背景:我们先前的研究综合了重复经颅磁刺激(rTMS)对背外侧前额叶皮质(DLPFC)试验的镇痛作用,直至2019年。在过去的几年中,疼痛试验显着增加,随着方法的变化,如样本量,刺激强度,和rTMS范例。
目的:因此,本研究更新了DLPFC-rTMS对慢性疼痛的影响,并量化了不同研究方法学差异的影响。
结果:共纳入36项研究。其中,26项研究为临床试验(更新=9,307/711患者),10名(更新=1,34/249名参与者)参与了疼痛研究.更新的荟萃分析不支持包括额外试验后对神经性疼痛的影响(pshort-term=0.20,pmid-term=0.50)。然而,在延长至六周随访的偏头痛试验中,有中等至较大的镇痛效果(SMDmid-term=-0.80,SMDlong-term=-0.51),这是以前没有报道的。考虑了研究的方法学差异。DLPFC-rTMS还诱导疼痛的情绪方面的潜在改善(SMDshort-term=-0.28)。
结论:更新的系统荟萃分析继续支持慢性疼痛的镇痛效果。然而,更新的结果不再支持DLPFC-rTMS缓解神经性疼痛,并支持DLPFC-rTMS治疗偏头痛。也有证据表明DLPFC-rTMS可以改善疼痛的情绪方面。
BACKGROUND: Our previous study synthesized the analgesic effects of repetitive Transcranial Magnetic Stimulation (rTMS) over the dorsolateral prefrontal cortex (
DLPFC) trials up to 2019. There has been a significant increase in pain trials in the past few years, along with methodological variabilities such as sample size, stimulation intensity, and rTMS paradigms.
OBJECTIVE: This study therefore updated the effects of DLPFC-rTMS on chronic pain and quantified the impact of methodological differences across studies.
RESULTS: A total of 36 studies were included. Among them, 26 studies were clinical trials (update = 9, 307/711 patients), and 10 (update = 1, 34/249 participants) were provoked pain studies. The updated meta-analysis does not support an effect on neuropathic pain after including the additional trials (pshort-term = 0.20, pmid-term = 0.50). However, there is medium-to-large analgesic effect in migraine trials extending up to six weeks follow-up (SMDmid-term = -0.80, SMDlong-term = -0.51), that was not previously reported. Methodological differences wthine the studies were considered.
DLPFC-rTMS also induces potential improvement in the emotional aspects of pain (SMDshort-term = -0.28).
CONCLUSIONS: The updated systematic meta-analysis continues to support analgesic effects for chronic pain overall. However, the updated results no longer support
DLPFC-rTMS for pain relief in neuropathic pain, and do supports
DLPFC-rTMS in the management of migraine. There is also evidence for
DLPFC-rTMS to improve emotional aspects of pain.