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脊髓损伤后神经性疼痛的非侵入性脑刺激：系统评价与网状Meta分析

Non-invasive Brain Stimulation for Neuropathic Pain After Spinal Cord Injury: A Systematic Review and Network Meta-Analysis.

作者信息

Li Lingling, Huang Hailiang, Yu Ying, Jia Yuqi, Liu Zhiyao, Shi Xin, Wang Fangqi, Zhang Tingting

机构信息

College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.

Innovative Institute of Chinese Medicine and Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, China.

出版信息

Front Neurosci. 2022 Feb 11;15:800560. doi: 10.3389/fnins.2021.800560. eCollection 2021.

DOI:10.3389/fnins.2021.800560
PMID:35221889
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8873374/
Abstract

OBJECTIVE

This study aims to systematically evaluate the effect of non-invasive brain stimulation (NIBS) on neuropathic pain (NP) after spinal cord injury and compare the effects of two different NIBS.

METHODS

Randomized controlled trials (RCTs) about the effect of NIBS on NP after spinal cord injury (SCI) were retrieved from the databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM from inception to September 2021. The quality of the trials was assessed, and the data were extracted according to the Cochrane handbook of systematic review. Statistical analysis was conducted with Stata (version 16) and R software (version 4.0.2).

RESULTS

A total of 17 studies involving 507 patients were included. The meta-analysis showed that NIBS could reduce the pain score (SMD = -0.84, 95% CI -1.27 -0.40, = 0.00) and the pain score during follow-up (SMD = -0.32, 95%CI -0.57 -0.07, = 0.02), and the depression score of the NIBS group was not statistically significant than that of the control group (SMD = -0.43, 95%CI -0.89-0.02, = 0.06). The network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the pain score was repetitive transcranial magnetic stimulation (rTMS) ( = 0.62) > transcranial direct current stimulation (tDCS) ( = 0.38).

CONCLUSION

NIBS can relieve NP after SCI. The effect of rTMS on NP is superior to that of tDCS. We suggest that the rTMS parameters are 80-120% resting motion threshold and 5-20 Hz, while the tDCS parameters are 2 mA and 20 min. However, it is necessary to carry out more large-scale, multicenter, double-blind, high-quality RCT to explore the efficacy and mechanism of NIBS for NP after SCI.

摘要

目的

本研究旨在系统评价无创脑刺激（NIBS）对脊髓损伤后神经病理性疼痛（NP）的影响，并比较两种不同NIBS的效果。

方法

从PubMed、Embase、Cochrane图书馆、Web of Science、中国知网、万方数据、维普和中国生物医学文献数据库中检索自数据库建库至2021年9月有关NIBS对脊髓损伤（SCI）后NP影响的随机对照试验（RCT）。评估试验质量，并根据Cochrane系统评价手册提取数据。使用Stata（16版）和R软件（4.0.2版）进行统计分析。

结果

共纳入17项研究，涉及507例患者。荟萃分析表明，NIBS可降低疼痛评分（标准化均数差[SMD]=-0.84，95%可信区间[CI]-1.27至-0.40，P=0.00）以及随访期间的疼痛评分（SMD=-0.32，95%CI-0.57至-0.07，P=0.02），且NIBS组的抑郁评分与对照组相比无统计学意义（SMD=-0.43，95%CI-0.89至-0.02，P=0.06）。网状荟萃分析表明，两种不同NIBS对疼痛评分影响的最佳概率排序为重复经颅磁刺激（rTMS）（P=0.62）>经颅直流电刺激（tDCS）（P=0.38）。

结论

NIBS可缓解SCI后的NP。rTMS对NP的效果优于tDCS。我们建议rTMS参数为静息运动阈值的80%-120%和5-20Hz，而tDCS参数为2mA和20分钟。然而，有必要开展更多大规模、多中心、双盲、高质量的RCT，以探索NIBS治疗SCI后NP的疗效和机制。

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