Ahmed Ishtiaq, Mustafaoglu Rustem, Memon Aamir R, Zafeer Rubab, Xiong Huanyu, Straudi Sofia, Runge Nils
Department of Physiotherapy, Pain in Motion International Research Group, Human Physiology and Anatomy.
Department of Movement and Nutrition for Health and Performance, Faculty of Physical Education and Physiotherapy.
Clin J Pain. 2025 May 1;41(5):e1282. doi: 10.1097/AJP.0000000000001282.
OBJECTIVES: There is tentative evidence to support the analgesic effects of noninvasive brain stimulation (NiBS) in fibromyalgia (FM), but a comprehensive synthesis is lacking. This systematic review with network meta-analysis (NMA) aimed to determine the relative effectiveness of different NiBS techniques, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) in FM, and to identify the optimal stimulation location and intensity/frequency. METHODS: Four databases were searched until July 9, 2023 for randomized trials (RCTs) comparing NiBS in FM. Pain was the primary outcome, while fatigue and sleep were secondary outcomes. A frequentist NMA calculated standardized-mean-differences (SMDs) for pain, with pairwise meta-analysis for fatigue and sleep. Bias was assessed with the Cochrane-risk-of-bias-tool (RoB-2.0), and evidence certainty through confidence-in-NMA. RESULTS: Forty-three RCTs with 2120 participants were included. NMA showed that low frequency (LF)-rTMS (SMD: -1.20, 95% CI: -1.82 to -0.58), dual tDCS (SMD: -0.91, 95% CI: -1.82 to -0.58), and high frequency (HF)-rTMS (SMD: -0.58, 95% CI: -1.00 to -0.17) likely results in a reduction in pain intensity at the end of intervention compared with sham stimulation. For stimulation location, right dorsolateral prefrontal cortex (DLPFC)(SMD: -1.42, 95% CI: -2.69 to -0.15), bilateral DLPFC (SMD: -0.94, 95% CI: -1.82 to -0.05), and left primary motor cortex (M1)(SMD: -0.49, 95% CI: -0.85 to -0.14) likely results in reduction in pain intensity at the end of intervention, with DLPFC maintaining effects in short-term. LF-rTMS over DLPFC (SMD: -1.42, 95% CI: -2.69 to -0.15) and HF-rTMS over M1 (SMD: -0.78, 95% CI: -1.39 to -0.18) likely results in the reduction in pain intensity at the end of intervention, with LF-rTMS over right DLPFC maintaining effects in the short term. NiBS appears to be safe and may reduce fatigue and improve sleep quality. DISCUSSION: Excitatory stimulation like HF-rTMS over M1 and inhibitory like LF-rTMS over DLPFC may yield better results.
目的：有初步证据支持非侵入性脑刺激（NiBS）对纤维肌痛（FM）的镇痛作用，但缺乏全面的综合分析。本系统评价和网状Meta分析旨在确定不同NiBS技术，如经颅直流电刺激（tDCS）和重复经颅磁刺激（rTMS）在FM中的相对有效性，并确定最佳刺激部位和强度/频率。 方法：检索四个数据库至2023年7月9日，查找比较FM中NiBS的随机试验（RCT）。疼痛是主要结局，疲劳和睡眠是次要结局。采用频率学派网状Meta分析计算疼痛的标准化均数差（SMD），对疲劳和睡眠进行成对Meta分析。使用Cochrane偏倚风险工具（RoB-2.0）评估偏倚，并通过对网状Meta分析的置信度确定证据的确定性。 结果：纳入43项RCT，共涉及2120名参与者。网状Meta分析表明，与假刺激相比，低频（LF）-rTMS（SMD：-1.20，95%CI：-1.82至-0.58）、双相tDCS（SMD：-0.91，95%CI：-1.82至-0.58）和高频（HF）-rTMS（SMD：-0.58，95%CI：-1.00至-0.17）可能在干预结束时导致疼痛强度降低。对于刺激部位，右侧背外侧前额叶皮质（DLPFC）（SMD：-1.42，95%CI：-2.69至-0.15）、双侧DLPFC（SMD：-0.94，95%CI：-1.82至-0.05）和左侧初级运动皮质（M1）（SMD：-0.49，95%CI：-0.85至-0.14）可能在干预结束时导致疼痛强度降低，DLPFC在短期内保持效果。DLPFC上的LF-rTMS（SMD：-1.42，95%CI：-2.69至-0.15）和M1上的HF-rTMS（SMD：-0.78，95%CI：-1.39至-0.18）可能在干预结束时导致疼痛强度降低，右侧DLPFC上LF-rTMS在短期内保持效果。NiBS似乎是安全的，可能会减轻疲劳并改善睡眠质量。 讨论：像M1上的HF-rTMS这样的兴奋性刺激和像DLPFC上的LF-rTMS这样的抑制性刺激可能会产生更好的效果。
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