非侵入性脑刺激治疗神经病理性疼痛的Meta分析

The Effectiveness of Noninvasive Brain Stimulations on Patients with Neuropathic Pain: A Meta-Analysis

摘要: 目的：系统评价非侵入性脑刺激(NIBS)治疗神经病理性疼痛(NP)的有效性。方法：通过计算机检索MEDLINE、Embase、PsycINFO、PEDro、Cochrane library等数据库，限定检索时间从数据库建立到2022年3月。由2名独立研究者按照提前制定好的纳排标准进行文献筛选和数据提取，应用STATA软件进行meta分析。结果：最终纳入13项随机对照研究，共计498名参与者。Meta分析结果显示：治疗结束后，NIBS在改善NP患者疼痛评分方面要显著优于假刺激(SMD = −0.60; 95% CI: −1.00~−0.20; p = 0.004)。对所有类型的NIBS进一步亚组分析发现，只有经颅直流电(SMD = −0.38; 95% CI: −0.71~−0.04; p = 0.030)和高频经颅磁刺激(SMD = −0.95; 95% CI: −1.85~−0.04; p = 0.040)对患者疼痛缓解有积极作用。随访发现，NIBS对神经病理性疼痛患者疼痛的改善作用仍显著优于假刺激(SMD = −0.51; 95% CI: −0.79~−0.23; p = 0.000)，而进一步亚组分析发现仅高频经颅磁刺激可持续改善患者的疼痛(SMD = −0.54; 95% CI: −0.85~−0.24; p = 0.000)。结论：NIBS能够有效缓解神经病理性疼痛患者的疼痛程度。但所纳入文献总体质量一般且样本量偏小，尚需要更高质量、大样本随机对照试验进一步验证。

Abstract: Objective: To comprehensively evaluate the effectiveness of noninvasive brain stimulations on pain symptoms of patients with neuropathic pain. Methods: A literature retrieval was performed on MEDLINE, Embase, PsycINFO, PEDro, and Cochrane library from the establishment of the databases to March 2022. Two independent researchers screened the articles and extracted data according to the inclusion and exclusion criteria, STATA software was used for meta-analysis. Results: A total of thirteen trials comprising 498 participants met the inclusion criteria. The pooled analysis found a significant effect on the improvement of pain scores at post-treatment, favoring NIBS over sham stimulation (SMD = −0.60; 95% CI: −1.00 to −0.20; p = 0.004). Subgroup analysis showed that only transcranial direct current stimulation (tDCS) (SMD = −0.38; 95% CI: −0.71 to −0.04; p = 0.030) and high-frequency repetitive transcranial magnetic stimulation (H-rTMS) (SMD = −0.95; 95% CI: −1.85 to −0.04; p = 0.040) had positive effects on pain reduction among all types of NIBS. The favorable effects of NIBS remained significant at follow-up visit (SMD = −0.51; 95% CI: −0.79 to −0.23; p = 0.000), while only H-rTMS was found in subgroup analyses to significantly improve pain scales of the patients (SMD = −0.54; 95% CI: −0.85 to −0.24; p = 0.000). Conclusions: This meta-analysis revealed the analgesic effect of NIBS on patients with NP, which needed to be further verified through con-ducting more high-quality RCTs with large sample.