物理治疗干预可能缓解中枢神经性疼痛患者的疼痛：一项随机对照试验的系统评价和荟萃分析。
Physiotherapy interventions may relieve pain in individuals with central neuropathic pain: a systematic review and meta-analysis of randomised controlled trials.
作者信息
Kannan Priya, Bello Umar Muhammad, Winser Stanley John
机构信息
Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Suite St532, 11, Yuk Choi Road, Hung HomKowloon 999077, Hong Kong.
Centre for Eye and Vision Research (CEVR), The Hong Kong Polytechnic University, Kowloon, Hong Kong; Physiotherapy Department, Yobe State University Teaching Hospital (YSUTH), Damaturu, Nigeria.
出版信息
Ther Adv Chronic Dis. 2022 Mar 24;13:20406223221078672. doi: 10.1177/20406223221078672. eCollection 2022.
OBJECTIVES
To evaluate the effectiveness of any form of physiotherapy intervention for the management of central neuropathic pain (cNeP) due to any underlying cause.
METHODS
Multiple databases were searched from inception until August 2021. Randomised controlled trials evaluating physiotherapy interventions compared to a control condition on pain among people with cNeP were included. Methodological quality and the quality of evidence were assessed using the Physiotherapy Evidence Database Scale and the Grading of Recommendations, Assessment, Development, and Evaluation tool, respectively.
RESULTS
The searches yielded 2661 studies, of which 23 randomised controlled trials met the inclusion criteria and were included in the meta-analyses. Meta-analyses of trials examining non-invasive neurostimulation revealed significant reductions in pain severity due to spinal cord injury (SCI; standardised mean difference (SMD): -0.59 (95% confidence interval [CI]: -1.07, -0.11), = 0.02) and phantom limb pain (weighted mean difference (WMD): -1.57 (95% CI: -2.85, -0.29), = 0.02). The pooled analyses of trials utilising acupuncture, transcutaneous electrical nerve stimulation (TENS), and mirror therapy showed significant reductions in pain severity among individuals with stroke (WMD: -1.46 (95% CI: -1.97, -0.94), < 0.001), multiple sclerosis (SMD: -0.32 (95% CI: -0.57, -0.06), = 0.01), and phantom limb pain (SMD: -0.74 (95% CI: -1.36, -0.11), = 0.02), respectively. Exercise was also found to significantly reduce pain among people with multiple sclerosis (SMD: -1.58 (95% CI: -2.85, -0.30), = 0.02).
CONCLUSION
Evidence supports the use of non-invasive neurostimulation for the treatment of pain secondary to SCI and phantom limb pain. Beneficial pain management outcomes were also identified for acupuncture in stroke, TENS in multiple sclerosis, and mirror therapy in phantom limb pain.
目的
评估任何形式的物理治疗干预对因任何潜在病因引起的中枢神经性疼痛（cNeP）的管理效果。
方法
从数据库建立至2021年8月进行多个数据库检索。纳入评估物理治疗干预与对照条件相比对cNeP患者疼痛影响的随机对照试验。分别使用物理治疗证据数据库量表和推荐分级、评估、制定与评价工具评估方法学质量和证据质量。
结果
检索得到2661项研究，其中23项随机对照试验符合纳入标准并纳入荟萃分析。对检查非侵入性神经刺激的试验进行的荟萃分析显示，脊髓损伤（SCI）导致的疼痛严重程度显著降低（标准化均数差（SMD）：-0.59（95%置信区间[CI]：-1.07，-0.11），P = 0.02）以及幻肢痛（加权均数差（WMD）：-1.57（95%CI：-2.85，-0.29），P = 0.02）。对采用针灸、经皮电刺激神经疗法（TENS）和镜像疗法的试验进行的汇总分析显示，中风患者（WMD：-1.46（95%CI：-1.97，-0.94），P < 0.001）、多发性硬化症患者（SMD：-0.32（95%CI：-0.57，-0.06），P = 0.01）和幻肢痛患者（SMD：-0.74（95%CI：-1.36，-0.11），P = 0.02）的疼痛严重程度均显著降低。还发现运动可显著减轻多发性硬化症患者的疼痛（SMD：-1.58（95%CI：-2.85，-0.30），P = 0.02）。
结论
有证据支持使用非侵入性神经刺激治疗SCI继发疼痛和幻肢痛。还确定了针灸治疗中风、TENS治疗多发性硬化症以及镜像疗法治疗幻肢痛的有益疼痛管理效果。
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