Grenouillet Solène, Balayssac David, Moisset Xavier, Peyron Roland, Fauchon Camille
Jean Monnet University, NEUROPAIN Team, CRNL, Inserm CNRS, CHU Hôpital Nord, Saint-Etienne, France.
University of Clermont Auvergne, NEURO-DOL, Inserm, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Support Care Cancer. 2025 Apr 3;33(4):346. doi: 10.1007/s00520-025-09378-w.
Chronic pain remains one of the most frequent and disabling symptoms of cancer, arising from tumors and/or treatments, and is poorly controlled in 40% of patients. Non-invasive brain stimulation (NIBS) is now widely recommended in drug-refractory neuropathic pain, but its effectiveness in chronic cancer-related pain remains unknown. A few observational studies and randomized controlled trials (RCTs) have assessed the effectiveness of NIBS on pain in this population.
A systematic review of neuromodulation studies on patients with chronic cancer-related pain involving transcranial direct currents stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) was conducted to estimate the analgesic efficacy, safety and feasibility in clinical routine.
Eleven publications (N = 298 patients) were included and analyzed. For tDCS, three RCT had a moderate effect size of 0.7 [0.6; 0.9] on a rating scale (0-10), and two case reports showed a significant decrease of pain intensity on average by -4.25 ± 0.36 points. The rTMS provided similar pain relief, with two RCTs showing a large effect size of 0.9 [0.7; 1.1], two observational study studies reporting a significant pooled effect on pain intensity (-0.9 [-1.6; -0.1] and -2.3 [-3.3; -1.3]), and two case reports where pain was reduced on average by -4.75 ± 0.36 points. None of these studies reported serious adverse events, and discontinuations of treatment were associated with cancer complications.
NIBS appears to have an analgesic effect in cancer-related pain. However, due to the high heterogeneity of pain conditions, placebo-controlled trials with larger and homogeneous patient cohorts are required to confirm these promising results.
慢性疼痛仍然是癌症最常见且使人丧失能力的症状之一，由肿瘤和/或治疗引起，40%的患者疼痛控制不佳。非侵入性脑刺激（NIBS）目前在药物难治性神经性疼痛中被广泛推荐，但其对慢性癌症相关疼痛的有效性仍不清楚。一些观察性研究和随机对照试验（RCT）评估了NIBS对该人群疼痛的有效性。
对涉及经颅直流电刺激（tDCS）或重复经颅磁刺激（rTMS）的慢性癌症相关疼痛患者的神经调节研究进行系统评价，以评估其在临床常规中的镇痛效果、安全性和可行性。
纳入并分析了11篇文献（N = 298例患者）。对于tDCS，三项RCT在0至10分的评分量表上有中度效应量0.7[0.6；0.9]，两项病例报告显示疼痛强度平均显著降低-4.25±0.36分。rTMS提供了类似的疼痛缓解，两项RCT显示有较大效应量0.9[0.7；1.1]，两项观察性研究报告对疼痛强度有显著的合并效应（-0.9[-1.6；-0.1]和-2.3[-3.3；-1.3]），两项病例报告中疼痛平均降低-4.75±0.36分。这些研究均未报告严重不良事件，治疗中断与癌症并发症有关。
NIBS似乎对癌症相关疼痛有镇痛作用。然而，由于疼痛情况高度异质性，需要更大规模且同质的患者队列进行安慰剂对照试验来证实这些有前景的结果。
