From the Center of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China (BY, HQ, Jiahui L, Jianan L); School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu Province, China (BY, HQ, Jiahui L, Jianan L); and School of Public Health, Nanjing Medical University, Nanjing, Jiangsu Province, China (CZ).
Am J Phys Med Rehabil. 2020 Sep;99(9):811-820. doi: 10.1097/PHM.0000000000001421.
The aim of the study was to examine the effectiveness of noninvasive brain stimulation on neuropathic pain in individuals with spinal cord injury.
A meta-analysis on pain intensity, depression, and anxiety levels was conducted to evaluate the effect of noninvasive brain stimulation on neuropathic pain in individuals with spinal cord injury. The authors searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), Embase (OvidSP), PsycINFO (OvidSP), and Physiotherapy Evidence Database (PEDro). Randomized controlled trials comparing noninvasive brain stimulation with sham stimulation were included.
Eleven studies were selected. The pooled analysis demonstrated no significant effect of repetitive transcranial magnetic stimulation, transcranial direct current stimulation, or cranial electrotherapy stimulation on neuropathic pain reduction after spinal cord injury. In addition, noninvasive brain stimulation showed no beneficial effect over sham stimulation on the improvement of depression, while it yielded a significant reduction of anxiety levels immediately after treatment. Subgroup analysis showed that only cranial electrotherapy stimulation had a significant effect on the reduction of anxiety levels among the three types of noninvasive brain stimulation.
In individuals with spinal cord injury, no significant effects of noninvasive brain stimulation on neuropathic pain and depression were observed. Cranial electrotherapy stimulation may be beneficial for the management of anxiety. These findings do not support the routine use of noninvasive brain stimulation for neuropathic pain in individuals with spinal cord injury.
本研究旨在探讨非侵入性脑刺激对脊髓损伤患者神经性疼痛的疗效。
对疼痛强度、抑郁和焦虑水平进行荟萃分析，以评估非侵入性脑刺激对脊髓损伤患者神经性疼痛的疗效。作者检索了 Cochrane 对照试验中心注册库（CENTRAL）、MEDLINE（PubMed）、Embase（OvidSP）、PsycINFO（OvidSP）和物理治疗证据数据库（PEDro）。纳入了比较非侵入性脑刺激与假刺激的随机对照试验。
选择了 11 项研究。汇总分析表明，重复经颅磁刺激、经颅直流电刺激或颅电刺激对脊髓损伤后神经性疼痛的减轻均无显著效果。此外，非侵入性脑刺激在改善抑郁方面并不优于假刺激，而在治疗后即刻可显著降低焦虑水平。亚组分析显示，在三种非侵入性脑刺激中，只有颅电刺激对降低焦虑水平有显著效果。
在脊髓损伤患者中，非侵入性脑刺激对神经性疼痛和抑郁无显著影响。颅电刺激可能有利于焦虑的管理。这些结果不支持常规使用非侵入性脑刺激治疗脊髓损伤患者的神经性疼痛。
