Portaro Simona, Alito Angelo, Leonardi Giulia, Marotta Nicola, Tisano Adriana, Bruschetta Daniele, Longo Umile Giuseppe, Ammendolia Antonio, Milardi Demetrio, de Sire Alessandro
Department of Physical and Rehabilitation Medicine, University Hospital "G. Martino", Messina, Italy.
Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.
Neurol Sci. 2025 Mar 11. doi: 10.1007/s10072-025-08077-y.
Spinal cord injury (SCI) is a debilitating neurological condition that causes physical dependency, psychological distress, and financial burden. Pain is a common consequence of SCI, significantly impacting quality of life. Effective pain management in SCI is challenging and requires multifaceted approaches. Among rehabilitation methods, non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS), theta burst stimulation (TBS), transcranial direct current stimulation (tDCS), transcutaneous electrical nerve stimulation (TENS), and virtual reality (VR) have been explored. This study aims to evaluate the efficacy of rehabilitation and non-invasive brain stimulation techniques on pain relief in SCI patients.
A systematic review of the literature was conducted using PubMed, Scopus, and ScienceDirect with the formula ("spinal cord injury") AND ("pain"). Risk of bias was assessed using the Cochrane Risk of Bias Tool.
Sixteen studies involving 319 patients were included. Patients in the control groups received: rTMS in seven trials, tDCS in seven trials, TBS in one trial, and TENS combined with VR in one trial. The trials analyzed were of poor methodological quality, characterized by small sample sizes, weak power analyses, varying clinical scores, and non-comparable follow-up periods. No major complications or serious adverse events were reported.
Results were inconsistent, with no solid evidence supporting the superiority of rehabilitation techniques over comparator treatments. However, the favorable safety profile and positive outcomes in some measures suggest potential benefits for pain management and quality of life. Further studies are necessary to better understand SCI-related pain and optimize treatment strategies.
脊髓损伤（SCI）是一种使人衰弱的神经疾病，会导致身体依赖、心理困扰和经济负担。疼痛是SCI的常见后果，对生活质量有重大影响。SCI的有效疼痛管理具有挑战性，需要多方面的方法。在康复方法中，已经探索了诸如重复经颅磁刺激（rTMS）、theta波爆发刺激（TBS）、经颅直流电刺激（tDCS）、经皮电刺激神经疗法（TENS）和虚拟现实（VR）等非侵入性脑刺激技术。本研究旨在评估康复和非侵入性脑刺激技术对SCI患者疼痛缓解的疗效。
使用PubMed、Scopus和ScienceDirect以公式（“脊髓损伤”）AND（“疼痛”）进行文献系统综述。使用Cochrane偏倚风险工具评估偏倚风险。
纳入了16项涉及319名患者的研究。对照组患者接受：7项试验中的rTMS、7项试验中的tDCS、1项试验中的TBS以及1项试验中的TENS联合VR。所分析的试验方法学质量较差，其特点是样本量小、功效分析薄弱、临床评分各异以及随访期不可比。未报告重大并发症或严重不良事件。
结果不一致，没有确凿证据支持康复技术优于对照治疗。然而，良好的安全性和一些指标中的积极结果表明其对疼痛管理和生活质量有潜在益处。有必要进行进一步研究以更好地了解与SCI相关的疼痛并优化治疗策略。
