Center for pain Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Exp Dermatol. 2022 Mar;31(3):280-289. doi: 10.1111/exd.14468. Epub 2021 Dec 7.
Approximately one fifth of the world population experiences continuous itch for 6 weeks or more during their life, that is chronic itch. It is diverse in its aetiologies, and it is notoriously hard to treat. Because itch and pain have largely overlapping pathophysiology and the demonstrated efficacy of neurostimulation in treatment of selected chronic pain conditions, we conducted a systematic review to investigate whether neurostimulation could be an effective treatment for chronic itch. We identified two randomized controlled trials and 17 open label studies or case reports investigating various neurostimulation modalities for the treatment of refractory itch of various aetiologies. Transcutaneous electrical nerve stimulation (TENS) was the most investigated modality (n = 17), and in the largest number of conditions. Other modalities were cutaneous field stimulation (n = 2), painscrambler (n = 1), transcranial direct current stimulation (n = 1) and peripheral nerve field stimulation (n = 1). Atopic dermatitis was the most studied condition (n = 5). Despite the large heterogeneity in used stimulation paradigms and outcome parameters, all studies reported a positive effect of at least one neurostimulation modality. Our review indicates that electrical neurostimulation could be considered for the treatment of refractory chronic itch of selected aetiologies, such as atopic dermatitis or burn pruritus. However, better understanding of the mechanisms of action of the neurostimulation modalities and regimens in various pruritic conditions is necessary.
大约五分之一的世界人口在其一生中会持续瘙痒 6 周或更长时间，这就是慢性瘙痒。它的病因多种多样，而且治疗起来非常困难。由于瘙痒和疼痛在很大程度上具有重叠的病理生理学机制，并且神经刺激在治疗某些慢性疼痛病症方面已被证明具有疗效，我们进行了一项系统评价，以调查神经刺激是否可以成为治疗慢性瘙痒的有效方法。我们确定了两项随机对照试验和 17 项开放性标签研究或案例报告，这些研究调查了各种神经刺激方式治疗各种病因的难治性瘙痒。经皮神经电刺激（TENS）是研究最多的方式（n=17），也是在最多的病症中进行研究。其他方式包括皮肤场刺激（n=2）、疼痛扰乱器（n=1）、经颅直流电刺激（n=1）和周围神经场刺激（n=1）。特应性皮炎是研究最多的病症（n=5）。尽管所使用的刺激模式和结果参数存在很大的异质性，但所有研究都报告了至少一种神经刺激方式的积极效果。我们的综述表明，对于某些病因引起的难治性慢性瘙痒，例如特应性皮炎或烧伤瘙痒，可以考虑使用电神经刺激治疗。然而，有必要更好地了解各种瘙痒病症中神经刺激方式和方案的作用机制。
