Venna Rahul, Yamamoto Tomohiro, Romman Adam, Koutrouvelis Aristides P, Yamamoto Satoshi
Anesthesiology, The University of Texas (UT) Medical Branch, Galveston, USA.
Medicine, Gunma University School of Medicine, Maebashi, JPN.
Cureus. 2025 Apr 25;17(4):e83004. doi: 10.7759/cureus.83004. eCollection 2025 Apr.
Postoperative analgesia following spinal surgical interventions continues to present a formidable challenge, particularly due to the high prevalence of lumbar spine surgeries and the inherent risks linked to opioid-based analgesic strategies. Neuromodulation has emerged as a promising therapeutic modality for the management of pain associated with these procedures. A systematic review was undertaken to identify randomized controlled trials (RCTs) that investigate the effectiveness of neuromodulation techniques in patients undergoing lumbar spinal surgeries for postoperative pain relief. A comprehensive search of online databases was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials investigating neuromodulation for postoperative pain relief following lumbar spinal surgery were included. Primary outcomes studied were opioid consumption and pain intensity scores. Through a systematic review, a limited selection of studies exploring neuromodulation techniques in patients undergoing lumbar spinal surgeries for postoperative pain relief was identified. Existing literature suggests potential benefits of transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) in reducing opioid consumption and alleviating postoperative pain. In individual randomized control trials within the review, TENS resulted in a 62% reduction in opioid use compared to sham, while motor/prefrontal tDCS had mixed results across trials. Findings from the studies suggest non-invasive neuromodulation techniques may potentially reduce postoperative opioid requirements after lumbar spine surgery. The smaller pool of available studies highlights a significant gap in research on neuromodulation for postoperative pain, especially for the lumbar surgery population. Further high-quality, large-scale randomized controlled trials are needed to investigate their functions within clinical practice.
脊柱外科手术后的镇痛仍然是一项艰巨的挑战，尤其是由于腰椎手术的高发生率以及与阿片类镇痛策略相关的固有风险。神经调节已成为管理与这些手术相关疼痛的一种有前景的治疗方式。进行了一项系统评价，以确定研究神经调节技术在接受腰椎手术的患者中缓解术后疼痛有效性的随机对照试验（RCT）。按照系统评价和Meta分析的首选报告项目（PRISMA）指南，对在线数据库进行了全面检索。纳入了研究神经调节用于腰椎手术后缓解疼痛的随机对照试验。研究的主要结局是阿片类药物消耗量和疼痛强度评分。通过系统评价，确定了有限的一些研究，这些研究探索了神经调节技术在接受腰椎手术的患者中缓解术后疼痛的情况。现有文献表明，经颅直流电刺激（tDCS）和经皮电刺激神经疗法（TENS）在减少阿片类药物消耗和减轻术后疼痛方面具有潜在益处。在该评价中的个别随机对照试验中，与假治疗相比，TENS使阿片类药物使用量减少了62%，而运动/前额叶tDCS在各试验中的结果不一。研究结果表明，非侵入性神经调节技术可能会降低腰椎手术后的术后阿片类药物需求量。现有研究数量较少，凸显了神经调节用于术后疼痛研究方面的重大差距，尤其是针对腰椎手术人群。需要进一步开展高质量、大规模的随机对照试验，以研究它们在临床实践中的作用。
