[A systematic review and Bayesian network meta-analysis of the effectiveness of non-pharmacological interventions in treating chronic wound pain in patients].

Abstract

Objective: To evaluate the effectiveness of non-pharmacological interventions in treating chronic wound pain in patients. Methods: This study was a systematic review and Bayesian network meta-analysis. Randomized controlled trials on the effectiveness of non-pharmacological interventions in treating chronic wound pain in patients, published from the establishment of the database until June 30, 2024, were retrieved from databases including China National Knowledge Infrastructure, Chinese Biomedical Literature Database, PubMed, Embase, and other databases. The outcome indicator was pain score. Pairwise meta-analysis and Bayesian network meta-analysis were conducted using ADDIS version 1.16.8 and Stata version 17.0 statistical softwares. Results: A total of 30 studies were included, involving 1 929 patients, including 1 016 patients in experimental group who received non-pharmacological intervention measures such as low-level laser therapy (LLLT), frequency rhythmic electrical modulation system (FREMS), virtual reality technology (VRT), non-contact low-frequency ultrasound (NCLFU), extracorporeal shock wave therapy, topical oxygen therapy, cold atmosphere plasma (CAP), negative pressure wound therapy, intermittent pneumatic compression (IPC), and exercise, and 913 patients in control group who received standard wound care, placebo treatment, etc. Pairwise meta-analysis showed that compared with that of control group, patients in experimental group who received LLLT, FREMS, VRT, NCLFU, CAP, and IPC had significantly reduced chronic wound pain scores (with standardized mean differences of -0.45, -4.09, -1.04, -0.61, -1.87, and -0.64, respectively, 95% confidence intervals of -0.76 to -0.15, -5.94 to -2.24, -1.56 to -0.52, -0.88 to -0.33, -3.16 to -0.58, and -1.03 to -0.25, respectively). Bayesian network meta-analysis showed that compared with that of standard wound care, patients who received FREMS, CAP, NCLFU, and LLLT had significantly reduced chronic wound pain scores (with standardized mean differences of -3.13, -1.75, -1.22, and -1.11, respectively, 95% confidence intervals of -4.35 to -1.98, -3.23 to -0.26, -2.36 to -0.06, and -2.18 to -0.06, respectively). FREMS had the highest probability of ranking 14^th, at 75%; the probability of CAP ranking 12^th was the highest, at 21%; the probability of NCLFU ranking 10^th and 9^th was the highest, both at 13%; LLLT had the highest probability of ranking 8^th, at 14%. Conclusions: Non-pharmacological intervention measures such as LLLT, FREMS, NCLFU, and CAP can effectively relieve chronic wound pain in patients, among which, FREMS shows the best effect, followed sequentially by CAP, NCLFU, and LLLT.