Xu Runbing, Yu Changhe, Zhang Xinyu, Zhang Yipin, Li Mengfei, Jia Bei, Yan Shiyan, Jiang Miao
Hematology and Oncology Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People's Republic of China.
Tuina and Pain Management Department, Beijing University of Chinese Medicine Affiliated Dongzhimen Hospital, Beijing, People's Republic of China.
J Pain Res. 2024 Apr 12;17:1423-1439. doi: 10.2147/JPR.S448528. eCollection 2024.
To determine the efficacy and safety of a neuromodulation intervention regimen in the treatment of chemotherapy-induced peripheral neuropathy (CIPN).
Systematic searches were conducted in seven English databases. Randomized controlled trials of all neuromodulation interventions (both invasive and non-invasive) for the treatment of CIPN were selected. Group comparisons of differences between interventions and controls were also made. We divided the outcomes into immediate-term effect (≤3 weeks), short-term effect (3 weeks to ≤3 months), and long-term effect (>3 months).
Sixteen studies and 946 patients with CIPN were included. Among immediate-term effects, neuromodulation interventions were superior to usual care for improving pain (SMD=-0.77, 95% CI -1.07~ 0.47), FACT-Ntx (MD = 5.35, 95% CI 2.84~ 7.87), and QOL (SMD = 0.44, 95% CI 0.09~ 0.79) (moderate certainty); neuromodulation loaded with usual care was superior to usual care for improving pain (SMD=-0.47, 95% CI -0.71 ~ -0.23), and QOL (SMD = 0.40, 95% CI 0.12 ~ 0.69) (moderate certainty). There were no statistically significant differences between the neuromodulation interventions regimen vs usual care in short- and long-term outcomes and neuromodulation vs sham stimulation from any outcome measure. There were mild adverse events such as pain at the site of stimulation and bruising, and no serious adverse events were reported.
Neuromodulation interventions had significant immediate-term efficacy in CIPN but had not been shown to be superior to sham stimulation; short-term and long-term efficacy could not be determined because there were too few original RCTs. Moreover, there are no serious adverse effects of this therapy.
确定一种神经调节干预方案治疗化疗引起的周围神经病变（CIPN）的疗效和安全性。
在七个英文数据库中进行系统检索。选取所有用于治疗CIPN的神经调节干预措施（包括侵入性和非侵入性）的随机对照试验。同时对干预组与对照组之间的差异进行组间比较。我们将结果分为近期效应（≤3周）、短期效应（3周至≤3个月）和长期效应（>3个月）。
纳入16项研究，共946例CIPN患者。在近期效应方面，神经调节干预措施在改善疼痛（标准化均数差=-0.77，95%置信区间-1.07~ -0.47）、FACT-Ntx（均数差=5.35，95%置信区间2.84~ 7.87）和生活质量（标准化均数差=0.44，95%置信区间0.09~ 0.79）方面优于常规护理（中等确定性）；常规护理加神经调节在改善疼痛（标准化均数差=-0.47，95%置信区间-0.71~ -0.23）和生活质量（标准化均数差=0.40，95%置信区间0.12~ 0.69）方面优于常规护理（中等确定性）。在短期和长期结果方面，神经调节干预方案与常规护理之间以及神经调节与假刺激之间在任何结局指标上均无统计学显著差异。存在轻度不良事件，如刺激部位疼痛和瘀伤，未报告严重不良事件。
神经调节干预措施在CIPN中具有显著的近期疗效，但未显示优于假刺激；由于原始随机对照试验数量过少，无法确定其短期和长期疗效。此外，该疗法无严重不良反应。
