Electroacupuncture effects on trigeminal neuralgia with comorbid anxiety and depression: The role of frequency and acupoint specificity

This study aimed to investigate the effects of electroacupuncture (EA) at specific acupoints (DU20 and ST36) and different frequencies (2 and 100 Hz) on brain regions associated with trigeminal neuralgia, anxiety, and depression. Chronic trigeminal neuralgia was induced by the chronic constriction of the infraorbital nerve (CION). Anxiety and depression were assessed through behavioral tests. The effects of high-frequency (100 Hz) and low-frequency (2 Hz) EA at DU20 and ST36 were compared using immunofluorescence staining to evaluate their impact on pain, anxiety, depression, and brain activity. CION induced prominent trigeminal neuralgia in mice, accompanied by anxiety- and depression-like behaviors. Two weeks post-CION surgery increased neural activity was observed in the Prl, Cg1, CeA, BLA, TRN, CA3, CA1, vlPAG, PC5, and LPB brain regions, while reduced activity was noted in the PVN, VTA, and LDTgv regions. EA at 100 Hz applied to DU20 and ST36 rapidly alleviated pain and specifically reduced despair behavior, a depressive-like phenotype. In contrast, 2 Hz EA at the same acupoints addressed both anxiety- and depression-like behaviors, modulating a broader range of brain regions, including the PrL, BLA, PVN, VTA, vlPAG, and LDTgv, compared to 100 Hz EA. Repeated 2 Hz EA exclusively at DU20 was sufficient for analgesia and improvement of anxiety and depression, demonstrating a more extensive modulation of brain activity, particularly in the VTA and LDTgv, than EA at ST36. The study reveals that CION induces significant trigeminal neuralgia, accompanied by anxiety and depression, characterized by distinct neural activity patterns. EA at 2 Hz exhibits greater effectiveness in alleviating anxiety and depression, exerting broad modulation across various brain regions. Notably, EA at DU20 demonstrates superior modulation of brain activity and enhanced antidepressant and analgesic effects compared to ST36. These findings provide valuable insights into the nuanced therapeutic effects of EA on the interplay between chronic pain and affective disorders, suggesting potential clinical strategies for intervention.