Department of Rehabilitation Medicine, General Hospital of Xinjiang Military Region, 830002 Urumchi, Xinjiang, China.
School of Clinical Medicine, Southwest Medical University, 646099 Luzhou, Sichuan, China.
J Integr Neurosci. 2023 Jul 20;22(4):102. doi: 10.31083/j.jin2204102.
To evaluate the efficacy and safety of noninvasive therapies in the treatment of central poststroke pain (CPSP) by network meta-analysis and to provide an evidence-based basis for clinical practice.
PubMed, Cochrane Library, EMBASE, CNKI, Wanfang, and VIP were searched for clinical randomized controlled studies on noninvasive therapy for CPSP. The retrieval time limit was from the establishment of each database to July 2022. The bias risk assessment tool recommended by Cochrane was used to evaluate the quality of the included randomized controlled trials (RCTs). Stata 14.0 was used for network meta-analysis, and Review Manager 5.3 software was used for traditional meta-analysis.
Twelve RCTs involving 8 treatment schemes and 641 patients were finally included. The results of the network meta-analysis showed the following rankings in visual analysis scale (VAS): super laser injury on stellate ganglia (SLI) > transcranial direct current stimulation (tDCS) > music therapy (MT) > repetitive transcranial magnetic stimulation (rTMS) > continuous theta burst stimulation (cTBS) > transcutaneous acupoint electrical stimulation (TAES) > common therapy (CT). The total clinical efficiency ranked as follows: psychological training of mindfulness (PT) > rTMS > CT. Clinical adverse reactions ranked as follows: rTMS > MT > CT > SLI.
Noninvasive complementary therapy can effectively alleviate the pain of CPSP patients, and the efficacy and safety of SLI are relatively significant. However, due to the limitations of this study, the efficacy ranking cannot fully explain the advantages and disadvantages of clinical efficacy. In the future, more multicentre, large sample, double-blind clinical randomized controlled trials are needed to supplement and demonstrate the results of this study.
采用网状meta 分析评价非侵入性疗法治疗脑卒中后中枢性疼痛（CPSP）的疗效和安全性，为临床实践提供循证依据。
计算机检索 PubMed、Cochrane Library、EMBASE、中国知网（CNKI）、万方、维普数据库，搜集关于非侵入性疗法治疗 CPSP 的临床随机对照研究，检索时限均为各数据库建库至 2022 年 7 月。采用 Cochrane 推荐的偏倚风险评估工具评价纳入研究的质量。采用 Stata 14.0 软件进行网状 meta 分析，RevMan 5.3 软件进行传统 meta 分析。
最终纳入 12 个 RCT，涉及 8 种治疗方案、641 例患者。网状meta 分析结果显示，视觉模拟评分法（VAS）排序结果为：星状神经节超激光照射（SLI）＞经颅直流电刺激（tDCS）＞音乐疗法（MT）＞重复经颅磁刺激（rTMS）＞连续经颅磁刺激（cTBS）＞经皮穴位电刺激（TAES）＞常规疗法（CT）。总临床有效率排序为：正念减压疗法（PT）＞rTMS＞CT。临床不良反应排序为：rTMS＞MT＞CT＞SLI。
非侵入性补充疗法能有效缓解 CPSP 患者的疼痛，SLI 的疗效和安全性相对更为显著。但受本研究纳入文献的限制，疗效排序尚不能充分说明临床疗效的优劣势，未来需要更多多中心、大样本、双盲的临床随机对照试验加以补充和验证。
