Jie Zhou , Ying Wang , Xi Luo , Paul B. Fitzgerald , Robin F.H. Cash , Bernadette M. Fitzgibbon , Xianwei Che
{"title":"重新审视经颅磁刺激背外侧前额叶皮层对疼痛的影响：最新系统综述和荟萃分析。","authors":"Jie Zhou , Ying Wang , Xi Luo , Paul B. Fitzgerald , Robin F.H. Cash , Bernadette M. Fitzgibbon , Xianwei Che","doi":"10.1016/j.brs.2024.07.011","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>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. <em>Objectives/Methods</em>: This study therefore updated the effects of DLPFC-rTMS on chronic pain and quantified the impact of methodological differences across studies.</p></div><div><h3>Results</h3><p>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 (p<sub>short-term</sub> = 0.20, p<sub>mid-term</sub> = 0.50). However, there is medium-to-large analgesic effect in migraine trials extending up to six weeks follow-up (SMD<sub>mid-term</sub> = −0.80, SMD<sub>long-term</sub> = −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 (SMD<sub>short-term</sub> = −0.28).</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":9206,"journal":{"name":"Brain Stimulation","volume":"17 4","pages":"Pages 928-937"},"PeriodicalIF":7.6000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1935861X24001268/pdfft?md5=361526da8c3297f9dfaa994412a1d8f5&pid=1-s2.0-S1935861X24001268-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Revisiting the effects of rTMS over the dorsolateral prefrontal cortex on pain: An updated systematic review and meta-analysis\",\"authors\":\"Jie Zhou , Ying Wang , Xi Luo , Paul B. Fitzgerald , Robin F.H. Cash , Bernadette M. Fitzgibbon , Xianwei Che\",\"doi\":\"10.1016/j.brs.2024.07.011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>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. <em>Objectives/Methods</em>: This study therefore updated the effects of DLPFC-rTMS on chronic pain and quantified the impact of methodological differences across studies.</p></div><div><h3>Results</h3><p>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 (p<sub>short-term</sub> = 0.20, p<sub>mid-term</sub> = 0.50). However, there is medium-to-large analgesic effect in migraine trials extending up to six weeks follow-up (SMD<sub>mid-term</sub> = −0.80, SMD<sub>long-term</sub> = −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 (SMD<sub>short-term</sub> = −0.28).</p></div><div><h3>Conclusions</h3><p>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. 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Revisiting the effects of rTMS over the dorsolateral prefrontal cortex on pain: An updated systematic review and meta-analysis
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. Objectives/Methods: 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.
期刊介绍：
Brain Stimulation publishes on the entire field of brain stimulation, including noninvasive and invasive techniques and technologies that alter brain function through the use of electrical, magnetic, radiowave, or focally targeted pharmacologic stimulation.
Brain Stimulation aims to be the premier journal for publication of original research in the field of neuromodulation. The journal includes: a) Original articles; b) Short Communications; c) Invited and original reviews; d) Technology and methodological perspectives (reviews of new devices, description of new methods, etc.); and e) Letters to the Editor. Special issues of the journal will be considered based on scientific merit.
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