Network Meta-analysis On The Efficacy And Safety Of The Acupuncture Associated Treatments For Trigeminal Neuralgia

Objective:To evaluate the effectiveness and safety of acupuncture associated treatments in the treatment of trigeminal neuralgia by using the method of network meta-analysis,and to sort out the best intervention plan,so as to provide evidence for clinical practice.Methods:Databases including Pub Med,Embase,Cochrane Library,Web of Science,Chinese Biomedical Database(CBM),China National Knowledge Infrastructure(CNKI),Wan Fang Databases,Chinese Journal Database(VIP)were searched for randomized controlled trials(RCTs)on Acupuncture related therapy for trigeminal neuralgia.Documents are screened and information is extracted according to the established inclusion and exclusion criteria.Use the Cochrane risk assessment tool to evaluate the quality of the included studies.Stata Version 14.0 software were used for Network meta-analysis.The “evidence network diagram”,“funnel plot”,“ranking probability table” and “network meta-analysis table” are used to show the comparison results of effectiveness and safety under different interventions.Results:A total of 6200 patients were included in 69 studies,involving 14 interventions,of which 67 studies reported total effectiveness,31 studies reported VAS scores,7 studies reported frequency of pain,19 studies reported adverse events,and 8 studies reported recurrence rate.(1)The network meta-analysis based on Total effective rate showed Top 4as follows:Acupoint injection + Acupuncture(SUCRA=98.0%),Electroacupuncture +Acupoint injection(SUCRA=79.0%),Acupuncture+Traditional Chinese medicine+Western medicine(SUCRA=75.4%),Acupuncture+Traditional Chinese medicine(SUCRA=73.0%).(2)In terms of VAS score reduction,the Top 4 as follows: Electro-acupuncture+ Acupoint injection(SUCRA=86.4%),Acupuncture + Moxibustion(SUCRA=74.0%),Acupuncture+Traditional Chinese medicine+ Western medicine(SUCRA=64.9%),Electroacupuncture+Western medicine(SUCRA=57.8%).(3)To reduce the frequency of pain,the Top 4 asfollows:Electroacupuncture+Blood-letting puncture(SUCRA=87.1%),Electroacupuncture+Acupoint injection(SUCRA=78.8%),Acupuncture+Western medicine(SUCRA=75.4%),Electroacupuncture +Western medicine(SUCRA=48.8%).(4)Incidence of adverse events,the ranked from high to low as follows: Western Medicine(31.29%),Electroacupuncture+Western medicine(12.63%),Acupuncture+Western medicine(9.69%),Acupuncture(9.04%),Acupuncture+Traditional Chinese medicine+Western medicine(7.30%),Electroacupuncture+Acupoint injection(3.33%),Acupuncture +Traditional Chinese medicine(2.17%).(5)To control recurrence rate,the ranked from high to low as follows:Acupuncture +Traditional Chinese medicine(SUCRA=88.6%),Acupuncture+Moxibustion(SUCRA=76.0%),Electroacupuncture+Western medicine(SUCRA=51.2%),Acupuncture(SUCRA=31.8%),Western medicine(SUCRA=2.3%).(6)Cluster analysis of total effective rate and VAS score indicated that Electroacupuncture + Acupoint injection was the best.Conclusion:In acupuncture related therapy,Electroacupuncture+Acupoint injection was the best,combination therapies is better than single therapy,and the safety is better than Western medicine,all kinds of combination therapies also have advantages and disadvantages.Due to the limitations of existing research,the conclusions of this study need to be further confirmed by more reasonable design,high quality RCTs.