Huang Jiapeng, Yang Chunlan, Zhao Kehong, Zhao Ziqi, Chen Yin, Wang Tingting, Qu Yun
Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China.
Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
Front Neurosci. 2022 Jan 31;16:831413. doi: 10.3389/fnins.2022.831413. eCollection 2022.
Transcutaneous electrical nerve stimulation (TENS) is a non-invasive therapeutic intervention that is typically used for many years to treat chronic pain in patients who are refractory to pain medications. However, evidence of the efficacy of TENS treatment for neuropathic pain is lacking in humans. To further understand the efficacy of TENS under various intervention conditions and illuminate the current circumstance and future research directions, we systematically reviewed animal studies investigating the efficacy of TENS in relieving pain in neuropathic pain rodent models. We searched the Cochrane Library, EMBASE, MEDLINE (via PubMed), and Web of Science and identified 11 studies. Two meta-analyses were performed. The first meta-analysis showed that a single TENS treatment was capable of temporarily ameliorating neuropathic pain when compared to control groups with a significant effect (standardized mean difference: 1.54; 95% CI: 0.65, 2.42; = 0.0007; = 58%). Significant temporary alleviation in neuropathic pain intensity was also observed in the meta-analysis of repetitive TENS (standardized mean difference: 0.85; 95% CI: 0.31, 1.40; = 0.002; = 75%). Subgroup analysis showed no effect of the timing of the application of TENS (test for subgroup difference, = 0.47). Leave-one-out sensitivity analyses suggested that no single study had an outsized effect on the pooled estimates, which may partly prove the robustness of these findings. Other stratified analyses were prevented by the insufficient number of included studies. Overall, current data suggest that TENS might be a promising therapy to ameliorate neuropathic pain. However, the high risk of bias in the included studies suggests that cautions must be considered when interpreting these findings and it is not reasonable to directly generalize the results obtained from animal studies to clinical practice. Future studies should pay more attention to improving the quality of study design and reporting, thereby facilitating the understanding of mechanisms underlying TENS treatment, reducing more potentially unsuccessful clinical trials, and optimizing the efficacy of TENS for people with neuropathic pain.
经皮电刺激神经疗法（TENS）是一种非侵入性治疗干预措施，多年来通常用于治疗对止痛药物无效的患者的慢性疼痛。然而，在人类中缺乏TENS治疗神经性疼痛疗效的证据。为了进一步了解TENS在各种干预条件下的疗效，并阐明当前情况和未来研究方向，我们系统回顾了调查TENS在缓解神经性疼痛啮齿动物模型疼痛方面疗效的动物研究。我们检索了Cochrane图书馆、EMBASE、MEDLINE（通过PubMed）和科学网，共识别出11项研究。进行了两项荟萃分析。第一项荟萃分析表明，与对照组相比，单次TENS治疗能够暂时改善神经性疼痛，具有显著效果（标准化平均差：1.54；95%置信区间：0.65，2.42；P = 0.0007；I² = 58%）。在重复性TENS的荟萃分析中也观察到神经性疼痛强度有显著的暂时减轻（标准化平均差：0.85；95%置信区间：0.31，1.40；P = 0.002；I² = 75%）。亚组分析显示TENS应用时间没有影响（亚组差异检验，P = 0.47）。逐一剔除敏感性分析表明，没有一项研究对汇总估计值有过大影响，这可能部分证明了这些发现的稳健性。由于纳入研究数量不足，无法进行其他分层分析。总体而言，目前的数据表明TENS可能是一种改善神经性疼痛的有前景的疗法。然而，纳入研究中存在的高偏倚风险表明，在解释这些发现时必须谨慎，直接将动物研究结果推广到临床实践是不合理的。未来的研究应更加注重提高研究设计和报告的质量，从而有助于理解TENS治疗的潜在机制，减少更多可能失败的临床试验，并优化TENS对神经性疼痛患者的疗效。
