Mohamed Mohamed S I, Alkahlout Lama, Elgamal Salma, Mohiuddin Amna, Al-Sayed Talal, Al-Marri Hamad, Zahid Fatima, Martínez-Magallanes Daniela, Fregni Felipe, Doi Suhail A R, Abdallah Abdallah M, Musa Omran A H, Khan Muhammad Naseem, Babu Giridhara R
Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Brain Netw Modul. 2024 Jul-Sep;3(3):63-70. doi: 10.4103/bnm.bnm_20_24.
Chronic neuropathic pain (CNP) affects 7% of the world's population and is challenging to control since existing medications are inadequate and have negative effects. Electro-cutaneous devices, such as Scrambler Therapy (ST), have emerged as a possible option and have shown promising results in multiple randomized controlled trials (RCTs). However, the long-term efficacy of ST remains unknown. We aimed to evaluate the efficacy of ST in CNP reduction over time. We used the data sources including PubMed, Embase, Scopus, and Cochrane Central Register of Controlled Trials from inception to September 2023. Five placebo and three routine-care controlled RCTs were selected among the screened abstracts. Two authors independently extracted the data. Data was pooled using a model under the common parameters assumption. The studies were evaluated for methodological quality using the MethodologicAl STandard for Epidemiological Research (MASTER) scale. The primary outcome measure was pain reduction; pain was converted to a common 0 to 10 scale, and a weighted mean difference of more than 2 points on a 10-point pain scale was considered clinically important. Eight RCTs that evaluated the effect of ST on CNP were included, with a total sample size of 350 participants. None of the participants withdrew in all these trials owing to adverse events or lack of efficacy. There was high-quality evidence that ST reduced pain in the short term, with a mean difference of -3 points. The dose-response meta-analysis demonstrated a significant reduction in pain scores post-treatment, with a peak reduction at day 40. The effect of ST remained below the baseline values for 90 days, although with limited certainty. This study is the first dose-response meta-analysis to assess the duration of efficacy of ST in the treatment of CNP. The results demonstrated a clinically significant and more sustained reduction in pain created by ST compared to conventional treatments. Our findings indicate that ST could be used as a safe and effective alternative for managing CNP.
慢性神经性疼痛（CNP）影响着全球7%的人口，由于现有药物疗效不佳且有副作用，控制起来颇具挑战。电皮肤设备，如扰频疗法（ST），已成为一种可能的选择，并在多项随机对照试验（RCT）中显示出有前景的结果。然而，ST的长期疗效仍不明确。我们旨在评估ST随时间推移在减轻CNP方面的疗效。我们使用了从创刊到2023年9月的数据源，包括PubMed、Embase、Scopus和Cochrane对照试验中央注册库。在筛选出的摘要中选择了五项安慰剂对照和三项常规护理对照的RCT。两位作者独立提取数据。在共同参数假设下使用模型对数据进行汇总。使用流行病学研究方法标准（MASTER）量表对研究的方法学质量进行评估。主要结局指标是疼痛减轻；疼痛被转换为常见的0至10分制，在10分疼痛量表上加权平均差异超过2分被认为具有临床意义。纳入了八项评估ST对CNP影响的RCT，总样本量为350名参与者。在所有这些试验中，没有参与者因不良事件或缺乏疗效而退出。有高质量证据表明ST在短期内减轻了疼痛，平均差异为-3分。剂量反应荟萃分析表明治疗后疼痛评分显著降低，在第40天达到最大降幅。ST的效果在90天内一直低于基线值，尽管确定性有限。本研究是第一项评估ST治疗CNP疗效持续时间的剂量反应荟萃分析。结果表明，与传统治疗相比，ST在临床上能显著且更持续地减轻疼痛。我们的研究结果表明，ST可作为管理CNP的一种安全有效的替代方法。
