Department of Onco-Anaesthesia and Palliative Medicine, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Pain Physician. 2020 Jul;23(4):349-364.
Certain types of cancer pain have remained hard to control even by highly skilled pain experts. Uncontrolled cancer pain can have severe effects on quality of life, physical functioning, and leads to psychological distress. From this perspective, nonpharmacologic modalities of treatment are important. Neuromodulatory techniques, such as transcutaneous electrical nerve stimulation and scrambler therapy (ST), have gained popularity in recent times. ST is a relatively new therapy that has been used for the management of cancer pain resistant to pharmacologic management. Several studies have shown that ST is an effective therapy for this type of pain.
The aim of this study was to detect possible gaps in the literature regarding the efficacy of ST for cancer pain and formulate recommendations for research through a systematic review of the literature.
A systematic review of the literature was performed following the recommendations of the PRISMA Statement.
PubMed and EMBASE were searched for studies that met the inclusion criteria using a predetermined search strategy. Reference list of retrieved studies and Google Scholar were used to verify that no relevant studies had been omitted. Data were extracted from the studies with a data extraction sheet. A qualitative analyses of the extracted data was undertaken.
Twenty-seven studies were retrieved. Ten were articles that were categorized as literature reviews, including 7 general literature reviews not following a specific review methodology, 1 editorial, and 2 systematic reviews. Seventeen were original studies, including 2 single-arm trials, 1 randomized controlled trial, 4 pilot trials, 4 case reports, 2 retrospective studies, and 4 prospective studies. By and large, the available literature supports the use of ST as an effective therapy for the management of refractory cancer pain. However, the level of evidence for its application to cancer pain is not particularly strong, and improvement in pain with ST may even be owing to a placebo effect.
This study was not a meta-review. Because of the limited number of clinical trials on ST in cancer pain, such a meta-review could not meaningfully be performed.
Methodologically sound, large randomized control trials are needed in this area. However at this stage, ST may be considered a good option for cancer patients suffering from pain that does not respond to pharmacologic treatment.
Scrambler therapy, cancer, cancer pain, neuropathic pain, Calmare therapy, evidence, noninvasive pain treatment, chronic pain.
即使是经验丰富的疼痛专家，某些类型的癌症疼痛仍然难以控制。未控制的癌症疼痛会对生活质量、身体功能产生严重影响，并导致心理困扰。从这个角度来看，非药物治疗方法很重要。近年来，神经调节技术，如经皮电神经刺激和乱序器疗法（ST）已经流行起来。ST 是一种相对较新的疗法，已用于治疗对药物治疗有抵抗力的癌症疼痛。多项研究表明，ST 是治疗这种类型疼痛的有效疗法。
本研究旨在通过对文献进行系统评价，发现 ST 治疗癌症疼痛疗效方面的文献空白，并提出研究建议。
按照 PRISMA 声明的建议，对文献进行系统评价。
使用预定的搜索策略，在 PubMed 和 EMBASE 中搜索符合纳入标准的研究。检索研究的参考文献列表和 Google Scholar 用于验证是否遗漏了任何相关研究。使用数据提取表从研究中提取数据。对提取的数据进行定性分析。
检索到 27 项研究。其中 10 项为文献综述，包括 7 篇未遵循特定综述方法的综述文章、1 篇社论和 2 篇系统综述。17 项为原始研究，包括 2 项单臂试验、1 项随机对照试验、4 项试验性试验、4 项病例报告、2 项回顾性研究和 4 项前瞻性研究。总的来说，现有文献支持 ST 作为治疗难治性癌症疼痛的有效疗法。然而，其应用于癌症疼痛的证据水平并不是特别高，并且 ST 带来的疼痛改善甚至可能归因于安慰剂效应。
本研究不是荟萃分析。由于关于 ST 在癌症疼痛中的临床试验数量有限，因此无法进行有意义的荟萃分析。
在这一领域需要进行方法学严谨、大型的随机对照试验。然而，在现阶段，对于疼痛对药物治疗无反应的癌症患者，ST 可以被视为一种较好的选择。
乱序器疗法、癌症、癌症疼痛、神经性疼痛、Calmare 疗法、证据、无创性疼痛治疗、慢性疼痛。
