Zheng Yilong, Liu Christopher Weiyang, Hui Chan Diana Xin, Kai Ong Damian Wen, Xin Ker Justin Rui, Ng Wai Hoe, Wan Kai Rui
Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Anaesthesiology and Pain Management, Singapore General Hospital, Singapore.
Neuromodulation. 2023 Oct;26(7):1276-1294. doi: 10.1016/j.neurom.2023.05.003. Epub 2023 Jul 10.
This study aimed to review the best evidence on the long-term efficacy of neurostimulation for chronic pain.
We systematically reviewed PubMed, CENTRAL, and WikiStim for studies published between the inception of the data bases and July 21, 2022. Randomized controlled trials (RCTs) with a minimum of one-year follow-up that were of high methodologic quality as ascertained using the Delphi list criteria were included in the evidence synthesis. The primary outcome was long-term reduction in pain intensity, and the secondary outcomes were all other reported outcomes. Level of recommendation was graded from I to III, with level I being the highest level of recommendation.
Of the 7119 records screened, 24 RCTs were included in the evidence synthesis. Therapies with recommendations for their usage include pulsed radiofrequency (PRF) for postherpetic neuralgia, transcutaneous electrical nerve stimulation for trigeminal neuralgia, motor cortex stimulation for neuropathic pain and poststroke pain, deep brain stimulation for cluster headache, sphenopalatine ganglion stimulation for cluster headache, occipital nerve stimulation for migraine, peripheral nerve field stimulation for back pain, and spinal cord stimulation (SCS) for back and leg pain, nonsurgical back pain, persistent spinal pain syndrome, and painful diabetic neuropathy. Closed-loop SCS is recommended over open-loop SCS for back and leg pain. SCS is recommended over PRF for postherpetic neuralgia. Dorsal root ganglion stimulation is recommended over SCS for complex regional pain syndrome.
Neurostimulation is generally effective in the long term as an adjunctive treatment for chronic pain. Future studies should evaluate whether the multidisciplinary management of the physical perception of pain, affect, and social stressors is superior to their management alone.
本研究旨在综述神经刺激治疗慢性疼痛长期疗效的最佳证据。
我们系统检索了PubMed、CENTRAL和WikiStim数据库，纳入自建库至2022年7月21日发表的研究。采用德尔菲清单标准确定为方法学质量高的、随访至少一年的随机对照试验（RCT）纳入证据合成。主要结局为疼痛强度的长期降低，次要结局为所有其他报告的结局。推荐等级从I到III分级，I级为最高推荐等级。
在筛选的7119条记录中，24项RCT纳入了证据合成。推荐使用的治疗方法包括用于带状疱疹后神经痛的脉冲射频（PRF）、用于三叉神经痛的经皮电神经刺激、用于神经性疼痛和中风后疼痛的运动皮层刺激、用于丛集性头痛的深部脑刺激、用于丛集性头痛的蝶腭神经节刺激、用于偏头痛的枕神经刺激、用于背痛的周围神经场刺激以及用于背痛和腿痛、非手术性背痛、持续性脊柱疼痛综合征和糖尿病性神经痛的脊髓刺激（SCS）。对于背痛和腿痛，推荐闭环SCS而非开环SCS。对于带状疱疹后神经痛，推荐SCS而非PRF。对于复杂性区域疼痛综合征，推荐背根神经节刺激而非SCS。
神经刺激作为慢性疼痛的辅助治疗方法，长期来看总体有效。未来的研究应评估对疼痛的身体感知、情感和社会应激源的多学科管理是否优于单独管理。
