Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA.
Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru.
Pain Med. 2020 Oct 1;21(10):2310-2322. doi: 10.1093/pm/pnaa039.
To evaluate the effects of neuromodulation techniques in adults with phantom limb pain (PLP).
A systematic search was performed, comprising randomized controlled trials (RCTs) and quasi-experimental (QE) studies that were published from database inception to February 2019 and that measured the effects of neuromodulation in adults with PLP. Hedge's g effect size (ES) and 95% confidence intervals were calculated, and random-effects meta-analyses were performed.
Fourteen studies (nine RCTs and five QE noncontrolled studies) were included. The meta-analysis of RCTs showed significant effects for i) excitatory primary motor cortex (M1) stimulation in reducing pain after stimulation (ES = -1.36, 95% confidence interval [CI] = -2.26 to -0.45); ii) anodal M1 transcranial direct current stimulation (tDCS) in lowering pain after stimulation (ES = -1.50, 95% CI = -2.05 to 0.95), and one-week follow-up (ES = -1.04, 95% CI = -1.64 to 0.45). The meta-analysis of noncontrolled QE studies demonstrated a high rate of pain reduction after stimulation with transcutaneous electrical nerve stimulation (rate = 67%, 95% CI = 60% to 73%) and at one-year follow-up with deep brain stimulation (rate = 73%, 95% CI = 63% to 82%).
The evidence from RCTs suggests that excitatory M1 stimulation-specifically, anodal M1 tDCS-has a significant short-term effect in reducing pain scale scores in PLP. Various neuromodulation techniques appear to have a significant and positive impact on PLP, but due to the limited amount of data, it is not possible to draw more definite conclusions.
评估神经调节技术在幻肢痛（PLP）成人患者中的疗效。
系统检索了从数据库建立到 2019 年 2 月发表的随机对照试验（RCT）和准实验（QE）研究，以评估神经调节对 PLP 成人患者的疗效。计算 Hedge's g 效应量（ES）和 95%置信区间，并进行随机效应荟萃分析。
纳入了 14 项研究（9 项 RCT 和 5 项 QE 非对照研究）。RCT 的荟萃分析显示，兴奋性初级运动皮层（M1）刺激在刺激后降低疼痛方面具有显著效果（ES=-1.36，95%置信区间[CI]：-2.26 至-0.45）；阳极 M1 经颅直流电刺激（tDCS）在刺激后降低疼痛方面也具有显著效果（ES=-1.50，95%CI：-2.05 至 0.95），且在一周后随访时仍具有显著效果（ES=-1.04，95%CI：-1.64 至 0.45）。QE 非对照研究的荟萃分析显示，经皮神经电刺激（TENS）在刺激后即刻的疼痛缓解率很高（缓解率=67%，95%CI：60%至 73%），深部脑刺激（DBS）在一年后随访时的疼痛缓解率也很高（缓解率=73%，95%CI：63%至 82%）。
RCT 的证据表明，兴奋性 M1 刺激，尤其是阳极 M1 tDCS，在短期降低 PLP 疼痛评分方面具有显著效果。各种神经调节技术似乎对 PLP 有显著而积极的影响，但由于数据有限，尚无法得出更明确的结论。
