Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD.
Departments of Medicine and Oncology, Section of Palliative Medicine, Johns Hopkins Hospital, Baltimore, MD.
Pain Physician. 2022 Nov;25(8):E1163-E1173.
First-line medications for the treatment of painful diabetic neuropathy (PDN) are associated with a substantial rate of discontinuation due to adverse effects or insufficient efficacy. Neuromodulation techniques have been used for PDN, but a comprehensive review of the literature that incorporates several distinct device categories has yet to be undertaken.
We aimed to summarize the evidence regarding 4 major types of neuromodulation devices for the treatment of PDN. We focused on spinal cord stimulators (SCS), peripheral nerve stimulators (PNS), transcutaneous electrical nerve stimulators (TENS), and scrambler therapy devices (ST) because they are often used for refractory neuropathic pain.
Narrative Review.
A comprehensive and reproducible literature search was performed using PubMed with no search restrictions applied. The available Medical Subject Headings were used. Inclusion criteria included prospective studies, retrospective studies, case series, and case reports indexed from database inception to the search date (September 14, 2021).
Seventeen studies met inclusion criteria, 10 of which were regarding SCS. Only 3 of the 10 were randomized controlled trials. We found no studies assessing contemporary PNS. Four studies assessed TENS, but the devices varied widely in voltages and waveforms. Two case reports described ST.
Potential selection bias due to the nature of a narrative review, although a reproducible search strategy was utilized. Several neuromodulation modalities have minimal published evidence available.
The evidence for neuromodulation devices for the treatment of PDN mostly comprises open-label prospective trials or case reports. SCS has the most volume of evidence for efficacy. Studies regarding TENS show mixed results, possibly due to numerous device varieties. PNS and ST may hold promise based on their proposed mechanisms of action, but prospective controlled trials are needed.
治疗糖尿病性周围神经痛（DPN）的一线药物由于不良反应或疗效不足，导致停药率相当高。神经调节技术已被用于 DPN，但尚未对纳入几种不同设备类别的文献进行全面综述。
我们旨在总结 4 种主要类型的神经调节设备治疗 DPN 的证据。我们重点关注脊髓刺激器（SCS）、周围神经刺激器（PNS）、经皮神经电刺激器（TENS）和扰频器治疗设备（ST），因为它们常用于治疗难治性神经性疼痛。
叙述性综述。
使用无搜索限制的 PubMed 进行全面且可重复的文献搜索。使用了可用的医学主题词。纳入标准包括前瞻性研究、回顾性研究、病例系列和从数据库创建到搜索日期（2021 年 9 月 14 日）索引的病例报告。
17 项研究符合纳入标准，其中 10 项涉及 SCS。仅有 3 项为随机对照试验。我们没有发现评估当代 PNS 的研究。有 4 项研究评估了 TENS，但设备在电压和波形方面差异很大。有 2 份病例报告描述了 ST。
由于叙述性综述的性质，存在潜在的选择偏倚，尽管采用了可重复的搜索策略。几种神经调节方式的可用证据很少。
用于治疗 DPN 的神经调节设备的证据主要包括开放性前瞻性试验或病例报告。SCS 的疗效证据最多。关于 TENS 的研究结果喜忧参半，可能是由于设备种类繁多所致。PNS 和 ST 可能具有前景，因为它们的作用机制被认为具有潜力，但需要进行前瞻性对照试验。
