Comparative Effectiveness of Non-invasive Brain Stimulation for the Treatment of Pain, Fatigue, and Sleep Quality in Fibromyalgia. A Systematic Review with Network Meta-Analysis.
Ishtiaq Ahmed, Rustem Mustafaoglu, Aamir Raoof Memon, Rubab Zafeer, Huanyu Xiong, Sofia Straudi, Nils Runge
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引用次数: 0
Abstract
Objectives: There is tentative evidence to support the analgesic effects of non-invasive brain stimulation (NiBS) in fibromyalgia (FM), but a comprehensive synthesis is lacking. This systematic review with network meta-analysis (NMA) aims to determine the relative effectiveness of different NiBS techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) in FM, and to identify the optimal stimulation location and intensity/frequency.
Methods: Four databases were searched until 9 July 2023 for randomized trials (RCTs) comparing NiBS in FM. Pain was the primary outcome, while fatigue and sleep were secondary outcomes. A frequentist NMA calculated standardized-mean-differences (SMDs) for pain, with pairwise meta-analysis for fatigue and sleep. Bias was assessed with the Cochrane-risk-of-bias-tool (RoB-2.0), and evidence certainty via Confidence-in-NMA.
Results: 43 RCTs with 2120 participants were included. NMA showed that low frequency (LF)-rTMS (SMD -1.20,(95%CI -1.82,-0.58)), dual tDCS (-0.91,(-1.82,-0.58)) and high frequency (HF)-rTMS (-0.58,(-1.00,-0.17)) likely results in reduction in pain intensity at the end of intervention compared with sham stimulation. For stimulation location, right dorsolateral prefrontal cortex (DLPFC)(-1.42,(-2.69,-0.15)), bilateral DLPFC (-0.94,(-1.82,-0.05), and left primary motor cortex (M1)(-0.49,(-0.85,-0.14)) likely results in reduction in pain intensity at the end of intervention, with DLPFC maintaining effects in short term. LF-rTMS over DLPFC (-1.42,(-2.69,-0.15)) and HF-rTMS over M1 (-0.78,(-1.39,-0.18)) likely results in reduction in pain intensity at the end of intervention, with LF-rTMS over right DLPFC maintaining effects in short term. NiBS appears to be safe and may reduce fatigue and improve sleep quality.
Discussion: Excitatory stimulation like HF-rTMS over M1 and inhibitory like LF-rTMS over DLPFC may yield better results.
期刊介绍：
The Clinical Journal of Pain explores all aspects of pain and its effective treatment, bringing readers the insights of leading anesthesiologists, surgeons, internists, neurologists, orthopedists, psychiatrists and psychologists, clinical pharmacologists, and rehabilitation medicine specialists. This peer-reviewed journal presents timely and thought-provoking articles on clinical dilemmas in pain management; valuable diagnostic procedures; promising new pharmacological, surgical, and other therapeutic modalities; psychosocial dimensions of pain; and ethical issues of concern to all medical professionals. The journal also publishes Special Topic issues on subjects of particular relevance to the practice of pain medicine.
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