Department of Rehabilitation Medicine (C.G., Q.Z., Z.G., T.L.), The Affiliated Hospital of Qingdao University, Qingdao, Shandong Provience, China.
Department of Cardiothoracic Surgery (J.Z.), Yantai Municipal Laiyang Central Hospital, Yantai, Shandong Provience, China.
J Pain Symptom Manage. 2022 Oct;64(4):e203-e215. doi: 10.1016/j.jpainsymman.2022.05.002. Epub 2022 May 10.
Noninvasive brain stimulations (NIBS) have been increasingly applied to the patients with neuropathic pain (NP), while the effectiveness of NIBS in the management of NP is still conflicting.
To examine the effectiveness of NIBS on pain and depression symptoms of patients with NP.
A comprehensive literature retrieval was performed on MEDLINE, Embase, PsycINFO, PEDro, and CENTRAL from the establishment of the databases to June 2021. Randomized controlled trials comparing NIBS with sham stimulation were included.
A total of thirteen trials comprising 498 participants met the inclusion criteria. The pooled analysis found a significant effect on the improvement of pain scores at post-treatment, favoring NIBS over sham stimulation (SMD = -0.60; 95% CI: -1.00 to -0.20; P = 0.004). Subgroup analysis showed that only transcranial direct current stimulation (tDCS) (SMD = -0.38; 95% CI: -0.71 to -0.04; P = 0.030) and high-frequency repetitive transcranial magnetic stimulation (H-rTMS) (SMD = -0.95; 95% CI: -1.85 to -0.04; P = 0.040) had positive effects on pain reduction among all types of NIBS. The favorable effects of NIBS remained significant at follow-up visit (SMD = -0.51; 95% CI: -0.79 to -0.23; P = 0.000), while only H-rTMS was found in subgroup analyses to significantly improve pain scales of the patients (SMD = -0.54; 95% CI: -0.85 to -0.24; P = 0.000). Additionally, overall NIBS showed no beneficial effect over sham stimulation in reducing depression symptoms of NP patients either at post-treatment (SMD = -0.19; 95% CI: -0.39 to 0.01; P = 0.061) or at follow-up visit (SMD = -0.18; 95% CI: -0.45 to 0.10; P = 0.202).
This meta-analysis revealed the analgesic effect of NIBS on patients with NP, while no beneficial effect was observed on reducing concomitant depression symptoms. The findings recommended the clinical application of NIBS in patients with NP.
非侵入性脑刺激（NIBS）已越来越多地应用于治疗神经性疼痛（NP）患者，但 NIBS 对 NP 管理的有效性仍存在争议。
研究 NIBS 对 NP 患者疼痛和抑郁症状的疗效。
对 MEDLINE、Embase、PsycINFO、PEDro 和 CENTRAL 数据库自建立以来至 2021 年 6 月进行全面文献检索。纳入比较 NIBS 与假刺激的随机对照试验。
共有 13 项试验纳入 498 名患者，符合纳入标准。汇总分析发现，NIBS 在治疗后疼痛评分的改善方面有显著效果，优于假刺激（SMD= -0.60；95%CI：-1.00 至-0.20；P=0.004）。亚组分析显示，仅经颅直流电刺激（tDCS）（SMD= -0.38；95%CI：-0.71 至-0.04；P=0.030）和高频重复经颅磁刺激（H-rTMS）（SMD= -0.95；95%CI：-1.85 至-0.04；P=0.040）对所有类型的 NIBS 均有降低疼痛的积极作用。NIBS 的有益效果在随访时仍有显著意义（SMD= -0.51；95%CI：-0.79 至-0.23；P=0.000），而仅 H-rTMS 在亚组分析中发现可显著改善患者的疼痛量表（SMD= -0.54；95%CI：-0.85 至-0.24；P=0.000）。此外，总体而言，NIBS 在治疗后（SMD= -0.19；95%CI：-0.39 至 0.01；P=0.061）或随访时（SMD= -0.18；95%CI：-0.45 至 0.10；P=0.202）均不能改善 NP 患者的抑郁症状。
本荟萃分析显示 NIBS 对 NP 患者具有镇痛作用，而对减轻伴随的抑郁症状则无有益作用。研究结果推荐将 NIBS 应用于 NP 患者。
