Zhou Jie, Wang Ying, Luo Xi, Fitzgerald Paul B, Cash Robin F H, Fitzgibbon Bernadette M, Che Xianwei
Centre for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China.
School of Nursing, Hangzhou Medical College, Hangzhou, Zhejiang, China.
Brain Stimul. 2024 Jul-Aug;17(4):928-937. doi: 10.1016/j.brs.2024.07.011. Epub 2024 Jul 30.
Our previous study synthesized the analgesic effects of repetitive Transcranial Magnetic Stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) trials up to 2019. There has been a significant increase in pain trials in the past few years, along with methodological variabilities such as sample size, stimulation intensity, and rTMS paradigms.
OBJECTIVES/METHODS: This study therefore updated the effects of DLPFC-rTMS on chronic pain and quantified the impact of methodological differences across studies.
A total of 36 studies were included. Among them, 26 studies were clinical trials (update = 9, 307/711 patients), and 10 (update = 1, 34/249 participants) were provoked pain studies. The updated meta-analysis does not support an effect on neuropathic pain after including the additional trials (p = 0.20, p = 0.50). However, there is medium-to-large analgesic effect in migraine trials extending up to six weeks follow-up (SMD = -0.80, SMD = -0.51), that was not previously reported. Methodological differences wthine the studies were considered. DLPFC-rTMS also induces potential improvement in the emotional aspects of pain (SMD = -0.28).
The updated systematic meta-analysis continues to support analgesic effects for chronic pain overall. However, the updated results no longer support DLPFC-rTMS for pain relief in neuropathic pain, and do supports DLPFC-rTMS in the management of migraine. There is also evidence for DLPFC-rTMS to improve emotional aspects of pain.
我们之前的研究综合了截至2019年重复经颅磁刺激（rTMS）作用于背外侧前额叶皮质（DLPFC）的试验的镇痛效果。在过去几年中，疼痛试验显著增加，同时存在样本量、刺激强度和rTMS模式等方法学差异。
目的/方法：因此，本研究更新了DLPFC-rTMS对慢性疼痛的影响，并量化了各研究中方法学差异的影响。
共纳入36项研究。其中，26项为临床试验（更新=9项，307/711例患者），10项（更新=1项，34/249名参与者）为诱发性疼痛研究。纳入额外试验后，更新的荟萃分析不支持对神经性疼痛有影响（p=0.20，p=0.50）。然而，在长达六周随访的偏头痛试验中存在中到大的镇痛效果（标准化均数差[SMD]=-0.80，SMD=-0.51），这是之前未报道过的。考虑了研究中的方法学差异。DLPFC-rTMS还能在疼痛的情感方面带来潜在改善（SMD=-0.28）。
更新后的系统荟萃分析继续支持总体上对慢性疼痛的镇痛效果。然而，更新后的结果不再支持DLPFC-rTMS用于缓解神经性疼痛，而是支持其用于偏头痛的治疗。也有证据表明DLPFC-rTMS可改善疼痛的情感方面。
