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Headache Medicine
ISSN 2178-7468
e
-ISSN 2763-6178
v.11
Supplement
p. 1
October 2020.
1
ASAA
DOI: 10.48208/HeadacheMed.2020.Supplement.1
Lelis, C; Dib, A.; Amaral, J; Guisolphi, N.; Martins, C.; Clementino, C.; Silva, L.
Headache Medicine
Uso da acupuntura no manejo da dor em pacientes com neuralgia primária do
trigêmeo: revisão sistemática da literatura
Caio Lellis, Ana Dib, Jordana Amaral, Natalia Guisolphi, Camila Martins, Lara Clementino, Ledismar da Silva
Pontifícia Universidade Católica de Goiás
Introdução
A neuralgia primária do trigêmeo (NPT) é um tipo de dor neuropática, que causa crises de dor em choque de forte intensidade.
Atualmente, o tratamento de escolha padrão é o farmacológico, mas há evidências de que a acupuntura pode ser favorável no manejo
desse tipo de dor crônica. O objetivo deste estudo foi avaliar a ecácia da acupuntura como tratamento não farmacológico da NPT.
Material e métodos
Foi realizada uma revisão sistemática da literatura no banco do PubMed, com os descritores: Idiopathic Trigeminal Neuralgia*
Acupuncture*. Os ltros utilizados foram: ensaios clínicos, metanálises e publicados nos últimos 10 anos (n=14 artigos). Foram excluídos
os estudos inconclusos e aqueles que não se enquadravam nos objetivos.
Resultados
Um estudo clínico randomizado apontou a necessidade de no mínimo 10 sessões de acupuntura no tratamento da NPT, sendo que a
melhora dos sintomas se destacam após a quinta ou sexta sessão. Também, outro ensaio randomizado, duplo cego, observou redução da
dor nos pacientes tratados com acupuntura, bem como manutenção dos resultados por 6 meses sem necessidade de incremento de dose
da terapia farmacológica usual. Além disso, destaca-se seu efeito analgésico para dor miofascial secundária a NPT. Ademais, um estudo
de caso controle, com 120 participantes, apontou que a técnica de acupuntura sensibilizada pelo calor, conhecida como moxabustão,
apresentou uma taxa de sensibilização em 83,3% dos portadores de NPT, associando-se com redução da dor e melhora na qualidade
de vida. Também, foi evidenciado, em outro estudo de caso controle, um decréscimo importante de síndromes dolorosas em pacientes
submetidos há pelo menos 6 semanas de acupuntura, em comparação com o grupo controle. No entanto, apesar de apresentar efeitos
positivos sobre a NPT, uma metanálise considera que ainda faltam evidências de alto teor cientíco para se conrmar essa relação. Por
m, outro estudo apontou que tanto a técnica de acupuntura com punção profunda quanto a de punção supercial foram ecazes na
redução da dor em pacientes com NPT, sendo que a primeira apresentou resultados mais signicativos que a segunda.
Conclusão
A acupuntura se mostrou uma opção terapêutica não farmacológica ecaz e segura no manejo da NPT, sendo a do tipo punção
profunda apresentou melhores resultados em relação à supercial. Ainda assim, torna-se necessário mais estudos com maior rigor
cientíco sobre o tema.
Palavras-chave:
Neuralgia primária do trigêmeo, Acupuntura, Dor neuropática