Wang Dengyu, Lu Yang, Han Yan, Zhang Xiaolei, Dong Sheng, Zhang Huifang, Wang Guoqin, Wang Guihuai, Wang James Jin
School of Medicine, Tsinghua University, Beijing, China; Institute for Precision Medicine, Tsinghua University, Beijing, China.
Institute for Precision Medicine, Tsinghua University, Beijing, China; Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Neuromodulation. 2024 Jan;27(1):83-94. doi: 10.1016/j.neurom.2022.12.002. Epub 2023 Jan 24.
Deep brain stimulation (DBS) to treat chronic neuropathic pain has shown variable outcomes. Variations in pain etiologies and DBS targets are considered the main contributing factors, which are, however, underexplored owing to a paucity of patient data in individual studies. An updated meta-analysis to quantitatively assess the influence of these factors on the outcome of DBS for chronic neuropathic pain is warranted, especially considering that the anterior cingulate cortex (ACC) has emerged recently as a new DBS target.
A comprehensive literature review was performed in PubMed, Embase, and Cochrane data bases to identify studies reporting quantitative outcomes of DBS for chronic neuropathic pain. Pain and quality of life (QoL) outcomes, grouped by etiology and DBS target, were extracted and analyzed (α = 0.05).
Twenty-five studies were included for analysis. Patients with peripheral neuropathic pain (PNP) had a significantly greater initial stimulation success rate than did patients with central neuropathic pain (CNP). Both patients with CNP and patients with PNP with definitive implant, regardless of targets, gained significant follow-up pain reduction. Patients with PNP had greater long-term pain relief than did patients with CNP. Patients with CNP with ACC DBS gained less long-term pain relief than did those with conventional targets. Significant short-term QoL improvement was reported in selected patients with CNP after ACC DBS. However, selective reporting bias was expected, and the improvement decreased in the long term.
Although DBS to treat chronic neuropathic pain is generally effective, patients with PNP are the preferred population over patients with CNP. Current data suggest that ACC DBS deserves further investigation as a potential way to treat the affective component of chronic neuropathic pain.
深部脑刺激（DBS）治疗慢性神经性疼痛的效果存在差异。疼痛病因和DBS靶点的差异被认为是主要影响因素，然而，由于个体研究中患者数据匮乏，这些因素尚未得到充分探索。鉴于前扣带回皮质（ACC）最近已成为新的DBS靶点，因此有必要进行一项更新的荟萃分析，以定量评估这些因素对DBS治疗慢性神经性疼痛疗效的影响。
在PubMed、Embase和Cochrane数据库中进行了全面的文献综述，以确定报告DBS治疗慢性神经性疼痛定量结果的研究。提取并分析按病因和DBS靶点分组的疼痛和生活质量（QoL）结果（α = 0.05）。
纳入25项研究进行分析。外周神经性疼痛（PNP）患者的初始刺激成功率显著高于中枢神经性疼痛（CNP）患者。无论靶点如何，植入确定的CNP患者和PNP患者在随访中疼痛均显著减轻。PNP患者的长期疼痛缓解程度高于CNP患者。接受ACC DBS的CNP患者的长期疼痛缓解程度低于接受传统靶点治疗的患者。部分接受ACC DBS的CNP患者报告短期QoL有显著改善。然而，预计存在选择性报告偏倚，且长期改善程度下降。
尽管DBS治疗慢性神经性疼痛总体有效，但与CNP患者相比，PNP患者是更优选的人群。目前的数据表明，ACC DBS作为治疗慢性神经性疼痛情感成分的一种潜在方法值得进一步研究。
