Trigeminal neuralgia in an octogenarian: Sustained clinical response to acupuncture

Trigeminal neuralgia is a common, painful neuropathy, with a high prevalence in the elderly population. A major source of disability and poor quality of life, trigeminal neuralgia pain typically remits and relapses, even when patients are on conventionally used treatments. These treatments include antiepileptic drugs such as gabapentin, carbamazepine, and valproate; opiate drugs such as oxycodone and morphine; and other drugs such as baclofen, and mexilitine.1 These medications have high potential for adverse effects in the elderly population, a population with multiple medical problems requiring multiple medications and with an age-related change in drug metabolism. In particular, central nervous system toxicity such as impaired cognition or somnolence often limits their use. Because of the potential adverse effects of the commonly used analgesics, a nondrug approach may be an important modality of pain relief in patients with trigeminal neuralgia. Indeed, studies in younger adults have shown acupuncture to be efficacious when used as initial therapy for patients with trigeminal neuralgia.2,3 On the other hand, controversy surrounds its efficacy in patients who have previously been on pharmacotherapy.2,4,5 In this report, we describe an 80-year-old man with 5-year remission of trigeminal neuralgia-related pain-and safe discontinuation of several analgesics-in response to acupuncture.