Abstract：
OBJECTIVE: This study aimed to review the best evidence on the long-term efficacy of neurostimulation for chronic pain.
METHODS: We systematically reviewed PubMed, CENTRAL, and WikiStim for studies published between the inception of the data bases and July 21, 2022. Randomized controlled trials (RCTs) with a minimum of one-year follow-up that were of high methodologic quality as ascertained using the Delphi list criteria were included in the evidence synthesis. The primary outcome was long-term reduction in pain intensity, and the secondary outcomes were all other reported outcomes. Level of recommendation was graded from I to III, with level I being the highest level of recommendation.
RESULTS: Of the 7119 records screened, 24 RCTs were included in the evidence synthesis. Therapies with recommendations for their usage include pulsed radiofrequency (PRF) for postherpetic neuralgia, transcutaneous electrical nerve stimulation for trigeminal neuralgia, motor cortex stimulation for neuropathic pain and poststroke pain, deep brain stimulation for cluster headache, sphenopalatine ganglion stimulation for cluster headache, occipital nerve stimulation for migraine, peripheral nerve field stimulation for back pain, and spinal cord stimulation (SCS) for back and leg pain, nonsurgical back pain, persistent spinal pain syndrome, and painful diabetic neuropathy. Closed-loop SCS is recommended over open-loop SCS for back and leg pain. SCS is recommended over PRF for postherpetic neuralgia. Dorsal root ganglion stimulation is recommended over SCS for complex regional pain syndrome.
CONCLUSIONS: Neurostimulation is generally effective in the long term as an adjunctive treatment for chronic pain. Future studies should evaluate whether the multidisciplinary management of the physical perception of pain, affect, and social stressors is superior to their management alone.
METHODS: We systematically reviewed PubMed, CENTRAL, and WikiStim for studies published between the inception of the data bases and July 21, 2022. Randomized controlled trials (RCTs) with a minimum of one-year follow-up that were of high methodologic quality as ascertained using the Delphi list criteria were included in the evidence synthesis. The primary outcome was long-term reduction in pain intensity, and the secondary outcomes were all other reported outcomes. Level of recommendation was graded from I to III, with level I being the highest level of recommendation.
RESULTS: Of the 7119 records screened, 24 RCTs were included in the evidence synthesis. Therapies with recommendations for their usage include pulsed radiofrequency (PRF) for postherpetic neuralgia, transcutaneous electrical nerve stimulation for trigeminal neuralgia, motor cortex stimulation for neuropathic pain and poststroke pain, deep brain stimulation for cluster headache, sphenopalatine ganglion stimulation for cluster headache, occipital nerve stimulation for migraine, peripheral nerve field stimulation for back pain, and spinal cord stimulation (SCS) for back and leg pain, nonsurgical back pain, persistent spinal pain syndrome, and painful diabetic neuropathy. Closed-loop SCS is recommended over open-loop SCS for back and leg pain. SCS is recommended over PRF for postherpetic neuralgia. Dorsal root ganglion stimulation is recommended over SCS for complex regional pain syndrome.
CONCLUSIONS: Neurostimulation is generally effective in the long term as an adjunctive treatment for chronic pain. Future studies should evaluate whether the multidisciplinary management of the physical perception of pain, affect, and social stressors is superior to their management alone.
摘要：
目的：本研究旨在回顾神经刺激治疗慢性疼痛长期疗效的最佳证据。
方法：我们系统地回顾了PubMed，中部,和WikiStim在数据库成立至2022年7月21日之间发表的研究。根据Delphi列表标准确定的具有至少一年随访的方法学质量高的随机对照试验（RCT）包括在证据综合中。主要结果是疼痛强度的长期降低，次要结局是所有其他报告的结局.推荐等级从I到III，一级是最高级别的推荐。
结果：在筛选的7119条记录中，24项随机对照试验包括在证据合成中。建议使用的疗法包括脉冲射频（PRF）治疗带状疱疹后神经痛，经皮神经电刺激治疗三叉神经痛,运动皮质刺激治疗神经性疼痛和中风后疼痛，深部脑刺激治疗丛集性头痛，蝶腭神经节刺激治疗丛集性头痛，枕骨神经刺激治疗偏头痛，周围神经场刺激治疗背痛，脊髓刺激（SCS）治疗背部和腿部疼痛，非手术背痛,持续性脊柱疼痛综合征,和痛苦的糖尿病神经病变。对于背部和腿部疼痛，建议使用闭环SCS而不是开环SCS。对于带状疱疹后遗神经痛，建议使用SCS优于PRF。对于复杂的区域疼痛综合征，建议在SCS上刺激背根神经节。
结论：神经刺激作为慢性疼痛的辅助治疗长期有效。未来的研究应该评估疼痛的身体感知的多学科管理，影响，社会压力源优于他们的管理。
方法：我们系统地回顾了PubMed，中部,和WikiStim在数据库成立至2022年7月21日之间发表的研究。根据Delphi列表标准确定的具有至少一年随访的方法学质量高的随机对照试验（RCT）包括在证据综合中。主要结果是疼痛强度的长期降低，次要结局是所有其他报告的结局.推荐等级从I到III，一级是最高级别的推荐。
结果：在筛选的7119条记录中，24项随机对照试验包括在证据合成中。建议使用的疗法包括脉冲射频（PRF）治疗带状疱疹后神经痛，经皮神经电刺激治疗三叉神经痛,运动皮质刺激治疗神经性疼痛和中风后疼痛，深部脑刺激治疗丛集性头痛，蝶腭神经节刺激治疗丛集性头痛，枕骨神经刺激治疗偏头痛，周围神经场刺激治疗背痛，脊髓刺激（SCS）治疗背部和腿部疼痛，非手术背痛,持续性脊柱疼痛综合征,和痛苦的糖尿病神经病变。对于背部和腿部疼痛，建议使用闭环SCS而不是开环SCS。对于带状疱疹后遗神经痛，建议使用SCS优于PRF。对于复杂的区域疼痛综合征，建议在SCS上刺激背根神经节。
结论：神经刺激作为慢性疼痛的辅助治疗长期有效。未来的研究应该评估疼痛的身体感知的多学科管理，影响，社会压力源优于他们的管理。
