance activity with relaxation and reflection. In this case, acupuncture will be needed to subdue this uprising Qi and herbal and dietary therapy will help to restore the Yin.
As with all other diseases, no two TN cases are exactly the same, and so TCM treatment is individualised to the precise set of symptoms of each particular patient. Sometimes TN is associated with different pathologies than those described above; we always start with a detailed consultation which enables us to understand in detail why a particular person suffers in the way they do, and then treat them on this basis.
Does it Work?
A small scale study (1) of ten patients with TN concluded that acupuncture is a useful therapeutic option in the treatment of TN; five of the patients were restored to a pain-free state, whilst the degree of pain in the other five was reduced. A larger retrospective study (2) of 201 patients with various kinds of facial pain treated at a hospital in Scotland concluded that acupuncture had a significant role to play in the treatment of TN; whilst it did not always eradicate the pain, it reduced it, enabling a reduction in carbamazepine dosage.
1 Beppu S et al (1992) Practical Application of Meridian Acupuncture Treatment for
Trigeminal Neuralgia Anesthesia and Pain Control in Dentistry 1(2): 103-8
2 Merchant N (1995) Facial Pain: A Review of 200 Cases Treated with Acupuncture
Acupuncture in Medicine XIII 2: 67-70