School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY 14214-3079, United States.
Pain Med. 2024 Jan 4;25(1):47-56. doi: 10.1093/pm/pnad112.
Neuropathic pain encompasses multiple diagnoses with detrimental impacts on quality of life and overall health. In older adults, pharmacological management is limited by adverse effects and drug interactions, while surgical management involves perioperative risk. Prior reviews addressing non-pharmacological interventions for neuropathic pain have not focused on this demographic. Therefore, this systematic review synthesizes the evidence regarding the effectiveness of non-pharmacological interventions in reducing neuropathic pain severity in older adults.
PubMed, CINAHL, Web of Science, and PsycInfo were searched using key terms, with inclusion criteria of age ≥ 65, neuropathic pain, non-pharmacological intervention, pain severity measurement, English language, peer-reviewed, and either randomized controlled trial (RCT) or quasi-experimental design. In total, 2759 records were identified, with an additional 28 records identified by review of reference lists. After removal of duplicates, 2288 records were screened by title and abstract, 404 full-text articles were assessed, and 19 articles were critically reviewed and synthesized.
Of the 14 RCTs and 5 quasi-experimental studies included in the review, the most common intervention was electric and/or magnetic therapy, followed by acupuncture, mindfulness meditation, exercise, and light therapy. Several studies revealed both statistical and clinical significance, but conclusions were limited by small sample sizes and methodological shortcomings. The interventions were generally safe and acceptable.
Results should be interpreted with consideration of clinical vs statistical significance, mediators of pain severity, and individual variations in effectiveness. Further research should address multimodal and novel interventions, newer models of care, and technology-based interventions.
神经性疼痛包括多种诊断，对生活质量和整体健康有不利影响。在老年人中，药物治疗受到不良反应和药物相互作用的限制，而手术治疗则涉及围手术期风险。以前针对神经性疼痛的非药物干预措施的综述并未关注这一年龄段。因此，本系统综述综合了关于非药物干预措施在减轻老年人神经性疼痛严重程度方面的有效性的证据。
使用关键词在 PubMed、CINAHL、Web of Science 和 PsycInfo 中进行检索，纳入标准为年龄≥65 岁、神经性疼痛、非药物干预、疼痛严重程度测量、英语、同行评议，以及随机对照试验（RCT）或准实验设计。共确定了 2759 条记录，通过审查参考文献又确定了 28 条记录。去除重复后，通过标题和摘要筛选了 2288 条记录，评估了 404 篇全文文章，并对 19 篇文章进行了批判性审查和综合分析。
在纳入的 14 项 RCT 和 5 项准实验研究中，最常见的干预措施是电和/或磁疗法，其次是针灸、正念冥想、运动和光疗法。几项研究显示了统计学和临床意义，但结论受到样本量小和方法学缺陷的限制。干预措施通常是安全且可接受的。
结果的解释应考虑到临床意义与统计学意义、疼痛严重程度的调节因素以及有效性的个体差异。进一步的研究应针对多模式和新型干预措施、新的护理模式和基于技术的干预措施。
