Revisiting the effects of rTMS over the dorsolateral prefrontal cortex on pain: An updated systematic review and meta-analysis

IF 7.6 1区医学 Q1 CLINICAL NEUROLOGY

Brain Stimulation Pub Date : 2024-07-01 DOI:10.1016/j.brs.2024.07.011

Jie Zhou , Ying Wang , Xi Luo , Paul B. Fitzgerald , Robin F.H. Cash , Bernadette M. Fitzgibbon , Xianwei Che

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引用次数: 0

Abstract

Background

Our previous study synthesized the analgesic effects of repetitive Transcranial Magnetic Stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) trials up to 2019. There has been a significant increase in pain trials in the past few years, along with methodological variabilities such as sample size, stimulation intensity, and rTMS paradigms. Objectives/Methods: This study therefore updated the effects of DLPFC-rTMS on chronic pain and quantified the impact of methodological differences across studies.

Results

A total of 36 studies were included. Among them, 26 studies were clinical trials (update = 9, 307/711 patients), and 10 (update = 1, 34/249 participants) were provoked pain studies. The updated meta-analysis does not support an effect on neuropathic pain after including the additional trials (p_short-term = 0.20, p_mid-term = 0.50). However, there is medium-to-large analgesic effect in migraine trials extending up to six weeks follow-up (SMD_mid-term = −0.80, SMD_long-term = −0.51), that was not previously reported. Methodological differences wthine the studies were considered. DLPFC-rTMS also induces potential improvement in the emotional aspects of pain (SMD_short-term = −0.28).

Conclusions

The updated systematic meta-analysis continues to support analgesic effects for chronic pain overall. However, the updated results no longer support DLPFC-rTMS for pain relief in neuropathic pain, and do supports DLPFC-rTMS in the management of migraine. There is also evidence for DLPFC-rTMS to improve emotional aspects of pain.

查看原文本刊更多论文

重新审视经颅磁刺激背外侧前额叶皮层对疼痛的影响：最新系统综述和荟萃分析。

背景：我们之前的研究综述了截至2019年的重复经颅磁刺激（rTMS）对背外侧前额叶皮层（DLPFC）的镇痛效果试验。在过去几年中，疼痛试验大幅增加，同时也出现了方法上的差异，如样本大小、刺激强度和经颅磁刺激范式：因此，本研究更新了DLPFC-rTMS对慢性疼痛的影响，并量化了不同研究中方法差异的影响：结果：共纳入 36 项研究。结果：共纳入 36 项研究，其中 26 项为临床试验（更新 = 9，307/711 名患者），10 项（更新 = 1，34/249 名参与者）为激痛研究。更新后的荟萃分析不支持纳入额外试验后对神经病理性疼痛的影响（pshort-term = 0.20，pmid-term = 0.50）。不过，在随访期长达六周的偏头痛试验中，存在中到大型的镇痛效果（SMDmid-term = -0.80，SMDlong-term = -0.51），这是之前未曾报道过的。这些研究在方法上存在差异。DLPFC-经颅磁刺激还能潜在改善疼痛的情绪方面（SMD短期=-0.28）：最新的系统荟萃分析继续支持对慢性疼痛的总体镇痛效果。然而，更新后的结果不再支持DLPFC-rTMS用于缓解神经性疼痛，但支持DLPFC-rTMS用于治疗偏头痛。还有证据表明，DLPFC-经颅磁刺激可改善疼痛的情绪方面。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Brain Stimulation 医学-临床神经学

CiteScore

13.10

自引率

9.10%

发文量

256

审稿时长

72 days

期刊介绍： Brain Stimulation publishes on the entire field of brain stimulation, including noninvasive and invasive techniques and technologies that alter brain function through the use of electrical, magnetic, radiowave, or focally targeted pharmacologic stimulation. Brain Stimulation aims to be the premier journal for publication of original research in the field of neuromodulation. The journal includes: a) Original articles; b) Short Communications; c) Invited and original reviews; d) Technology and methodological perspectives (reviews of new devices, description of new methods, etc.); and e) Letters to the Editor. Special issues of the journal will be considered based on scientific merit.