Qassim Hebatallah, Zhao Yining, Ströbel Armin, Regensburger Martin, Buchfelder Michael, de Oliveira Daniela Souza, Del Vecchio Alessandro, Kinfe Thomas
Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany.
Center for Clinical Studies (CCS), Medical Faculty, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, 91054 Erlangen, Germany.
Brain Sci. 2023 Mar 14;13(3):492. doi: 10.3390/brainsci13030492.
Despite available, advanced pharmacological and behavioral therapies, refractory chronic facial pain of different origins still poses a therapeutic challenge. In circumstances where there is insufficient responsiveness to pharmacological/behavioral therapies, deep brain stimulation should be considered as a potential effective treatment option. We performed an individual participant data (IPD) meta-analysis including searches on PubMed, Embase, and the Cochrane Library (2000-2022). The primary endpoint was the change in pain intensity (visual analogue scale; VAS) at a defined time-point of ≤3 months post-DBS. In addition, correlation and regression analyses were performed to identify predictive markers (age, duration of pain, frequency, amplitude, intensity, contact configuration, and the DBS target). A total of seven trials consisting of 54 screened patients met the inclusion criteria. DBS significantly reduced the pain levels after 3 months without being related to a specific DBS target, age, contact configuration, stimulation intensity, frequency, amplitude, or chronic pain duration. Adverse events were an infection or lead fracture (19%), stimulation-induced side effects (7%), and three deaths (unrelated to DBS-from cancer progression or a second stroke). Although comparable long-term data are lacking, the current published data indicate that DBS (thalamic and PVG/PAG) effectively suppresses facial pain in the short-term. However, the low-quality evidence, reporting bias, and placebo effects must be considered in future randomized-controlled DBS trials for facial pain.
尽管有先进的药物和行为疗法，但不同起源的难治性慢性面部疼痛仍然是一个治疗挑战。在对药物/行为疗法反应不足的情况下，深部脑刺激应被视为一种潜在的有效治疗选择。我们进行了一项个体参与者数据（IPD）荟萃分析，包括在PubMed、Embase和Cochrane图书馆（2000 - 2022年）进行检索。主要终点是在深部脑刺激术后≤3个月的特定时间点疼痛强度的变化（视觉模拟量表；VAS）。此外，进行了相关性和回归分析以确定预测指标（年龄、疼痛持续时间、频率、幅度、强度、接触配置和深部脑刺激靶点）。共有7项试验，包括54名经筛选的患者符合纳入标准。深部脑刺激在3个月后显著降低了疼痛水平，且与特定的深部脑刺激靶点、年龄、接触配置、刺激强度、频率、幅度或慢性疼痛持续时间无关。不良事件包括感染或电极断裂（19%）、刺激引起的副作用（7%）以及3例死亡（与深部脑刺激无关——因癌症进展或第二次中风）。尽管缺乏可比的长期数据，但目前已发表的数据表明，深部脑刺激（丘脑和PVG/PAG）在短期内能有效抑制面部疼痛。然而，在未来针对面部疼痛的随机对照深部脑刺激试验中，必须考虑证据质量低、报告偏倚和安慰剂效应。
