Deep Brain Stimulation (DBS) and Motor Cortex Stimulation (MCS) for Central Post-Stroke Pain: A Systematic Review And Meta-Analysis.

IF 2.9 3区 医学 Q1 ANESTHESIOLOGY Pain Medicine Pub Date : 2025-01-11 DOI:10.1093/pm/pnaf001
Siddarth Kannan, Conor S Gillespie, Jeremy Hanemaaijer, John Eraifej, Andrew F Alalade, Alex Green
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Abstract

Introduction: Deep Brain Stimulation (DBS) and Motor Cortex stimulation (MCS) are invasive interventions in order to treat various neuropathic pain syndromes such as Central Post-Stroke Pain. While each treatment has varying degree of success, comparative analysis has not yet been performed, and the success rates of these techniques using validated, objective pain scores have not been synthesised.

Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Three databases were searched, and articles published from January 2000 October 2024 were included (last search date 25 October 2024). Meta-Analysis was performed using random effects models. We evaluated the performance of DBS or MCS by assessing studies that reported pain relief using Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS) scores.

Results: Of the 478 articles identified, 32 were included in the analysis (330 patients- 139 DBS, & 191 MCS). The improvement in mean VAS score for patients that underwent DBS post-surgery was 48.6% compared to a score of 53.1% for patients that had MCS. The pooled number of patients who improved after DBS was 0.62 (95% CI, 0.51-0.71, I2=16%). The pooled number of patients who improved after MCS was 0.64 (95% CI, 0.53-0.74, I2=40%).

Conclusion: The use of neurosurgical interventions such as DBS and MCS are last-resort treatments for Central Post-Stroke Pain, with limited studies exploring and comparing these two techniques. While our study shows that MCS might be a slightly better treatment option, further research would need to be done to determine the appropriate surgical intervention in the treatment of Central Post-Stroke Pain.

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深部脑刺激(DBS)和运动皮质刺激(MCS)治疗中枢性卒中后疼痛:系统回顾和荟萃分析。
脑深部电刺激(DBS)和运动皮质刺激(MCS)是治疗各种神经性疼痛综合征(如中枢性卒中后疼痛)的侵入性干预措施。虽然每种治疗方法都有不同程度的成功,但尚未进行比较分析,并且使用经过验证的客观疼痛评分的这些技术的成功率尚未合成。方法:根据PRISMA指南进行系统评价和荟萃分析。检索了三个数据库,纳入了2000年1月至2024年10月发表的文章(最后检索日期为2024年10月25日)。采用随机效应模型进行meta分析。我们通过使用视觉模拟量表(VAS)或数值评定量表(NRS)评分评估报告疼痛缓解的研究来评估DBS或MCS的性能。结果:在纳入的478篇文献中,32篇纳入分析(330例患者- 139例DBS, 191例MCS)。术后接受DBS的患者的VAS平均评分改善48.6%,而MCS患者的VAS平均评分改善53.1%。DBS后改善的患者总数为0.62 (95% CI, 0.51-0.71, I2=16%)。MCS后改善的患者总数为0.64 (95% CI, 0.53-0.74, I2=40%)。结论:DBS和MCS等神经外科干预措施是中枢性卒中后疼痛的最后治疗手段,对这两种技术的探索和比较研究有限。虽然我们的研究表明MCS可能是一个稍微更好的治疗选择,但需要进一步的研究来确定治疗中枢性卒中后疼痛的适当手术干预。
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来源期刊
Pain Medicine
Pain Medicine 医学-医学:内科
CiteScore
6.50
自引率
3.20%
发文量
187
审稿时长
3 months
期刊介绍: Pain Medicine is a multi-disciplinary journal dedicated to pain clinicians, educators and researchers with an interest in pain from various medical specialties such as pain medicine, anaesthesiology, family practice, internal medicine, neurology, neurological surgery, orthopaedic spine surgery, psychiatry, and rehabilitation medicine as well as related health disciplines such as psychology, neuroscience, nursing, nurse practitioner, physical therapy, and integrative health.
期刊最新文献
Building Community Through Data: The value of a Researcher Driven Open Science Ecosystem. Patient-Expressed Goals in Chronic Pain Management: A Qualitative Analysis of Primary Care Visits. Effectiveness of cognitive functional therapy (CFT) for chronic spinal pain: a systematic review with meta-analysis. Deep Brain Stimulation (DBS) and Motor Cortex Stimulation (MCS) for Central Post-Stroke Pain: A Systematic Review And Meta-Analysis. Transforming Pain Medicine: The Power of Collaboration, Entrepreneurship, and Innovation.
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