European Journal of Pain最新文献

Development and Validation of a Short Version (PAIC6) of the Pain Assessment in Impaired Cognition Scale

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-02-08 DOI: 10.1002/ejp.4795

Vivien Schreiber, Miriam Kunz, Wilco Achterberg, Jenny T. van der Steen, Frank Lobbezoo, Bernhard Langner, Stefan Lautenbacher

Background

Observer pain scales are commonly used to assess pain in individuals with impaired cognition. However, nursing staff have highlighted that extremely tight time schedules and increasing workload demands prevent regular use. With the development of a short version of the Pain Assessment in Impaired Cognition (PAIC15), we aimed to reduce implementation barriers in everyday clinical practice.

Methods

We developed a new 6-item short version (PAIC6) in a first sample (N = 59) and validated its psychometric properties in a second sample (N = 250) of older individuals with cognitive impairments. The item reduction and evaluation involved four steps. First, we used Sample 1 to exclude items based on item quality statistics (e.g., difficulty, reliability). Second, the Partial Credit Model (PCM) was utilised for further reduction using again Sample 1. Third, an expert panel evaluated the preceding steps and suggested a draft short version with six items (PAIC6). Fourth, psychometric properties of the short version were evaluated in the independent Sample 2. Thereafter, the final short version was approved.

Results

The new PAIC6 showed a high correlation with the total scale PAIC15 (r = 0.870), good reliability (Cronbach's α = 0.684), and high convergent construct validity, as observed by a high correlation with the established Pain Assessment in Advanced Dementia (r = 0.602).

Conclusions

Overall, we developed a valid, reliable, and clinically valuable PAIC6 that allows a more time-efficient pain assessment, by reducing the assessment time from 5 min to approximately 2 min (60% time saving).

Significance

Observer pain scales are commonly used to assess pain in individuals with impaired cognition. However, nursing staff have highlighted that extremely tight time schedules and increasing workload demands prevent regular use. To address this, we developed PAIC6, a short version of the Pain Assessment in Impaired Cognition 15 (PAIC15). PAIC6 includes six items and takes 2 min for completion after training, realising a 60%-time reduction compared to the original scale while keeping the psychometric quality high.

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引用次数: 0

Prevalence of Temporomandibular Disorder Symptoms After Whiplash Trauma—A Systematic Review and Meta-Analysis

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-02-08 DOI: 10.1002/ejp.4792

Birgitta Häggman-Henrikson, Anna Lövgren, Wendy Yi-Ying Wu, Christopher Peck, Hans Westergren, Thomas List

Background and Objectives

Temporomandibular disorders (TMDs) is an umbrella term for pain and dysfunction involving jaw muscles and/or the temporomandibular joint, with whiplash trauma suggested to be one risk factor. The aim was to evaluate prevalence and relative risk of TMDs in the acute and chronic stages after whiplash trauma.

Databases and Data Treatment

This review was registered in Prospero (CRD42023407091) and followed the PRISMA guidelines. A literature search in PubMed, Scopus and Web of Science on 10 March 2023 and updated 29 April 2024 identified studies reporting prevalence of TMD after whiplash trauma. Risk of bias was assessed with Joanna Briggs Institute Prevalence Critical Appraisal Tool. A random effect meta-analysis was performed for prevalence of TMD pain.

Results

After screening of 671 identified studies, 96 articles were assessed in full text. Fourteen studies, with 840 cases in the acute and 8293 cases in the chronic stage (i.e., > 3 months post-trauma) were included in a qualitative analysis together with 1591 controls. Nine studies, including 449 cases in the acute and 7912 individuals in the chronic stage after trauma, together with 515 controls, were included in the meta-analysis. Mean prevalence for TMD pain was 18.9% (95% CI 9.71–29.98) in the acute case group, 26.8% (95% CI 15.07–38.79) in the chronic case group, and 5.7% (95% CI 3.08–8.96) in the control group.

Conclusions

The higher prevalence of TMD pain already in the early stage after whiplash trauma, emphasises the need for early comprehensive clinical assessment as well as targeted research to understand underlying mechanisms.

Significance

The prevalence of Temporomandibular disorder pain was high already in the acute stage after whiplash trauma, and there was no evidence of any decrease from the acute to the chronic stage. This finding suggests that early assessment and management rather than a 'wait-and see' approach should be recommended when patients present with orofacial pain related to whiplash trauma.

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引用次数: 0

Ten Minutes of Core Stabilisation Exercise Result in Local Exercise-Induced Hypoalgesia in Patients With Chronic Unspecific Low Back Pain

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-02-08 DOI: 10.1002/ejp.4794

Fabian Tomschi, Andre Zschunke, Thomas Hilberg

<div> <section> <h3> Background</h3> <p>Core stabilisation training is known to be effective in managing pain in patients suffering from chronic low back pain (CLBP). Yet, acute effects of core stabilisation exercise on exercise-induced hypoalgesia (EIH) are largely unknown. This study aimed to examine the EIH effects of an easy-to-perform core stabilisation exercise in CLBP patients and to explore associations between EIH and potential influencing factors (i.e., physical activity, catastrophizing, kinesiophobia, subjective pain state and exercise exertion).</p> </section> <section> <h3> Methods</h3> <p>Thirty patients with unspecific CLBP finished this randomised controlled crossover trial. Patients performed a 10-min isometric core stabilisation exercise and a 10-min control session. Before and after, pain sensitivity was measured via pressure pain thresholds [Newton/cm<sup>2</sup>] locally (low back; PPT<sub>local</sub>) and remotely (forehead, thumb; PPT<sub>remote</sub>). Correlation analyses were performed between EIH and influencing factors.</p> </section> <section> <h3> Results</h3> <p>A ‘Time’ × ‘Intervention’ interaction (<i>p</i> < 0.001) was observed for PPT<sub>local</sub> with post hoc analysis revealing higher values post exercise (<i>p</i> < 0.001; pre: 56.6 ± 20.6, post: 67.5 ± 26.1). No differences were observed for the control session (<i>p</i> = 0.894; pre: 58.5 ± 24.0, post: 58.4 ± 23.3). No such effect was observed for PPT<sub>remote</sub> (<i>p</i> = 0.014). Post hoc analyses showed no differences following the exercise session (<i>p</i> = 0.103; pre: 41.3 ± 12.5, post: 42.5 ± 13.6), while lower PPT<sub>remote</sub> post values were observed post control compared to pre values (<i>p</i> = 0.031; 42.5 ± 14.5, post: 41.3 ± 13.7). The only significant moderate correlation was observed between ΔPPT<sub>local</sub> of the exercise session and catastrophizing with <i>rho</i> = −0.381.</p> </section> <section> <h3> Conclusion</h3> <p>A 10-min isometric core stabilisation exercise results in local lumbar EIH, while no systemic effects are observed. A higher degree of catastrophizing is associated with lower hypoalgesic responses.</p> </section> <section> <h3> Significance</h3> <p>This study shows for the first time that a brief and easy-to-perform 10-min core stabilisation exercise produces significant local pain relief (EIH) in patients with unspecific CLBP. The effect is localised to the lumbar region, with no observed impact

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引用次数: 0

A Multidimensional Regression Model for Predicting Recurrence in Chronic Low Back Pain

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-02-04 DOI: 10.1002/ejp.4793

Yilong Huang, Chunli Li, Jiaxin Chen, Zhongwei Wang, Derong Zhao, Lei Yang, Zhenguang Zhang, Yuanming Jiang, Xiaolina Zhang, Bo He, Zaiyi Liu

Background

Recurrence is common in chronic low back pain (CLBP). However, predicting the recurrence risk remains a challenge. The aim is to develop and validate a machine learning tool to predict the recurrence risk in patients with CLBP by using multidimensional medical information.

Methods

This prospective cohort study consecutively enrolled 341 patients with CLBP from two hospitals between 1 January 2021 and 31 December 2021. Patients from both centres were used for model development and internal validation, employing multivariate logistic regression (MRL) along with three additional machine learning algorithms. The multidimensional model (MDM) was used to predict recurrence in the next 2 years and was compared with the widely used prognostic tool, the STarT BACK Tool (SBT). The models' performance in detecting recurrence was evaluated using several metrics, including the area under the receiver operating characteristic curve (AUC), decision curve analysis, accuracy, sensitivity and specificity.

Results

A total of 131 patients (38.42%) experienced recurrence. In the MRL model, factors linked to recurrence odds included progressive lower limb weakness, anxiety, mechanical pressure test, number of previous episodes, Oswestry disability index and multifidus proton density fat fraction. For recurrence prediction, the MRL-MDM achieved an AUC of 0.813 (95% CI, 0.765–0.862), sensitivity of 85.2% and specificity of 70.2% in internal validation. In comparison, the SBT for recurrence had an AUC of 0.555 (95% CI, 0.518–0.592), sensitivity of 93.3% and specificity of 17.6%.

Conclusion

The MDM may predict recurrence in patients with CLBP over a 2-year period, surpassing the performance of SBT.

Significance Statement

This study found that the STarT BACK tool is suboptimal in predicting the 2-year recurrence of chronic low back pain (CLBP). Our proposed multidimensional machine learning model aids clinicians in identifying patients at high risk for future recurrence of CLBP and in implementing appropriate preventive measures. Given the considerable healthcare resource utilisation associated with the frequent recurrence of CLBP, our novel model provides significant assistance in addressing this issue, demonstrating substantial clinical relevance.

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引用次数: 0

Spontaneous Pain and Pain Sensitivity in Response to Prolonged Experimental Sleep Disturbances—Potential Sex Differences

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-02-04 DOI: 10.1002/ejp.4789

Keeyon Olia, Michael R. Goldstein, Larissa C. Engert, Luciana Besedovsky, Rammy Dang, Suzanne M. Bertisch, Navil Sethna, Monika Haack

Introduction

Insomnia is a highly prevalent condition that predisposes individuals to many chronic pain disorders, with most of them showing pronounced sexual dimorphism. We investigated whether experimental insomnia-like sleep disturbances (ESD) affect spontaneous pain and pain sensitivity, and whether sex modulates pain responses.

Methods

Twenty-four healthy participants (50% females, age 28.3 ± 5.9 years) participated in a study consisting of two 19-day in-laboratory protocols—an ESD protocol consisting of repeated nights of short and disrupted sleep with intermittent nights of undisturbed sleep and a control sleep (CS) protocol consisting of 18 nights with an undisturbed 8-h sleep opportunity. Spontaneous pain was assessed using electronic rating scales during daytime and night-time wake periods. Pain sensitivity was assessed through pressure and heat pain threshold measures every other day of the protocol.

Results

Females responded with higher daytime pain ratings in the ESD compared to the CS condition, while males responded with lower pain ratings (p < 0.05 for condition*sex). Spontaneous pain ratings were higher at night-time than during daytime and worsened across successive nights of sleep disturbances, independent of sex (p < 0.05 for condition*study day*daytime-night-time). Females developed greater pressure pain sensitivity, while males developed greater pain sensitivity to heat in the ESD compared to the CS condition (p < 0.05 for condition*sex).

Conclusion

Pain responses to sleep disturbances strongly vary by sex and may contribute to sex differences in the prevalence and symptom burden of many chronic pain conditions. Because the study was not a priori powered on sex, findings are preliminary and require follow-up in larger samples. Findings further suggest to specifically target night-time pain in sleep disturbed individuals, for example, through optimised timing of analgesic-acting medications.

Significance

Exploration of sex as a modulator suggest that sleep disturbances amplify spontaneous pain and pressure pain sensitivity to a greater extent in females than in males, and this may contribute to females' overrepresentation and disproportionate symptom burden observed for many pain-related disorders for which insomnia is comorbid or a risk factor.

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引用次数: 0

Eyes on Newborns: How NICU Staff's Attention and Emotions Shape Neonatal Pain Assessment

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-02-03 DOI: 10.1002/ejp.4791

Philipp Deindl, Alexandra Luister, Eik Vettorazzi, Nadine Pointner, Dominique Singer, Angelika Berger, Michael Wagner, Vito Giordano

Background

Assessing pain in neonates is crucial for their management but is inherently subjective. This study investigated the effects of visual attention, gaze patterns, and empathic responses of neonatal healthcare professionals on their assessments of neonatal pain.

Methods

Conducted at the Department of Neonatology, University Medical Center Hamburg-Eppendorf, we employed eye-tracking to monitor staff's responses to videos depicting neonates experiencing non-noxious thermal, brief noxious, and prolonged noxious stimuli. Videos were presented in two formats: full body view, providing contextual information, and face-only view, lacking contextual details. Pain assessments were measured using a Faces Pain Rating Scale (FPRS), exploring the impacts of contextual cues, professional experience, and job roles.

Results

The study found brief and prolonged noxious stimuli eliciting significantly higher FPRS scores compared to non-painful stimuli, with the full body view resulting in higher pain ratings than the face-only view. The mouth region attracted focused attention. Nurses generally reported higher pain scores and exhibited larger pupil diameters compared to physicians, suggesting a stronger empathic response.

Conclusion

This research highlights the essential role of visual cues and empathic responses in neonatal pain assessment, demonstrating how professional roles and stimulus presentation format impact evaluations, and underlining the need for standardised protocols to improve neonatal pain management accuracy.

Significance

The study emphasises the importance of visual cues and empathy in neonatal pain assessment, highlighting the roles of healthcare professionals and stimulus presentation formats. It addresses challenges in understanding neonatal pain, advocating for standardised protocols. Using eye-tracking technology, the research explores how professionals' visual attention and empathy affect pain evaluations, suggesting more objective assessment methods.

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引用次数: 0

Cannabinoids for Acute Postoperative Pain Management: A Systematic Review and Meta-Analysis of Clinical Trials

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-01-29 DOI: 10.1002/ejp.4790

Víctor Hugo González Cárdenas, Mariafernanda Valdivieso Díaz, Carlos Felipe Mateus Almeciga, Juan Carlos Echeverry Carrillo, Juan Carlos López Trujillo, Angela Rocío Hernández Arenas, Jorge Luis Paternina Rojas

<div> <section> <h3> Background</h3> <p>Poor acute postoperative pain control, coupled with the use of intravenous medications with a limited and unsafety efficacy spectrum, has led to new therapeutic alternative explorations to reduce adverse events while increasing its analgesic efficacy. There cannabinoids have been proposed as a useful control agent in post-surgical pain. Nevertheless, to date, there is no solid evidence to evaluate them. The current article sought to determine cannabinoids' effectiveness and safety in the aforementioned context.</p> </section> <section> <h3> Methods</h3> <p>A systematic review of controlled clinical trials evaluated the efficacy and safety of cannabinoids for the treatment of acute postoperative pain. The study was structured under the Cochrane recommendations. Primary outcomes included: pain intensity reduction, the number and doses of rescue analgesics and adverse events.</p> </section> <section> <h3> Results</h3> <p>Of 62 articles found, only five were included. Four of them presented high inter-observer agreement and 60% were classified as having a low risk of bias. When evaluating the objectives of each article, a disparity was found in the investigative methods and terms implemented. Due to the heterogeneity of methods, it was not possible to carry out meta-analytic evaluations and only qualitative evaluations were feasible.</p> </section> <section> <h3> Conclusions</h3> <p>Despite finding contradictory evidence in relation to the analgesic cannabis effect in the postoperative context, methodological disparities found in the included articles and the impossibility of performing collective quantitative analyses were more significant. Before concluding with the well-known sentence: “further intervention studies are necessary”, this report has identified limitations and has proposed recommendations for the planning and execution of future cannabis clinical trials, which will support new and necessary evidence for stronger meta-analytic reviews.</p> </section> <section> <h3> Significance</h3> <p>The management of severe pain after surgery, and the use of intravenous drugs with limited and potentially unsafe effectiveness, has led to the exploration of new treatment options to minimize side effects while improving pain relief. Cannabinoids have been suggested as a potential solution for managing post-surgical pain, but there is currently insufficient evidence to assess their effectiveness. The purpose of this article was to evaluate the effectiveness and safety of cannabinoids in this context.</p> </

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引用次数: 0

A Parallel Human and Rat Investigation of the Interaction Between Descending and Spinal Modulatory Mechanisms

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-01-23 DOI: 10.1002/ejp.4775

Anna Fieldwalker, Ryan Patel, Lucy Zhao, Mateusz W. Kucharczyk, Michael Mansfield, Kirsty Bannister

<div> <section> <h3> Background</h3> <p>Healthy individuals demonstrate considerable heterogeneity upon dynamic quantitative sensory testing assessment of endogenous pain modulatory mechanisms. For those who stratify into a ‘pro-nociceptive profile’ cohort, consisting of inefficient conditioned pain modulation (CPM) and elevated temporal summation of pain (TSP), the optimal approach for balancing the net output of pain modulatory processes towards anti-nociception remains unresolved. In this translational healthy human and rat study, we examined whether descending modulation countered spinal amplification during concurrent application of a CPM and TSP paradigm alongside pupillometry since pontine activity was previously linked to functionality of endogenous pain modulatory mechanisms and pupil dilation.</p> </section> <section> <h3> Methods</h3> <p>Perceptual (quantitative sensory testing) and spinal neuronal (in vivo electrophysiology) assessment was performed in healthy humans and rats respectively upon application of parallel CPM/diffuse noxious inhibitory controls (cuff algometry) and TSP/wind-up (pinprick) paradigms alongside pupillometry.</p> </section> <section> <h3> Results</h3> <p>In humans, repetitive pinprick stimulation produced TSP while concurrent application of a noxious conditioning stimulus did not affect pain ratings to a single pinprick stimulus, repetitive stimulation or the wind-up ratio. In rats, repetitive pinprick produced neuronal wind-up while concurrent application of a noxious conditioning stimulus inhibited neuronal responses to a single stimulus and repetitive stimulation but not the wind-up ratio. For pupillometry experiments, dilatory responses did not increase during application of a TSP or CPM paradigm in humans, while reliable rat responses were not obtained.</p> </section> <section> <h3> Conclusions</h3> <p>Under the conditions of our study, spinal amplification mechanisms surpassed descending inhibitory controls while pupillometry did not offer a reliable indicator of endogenous pain modulatory mechanism function.</p> <p><b>Significance:</b> In this translational healthy human and rat study, activity in descending inhibitory controls did not counter spinal amplification processes underpinned by wind up. Despite pupil dilation being previously linked to modulatory mechanisms, dilatory responses did not offer a reliable indicator of functionality. For pro-nociceptive individuals exhibiting inefficient conditioned pain modulation and/or high temporal summation of pain, dampening facil

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引用次数: 0

The Role of Negative Affect and Experiential Avoidance in Postsurgical Pain and Fatigue Among Norwegian Women With Breast Cancer 负面情绪和经验回避在挪威乳腺癌妇女术后疼痛和疲劳中的作用。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-01-21 DOI: 10.1002/ejp.4788

Maria Frøseth Rosenblom, Silje Endresen Reme, Henrik Børsting Jacobsen

Background

Women undergoing breast cancer surgery frequently experience postsurgical pain and fatigue, which reduces their quality of life. Although psychological factors have been shown to play a role in predicting postsurgical outcomes, the subacute recovery phase often remains underexplored. In this secondary analysis of data from a randomised controlled trial, we sought to investigate the predictive role of negative affect and experiential avoidance on postsurgical symptoms during both acute and subacute recovery.

Methods

From the initial sample, 189 women who met the inclusion criteria completed the Acceptance and Action Questionnaire (AAQ-II) before surgery to assess levels of negative affect and experiential avoidance. Postsurgical pain and fatigue were measured at hospital discharge and again 3–4 weeks later using a 100 mm Visual Analogue Scale (VAS).

Results

Bivariate linear regression analyses revealed that higher presurgical negative affect and experiential avoidance significantly predicted increased levels of all acute and subacute postsurgical symptoms (all p ≤ 0.027). After adjusting for covariates in multivariate regression analyses, the AAQ-II remained a predictor of acute pain unpleasantness (p = 0.011) and fatigue (p = 0.048), although the effect estimates were modest.

Conclusions

These findings underscore the need to take psychological factors into account in treatment planning for acute postsurgical symptoms in order to develop more individualised approaches to optimise recovery for women undergoing breast cancer surgery.

Significance

Women with higher levels of negative affect and experiential avoidance before undergoing breast cancer surgery appear to be at greater risk for experiencing heightened acute postsurgical pain and fatigue. The identification of these psychological predictors can help clinicians recognise individuals at risk for severe postoperative symptoms and develop targeted preventive and curative interventions to mitigate these symptoms and prevent them from becoming chronic.

背景：接受乳腺癌手术的女性经常经历术后疼痛和疲劳，这降低了她们的生活质量。虽然心理因素已被证明在预测术后预后方面发挥作用，但亚急性恢复阶段往往仍未得到充分探讨。在对一项随机对照试验数据的二次分析中，我们试图研究急性和亚急性恢复期间负面情绪和经验回避对术后症状的预测作用。方法：从最初的样本中，189名符合纳入标准的妇女在手术前完成接受和行动问卷（AAQ-II），以评估负面影响和经验回避的水平。术后疼痛和疲劳在出院时和3-4周后再次使用100 mm视觉模拟量表（VAS）进行测量。结果：双变量线性回归分析显示，较高的术前负面情绪和经验回避显著预测所有急性和亚急性术后症状水平的增加（均p≤0.027）。在多变量回归分析中调整协变量后，AAQ-II仍然是急性疼痛不愉快（p = 0.011）和疲劳（p = 0.048）的预测因子，尽管效果估计是适度的。结论：这些发现强调了在制定急性术后症状的治疗计划时考虑心理因素的必要性，以便开发更个性化的方法来优化乳腺癌手术妇女的恢复。意义：在接受乳腺癌手术前，负面情绪和经验回避水平较高的女性出现急性术后疼痛和疲劳加剧的风险更大。识别这些心理预测因素可以帮助临床医生识别有严重术后症状风险的个体，并制定有针对性的预防和治疗干预措施，以减轻这些症状并防止其成为慢性症状。

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引用次数: 0

Evidence-Based Umbrella Review of Non-Invasive Neuromodulation in Chronic Neuropathic Pain 慢性神经性疼痛无创神经调节的循证综合综述。

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain

Pub Date : 2025-01-21 DOI: 10.1002/ejp.4786

Rafael Jardim Duarte-Moreira, Lívia Shirahige, Indira Enith Rodriguez-Prieto, Maércio Maia Alves, Tiago da Silva Lopes, Rachel Fontes Baptista, Fuad Ahmad Hazime, Yossi Zana, Gabriel Taricani Kubota, Daniel Ciampi de Andrade, Lin Tchia Yeng, Manoel Jacobsen Teixeira, Egas Caparelli Moniz de Aragão Dáquer, Katia Nunes Sá, Kátia Monte-Silva, Abrahão Fontes Baptista

Background and Objective

Non-invasive neuromodulation techniques (NIN), such as transcranial Direct Current Stimulation (tDCS) and repetitive Transcranial Magnetic Stimulation (rTMS), have been extensively researched for their potential to alleviate pain by reversing neuroplastic changes associated with neuropathic pain (NP), a prevalent and complex condition. However, treating NP remains challenging due to the numerous variables involved, such as different techniques, dosages and aetiologies. It is necessary to provide insights for clinicians and public healthcare managers to support clinical decision-making. This umbrella review aims to consolidate existing evidence on the effectiveness of various NIN in managing chronic NP.

Databases and Data Treatment

A systematic search was conducted in the PubMed/MEDLINE database, including meta-analyses of controlled trials comparing NIN techniques with sham interventions for NP treatment. The quality of included studies was assessed using the AMSTAR-2 tool and the GRADE system, with effect sizes adjusted to the standard mean difference (SMD).

Results

The review included 22 meta-analyses comprising 8151 participants from 214 controlled trials. The most investigated NIN techniques were tDCS and rTMS, with primary targets being the motor cortex and dorsolateral prefrontal cortex. The findings suggest that excitatory protocols, particularly high-frequency rTMS and anodal tDCS, are effective in reducing pain intensity in individuals with NP. However, the overall quality of evidence was rated low, primarily due to heterogeneity among studies and small sample sizes.

Conclusion

NIN techniques show promise in managing NP, with potential benefits in pain reduction. However, further high-quality research is needed to establish optimal protocols and long-term effects.

Significance Statement

This paper consolidates the evidence regarding non-invasive neuromodulation for the treatment of neuropathic pain, including differentiating the most effective techniques based on the aetiology of pain, and provides clinicians with easy access to this critical information. It also highlights key aspects that require further research in the field of non-invasive neuromodulation and neuropathic pain.

背景和目的：非侵入性神经调节技术（NIN），如经颅直流电刺激（tDCS）和重复经颅磁刺激（rTMS），由于其通过逆转神经性疼痛（NP）相关的神经可塑性变化来减轻疼痛的潜力而被广泛研究，神经性疼痛是一种普遍而复杂的疾病。然而，由于涉及许多变量，如不同的技术、剂量和病因，治疗NP仍然具有挑战性。有必要为临床医生和公共卫生管理人员提供见解，以支持临床决策。本综述旨在巩固现有的各种NIN治疗慢性NP有效性的证据。数据库和数据处理：在PubMed/MEDLINE数据库中进行了系统搜索，包括比较NIN技术与假干预治疗NP的对照试验的荟萃分析。采用AMSTAR-2工具和GRADE系统评估纳入研究的质量，效应量调整为标准平均差（SMD）。结果：本综述包括22项荟萃分析，包括来自214项对照试验的8151名参与者。研究最多的NIN技术是tDCS和rTMS，主要目标是运动皮层和背外侧前额叶皮层。研究结果表明，兴奋性方案，特别是高频rTMS和阳极tDCS，对减轻NP患者的疼痛强度有效。然而，证据的总体质量被评为低，主要是由于研究之间的异质性和小样本量。结论：NIN技术在治疗NP方面有前景，在减轻疼痛方面有潜在的好处。然而，需要进一步的高质量研究来建立最佳方案和长期效果。意义声明：本文巩固了关于非侵入性神经调节治疗神经性疼痛的证据，包括根据疼痛的病因区分最有效的技术，并为临床医生提供了方便获取这一关键信息的途径。它还强调了在非侵入性神经调节和神经性疼痛领域需要进一步研究的关键方面。

{"title":"Evidence-Based Umbrella Review of Non-Invasive Neuromodulation in Chronic Neuropathic Pain","authors":"Rafael Jardim Duarte-Moreira, Lívia Shirahige, Indira Enith Rodriguez-Prieto, Maércio Maia Alves, Tiago da Silva Lopes, Rachel Fontes Baptista, Fuad Ahmad Hazime, Yossi Zana, Gabriel Taricani Kubota, Daniel Ciampi de Andrade, Lin Tchia Yeng, Manoel Jacobsen Teixeira, Egas Caparelli Moniz de Aragão Dáquer, Katia Nunes Sá, Kátia Monte-Silva, Abrahão Fontes Baptista","doi":"10.1002/ejp.4786","DOIUrl":"10.1002/ejp.4786","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Non-invasive neuromodulation techniques (NIN), such as transcranial Direct Current Stimulation (tDCS) and repetitive Transcranial Magnetic Stimulation (rTMS), have been extensively researched for their potential to alleviate pain by reversing neuroplastic changes associated with neuropathic pain (NP), a prevalent and complex condition. However, treating NP remains challenging due to the numerous variables involved, such as different techniques, dosages and aetiologies. It is necessary to provide insights for clinicians and public healthcare managers to support clinical decision-making. This umbrella review aims to consolidate existing evidence on the effectiveness of various NIN in managing chronic NP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Databases and Data Treatment</h3>\u0000 \u0000 <p>A systematic search was conducted in the PubMed/MEDLINE database, including meta-analyses of controlled trials comparing NIN techniques with sham interventions for NP treatment. The quality of included studies was assessed using the AMSTAR-2 tool and the GRADE system, with effect sizes adjusted to the standard mean difference (SMD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The review included 22 meta-analyses comprising 8151 participants from 214 controlled trials. The most investigated NIN techniques were tDCS and rTMS, with primary targets being the motor cortex and dorsolateral prefrontal cortex. The findings suggest that excitatory protocols, particularly high-frequency rTMS and anodal tDCS, are effective in reducing pain intensity in individuals with NP. However, the overall quality of evidence was rated low, primarily due to heterogeneity among studies and small sample sizes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>NIN techniques show promise in managing NP, with potential benefits in pain reduction. However, further high-quality research is needed to establish optimal protocols and long-term effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Significance Statement</h3>\u0000 \u0000 <p>This paper consolidates the evidence regarding non-invasive neuromodulation for the treatment of neuropathic pain, including differentiating the most effective techniques based on the aetiology of pain, and provides clinicians with easy access to this critical information. It also highlights key aspects that require further research in the field of non-invasive neuromodulation and neuropathic pain.</p>\u0000 </section>\u0000 </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"29 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143002558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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