慢性神经性疼痛无创神经调节的循证综合综述。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-01-21 DOI:10.1002/ejp.4786

Rafael Jardim Duarte-Moreira, Lívia Shirahige, Indira Enith Rodriguez-Prieto, Maércio Maia Alves, Tiago da Silva Lopes, Rachel Fontes Baptista, Fuad Ahmad Hazime, Yossi Zana, Gabriel Taricani Kubota, Daniel Ciampi de Andrade, Lin Tchia Yeng, Manoel Jacobsen Teixeira, Egas Caparelli Moniz de Aragão Dáquer, Katia Nunes Sá, Kátia Monte-Silva, Abrahão Fontes Baptista

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引用次数: 0

摘要

背景和目的：非侵入性神经调节技术（NIN），如经颅直流电刺激（tDCS）和重复经颅磁刺激（rTMS），由于其通过逆转神经性疼痛（NP）相关的神经可塑性变化来减轻疼痛的潜力而被广泛研究，神经性疼痛是一种普遍而复杂的疾病。然而，由于涉及许多变量，如不同的技术、剂量和病因，治疗NP仍然具有挑战性。有必要为临床医生和公共卫生管理人员提供见解，以支持临床决策。本综述旨在巩固现有的各种NIN治疗慢性NP有效性的证据。数据库和数据处理：在PubMed/MEDLINE数据库中进行了系统搜索，包括比较NIN技术与假干预治疗NP的对照试验的荟萃分析。采用AMSTAR-2工具和GRADE系统评估纳入研究的质量，效应量调整为标准平均差（SMD）。结果：本综述包括22项荟萃分析，包括来自214项对照试验的8151名参与者。研究最多的NIN技术是tDCS和rTMS，主要目标是运动皮层和背外侧前额叶皮层。研究结果表明，兴奋性方案，特别是高频rTMS和阳极tDCS，对减轻NP患者的疼痛强度有效。然而，证据的总体质量被评为低，主要是由于研究之间的异质性和小样本量。结论：NIN技术在治疗NP方面有前景，在减轻疼痛方面有潜在的好处。然而，需要进一步的高质量研究来建立最佳方案和长期效果。意义声明：本文巩固了关于非侵入性神经调节治疗神经性疼痛的证据，包括根据疼痛的病因区分最有效的技术，并为临床医生提供了方便获取这一关键信息的途径。它还强调了在非侵入性神经调节和神经性疼痛领域需要进一步研究的关键方面。

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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Evidence-Based Umbrella Review of Non-Invasive Neuromodulation in Chronic Neuropathic Pain

Background and Objective

Non-invasive neuromodulation techniques (NIN), such as transcranial Direct Current Stimulation (tDCS) and repetitive Transcranial Magnetic Stimulation (rTMS), have been extensively researched for their potential to alleviate pain by reversing neuroplastic changes associated with neuropathic pain (NP), a prevalent and complex condition. However, treating NP remains challenging due to the numerous variables involved, such as different techniques, dosages and aetiologies. It is necessary to provide insights for clinicians and public healthcare managers to support clinical decision-making. This umbrella review aims to consolidate existing evidence on the effectiveness of various NIN in managing chronic NP.

Databases and Data Treatment

A systematic search was conducted in the PubMed/MEDLINE database, including meta-analyses of controlled trials comparing NIN techniques with sham interventions for NP treatment. The quality of included studies was assessed using the AMSTAR-2 tool and the GRADE system, with effect sizes adjusted to the standard mean difference (SMD).

Results

The review included 22 meta-analyses comprising 8151 participants from 214 controlled trials. The most investigated NIN techniques were tDCS and rTMS, with primary targets being the motor cortex and dorsolateral prefrontal cortex. The findings suggest that excitatory protocols, particularly high-frequency rTMS and anodal tDCS, are effective in reducing pain intensity in individuals with NP. However, the overall quality of evidence was rated low, primarily due to heterogeneity among studies and small sample sizes.

Conclusion

NIN techniques show promise in managing NP, with potential benefits in pain reduction. However, further high-quality research is needed to establish optimal protocols and long-term effects.

Significance Statement

This paper consolidates the evidence regarding non-invasive neuromodulation for the treatment of neuropathic pain, including differentiating the most effective techniques based on the aetiology of pain, and provides clinicians with easy access to this critical information. It also highlights key aspects that require further research in the field of non-invasive neuromodulation and neuropathic pain.

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.