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Acupuncture Modalities Show Distinct Benefits for Trigeminal NeuralgiaNew analysis shows acupuncture and bloodletting help trigeminal neuralgia
Frontiers in MedicinePublished July 15, 2026Study authors: Guanxi Ren, Yinsu Chen, Xinyu Zhang, Yaqing Guo, Weijia Peng, Kunping Jia, Jiawen Li, Yulong Shan, X…DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Bloodletting therapy improves response and pain; acupuncture plus conventional Western medicine reduces attack frequency and adverse events in trigeminal neuralgia.
A network meta-analysis of 58 randomized controlled trials evaluated the comparative effectiveness of various acupuncture modalities for primary trigeminal neuralgia (PTN). The study assessed outcomes including total effective rate (TER), visual analogue scale (VAS), attack frequency (AF), traditional Chinese medicine syndrome score (TCMSS), and adverse events (AEs).
Bloodletting therapy emerged as potentially effective for improving TER (RR = 2.00, 95% CI: 1.15–3.47) and reducing VAS scores (MD = 0.07, 95% CI: 0.01–0.61). In contrast, acupuncture combined with conventional Western medicine demonstrated superior performance in reducing AF (MD = 0.05, 95% CI: 0.02–0.14) and improving TCMSS (SMD = 0.15, 95% CI: 0.07–0.34).
Notably, the combination therapy also significantly decreased the risk of AEs compared to other interventions (OR = 0.18, 95% CI: 0.12–0.28). However, the certainty of evidence was generally low due to moderate-to-high heterogeneity across outcomes, except for AEs which had moderate certainty.
These findings suggest that different acupuncture modalities may offer distinct therapeutic benefits for PTN. Bloodletting therapy may be preferred for improving response rates and pain relief, while combining acupuncture with conventional Western medicine appears better for reducing attack frequency, symptom scores, and adverse events. Clinicians should consider these differential effects when selecting treatment approaches.
How this fits prior evidence
This network meta-analysis addresses a gap in understanding specific acupuncture modalities for trigeminal neuralgia. While prior evidence established a 30.2% success rate for MVD in TN-MS patients and identified percutaneous balloon compression as an option for MS-related cases, this study provides new data on non-surgical interventions. Specifically, it highlights that bloodletting may improve total effective rates while combined acupuncture therapy offers better outcomes for attack frequency and safety compared to other modalities.
Living with trigeminal neuralgia means dealing with intense, often debilitating facial pain. While many treatments exist, finding the right combination to manage daily attacks and overall discomfort is a constant challenge for patients.
A large-scale analysis of 58 different trials looked at various acupuncture methods. The findings suggest that bloodletting therapy may be effective in improving total success rates and lowering pain scores on visual scales. Meanwhile, combining acupuncture with standard Western medicine showed better results in reducing the frequency of pain attacks and improving overall syndrome scores.
Safety is also a key factor in choosing treatment. The data indicates that combining acupuncture with conventional medicine significantly lowers the risk of adverse events compared to other methods. While the evidence for some specific outcomes remains uncertain due to variations in how studies were conducted, these findings offer new insights into how different acupuncture styles can provide unique benefits for managing this chronic condition.
What this means for you:
Combining acupuncture with Western medicine may reduce pain frequency and improve safety for trigeminal neuralgia.
Common questions
Is acupuncture safe for trigeminal neuralgia?
Combining acupuncture with conventional Western medicine was shown to have a lower risk of adverse events compared to other methods. While the evidence is of moderate certainty regarding safety, this combination may offer a more manageable experience for patients seeking relief from facial pain.
How does bloodletting help with nerve pain?
In this analysis of 58 trials, bloodletting therapy was identified as potentially effective for improving total success rates and reducing scores on the visual analogue scale. These results suggest it may help manage the intensity of trigeminal neuralgia symptoms.
Is acupuncture better than standard medicine alone?
The study found that combining acupuncture with conventional Western medicine performed better at reducing the frequency of pain attacks and improving overall syndrome scores compared to other modalities. You should discuss these specific combinations with your doctor.
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.
To compare the efficacy and safety of various acupuncture therapies for PTN using a network meta-analysis (NMA).
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.
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).
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.
https://www.crd.york.ac.uk/prospero/, PROSPERO (CRD420261339021).
