Non-invasive neuromodulation effects on painful diabetic peripheral neuropathy: a systematic review and meta-analysis

Zeng, Hui; Pacheco‐Barrios, Kevin; Cao, Ying; Liu, Ying; Zhang, Jinming; Yang, Caifeng; Fregni, Felipe

doi:10.1038/s41598-020-75922-9

Cited by 16 publications

(9 citation statements)

References 71 publications

(88 reference statements)

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“…There were five reviews on painful peripheral diabetic neuropathy ( Table 13 ). The most recent review published Zeng et al [ 169 ] was published in 2020 and included seven studies and a meta-analysis on that pooled data from various peripheral electrical stimulation techniques that failed to find differences with controls. However, the authors claimed that their subgroup analysis demonstrated “… a large effect for one of its subgroups (electrical peripheral techniques, predominantly TENS) …”, although the effect size for TENS per se was not reported and pooled samples did not reach our threshold for sufficient data to make a judgement.…”

Section: Resultsmentioning

confidence: 99%

Does TENS Reduce the Intensity of Acute and Chronic Pain? A Comprehensive Appraisal of the Characteristics and Outcomes of 169 Reviews and 49 Meta-Analyses

et al. 2021

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Background and Objectives: Uncertainty about the clinical efficacy of transcutaneous electric nerve stimulation (TENS) to alleviate pain spans half a century. There has been no attempt to synthesise the entire body of systematic review evidence. The aim of this comprehensive review was to critically appraise the characteristics and outcomes of systematic reviews evaluating the clinical efficacy of TENS for any type of acute and chronic pain in adults. Materials and Methods: We searched electronic databases for full reports of systematic reviews of studies, overviews of systematic reviews, and hybrid reviews that evaluated the efficacy of TENS for any type of clinical pain in adults. We screened reports against eligibility criteria and extracted data related to the characteristics and outcomes of the review, including effect size estimates. We conducted a descriptive analysis of extracted data. Results: We included 169 reviews consisting of eight overviews, seven hybrid reviews and 154 systematic reviews with 49 meta-analyses. A tally of authors’ conclusions found a tendency toward benefits from TENS in 69/169 reviews, no benefits in 13/169 reviews, and inconclusive evidence in 87/169 reviews. Only three meta-analyses pooled sufficient data to have confidence in the effect size estimate (i.e., pooled analysis of >500 events). Lower pain intensity was found during TENS compared with control for chronic musculoskeletal pain and labour pain, and lower analgesic consumption was found post-surgery during TENS. The appraisal revealed repeated shortcomings in RCTs that have hindered confident judgements about efficacy, resulting in stagnation of evidence. Conclusions: Our appraisal reveals examples of meta-analyses with ‘sufficient data’ demonstrating benefit. There were no examples of meta-analyses with ‘sufficient data’ demonstrating no benefit. Therefore, we recommend that TENS should be considered as a treatment option. The considerable quantity of reviews with ‘insufficient data’ and meaningless findings have clouded the issue of efficacy. We offer solutions to these issues going forward.

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Section: Resultsmentioning

confidence: 99%

Does TENS Reduce the Intensity of Acute and Chronic Pain? A Comprehensive Appraisal of the Characteristics and Outcomes of 169 Reviews and 49 Meta-Analyses

et al. 2021

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“…By contrast, the synthesis results for the low frequencies (1 and 0.5 Hz) showed no difference or were mixed, meaning these intervention protocols may be less effective or inappropriate for some specific NPs. (3) The impact of the quality Galhardoni et al, 2015;Jin et al, 2015;Kumru et al, 2017;O'Connell et al, 2018*;Aamir et al, 2020;Liampas et al, 2020b;Moisset et al, 2020b;Yang and Chang, 2020;Zeng et al, 2020Onesti et al, 2013 Cragg et al, 2016;Gao et al, 2017;O'Connell et al, 2018*;Akyuz and Giray, 2019;Nardone et al, 2019;Aamir et al, 2020;Gatzinsky et al, 2020;Moisset et al, 2020b;Shen et al, 2020;Chang, 2020 Yilmaz et al, 2014*;Ma et al, 2015;Malavera et al, 2016;Choi and Chang, 2018 Lin et al, Kumar et al, 2009;Leung et al, 2009;Zaghi et al, 2011;Galhardoni et al, 2015;Chen et al, 2016;Gao et al, 2017;Kumru et al, 2017;Herrero Babiloni et al, 2018;O'Connell et al, 2018*;Gatzinsky et al, 2020;Moisset et al, 2020a;Yang and Chang, 2020Lefaucheur et al, 2004…”

Section: Discussion Principal Findings Of Evidence Mappingmentioning

confidence: 99%

“…Qualitative studies may arrive at conclusions different from those in quantitative studies. For example, a primary study by Onesti et al (2013) and meta-analysis of Zeng et al (2020) had a “no difference” conclusion, while the review of Yang and Chang (2020) , which only mentioned pain relief, showed a “potentially better” conclusion. The final conclusion in the evidence map of Onesti et al’s study was “mixed.” (3) Populations with different diseases that cause NP could cause heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

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Evidence Mapping Based on Systematic Reviews of Repetitive Transcranial Magnetic Stimulation on the Motor Cortex for Neuropathic Pain

Zang

Zhang

Lai

et al. 2022

Front. Hum. Neurosci.

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Background and ObjectiveThere is vast published literature proposing repetitive transcranial magnetic stimulation (rTMS) technology on the motor cortex (M1) for the treatment of neuropathic pain (NP). Systematic reviews (SRs) focus on a specific problem and do not provide a comprehensive overview of a research area. This study aimed to summarize and analyze the evidence of rTMS on the M1 for NP treatment through a new synthesis method called evidence mapping.MethodsSearches were conducted in PubMed, EMBASE, Epistemonikos, and The Cochrane Library to identify the studies that summarized the effectiveness of rTMS for NP. The study type was restricted to SRs with or without meta-analysis. All literature published before January 23, 2021, was included. Two reviewers independently screened the literature, assessed the methodological quality, and extracted the data. The methodological quality of the included SRs was assessed by using the A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). Data were extracted following a defined population, intervention, comparison, and outcome (PICO) framework from primary studies that included SRs. The same PICO was categorized into PICOs according to interventions [frequency, number of sessions (short: 1–5 sessions, medium: 5–10 sessions, and long: >10 sessions)] and compared. The evidence map was presented in tables and a bubble plot.ResultsA total of 38 SRs met the eligibility criteria. After duplicate primary studies were removed, these reviews included 70 primary studies that met the scope of evidence mapping. According to the AMSTAR-2 assessment, the quality of the included SRs was critically low. Of these studies, 34 SRs scored “critically low” in terms of methodological quality, 2 SR scored “low,” 1 SR scored “moderate,” and 1 SR scored “high.”ConclusionEvidence mapping is a useful methodology to provide a comprehensive and reliable overview of studies on rTMS for NP. Evidence mapping also shows that further investigations are necessary to highlight the optimal stimulation protocols and standardize all parameters to fill the evidence gaps of rTMS. Given that the methodological quality of most included SRs was “critically low,” further investigations are advised to improve the methodological quality and the reporting process of SRs.

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“…A neuromodulação não invasiva em pacientes com sintomas de resistência ou intolerância a medicamentos analgésicos podem ser alternativas seguras, mas são necessárias mais evidências antes que as recomendações de tratamento possam ser feitas. (Zeng et al, 2020). Terapias eletrofísicas como terapia a laser de baixa intensidade mostraram resultados favoráveis nos sintomas e reabilitação sensório-motora, mas nenhum considerado clinicamente significativo (Bula-Oyola et al, 2021).…”

Section: Tratamentos Não Farmacológicosunclassified

A eficácia dos tratamentos para a dor neuropática

Filho

Vieira

Gonzalez

et al. 2022

RSD

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The neuropathic pain is a type of chronic pain that arises from an injury or disease of the somatosensory nervous system, central or peripheral origin. It is a heterogeneous range of pain syndromes, with different pathophysiological mechanisms and different degrees of intensity of signs and symptoms. As a result, there are several therapeutic resources, whether they are pharmacological, physical or cognitive, and obstacles to an adequate and effective treatment. From the advances in therapy alone, only a minority of patients achieve significant pain relief. To analyze available treatments for neuropathic pain and present the best pharmacological options. A literature review was carried out, using the descriptors "pain", "neuropathy", "treatment". The database used was PUBMED, with filters for full free text, systematic review and meta-analysis, from 2016 to 2021. This review found that there is evident efficacy when using gabapentin and pregabalin to relieve neuropathic pain. These drugs are neuromodulators of the antidepressant class, and both showed greater improvement than the placebo group. In addition, the use of vitamin B12 (methylcobalamin) and acupuncture was also shown to be effective, but on a smaller scale and with a longer treatment time. Studies on the treatment of neuropathic pain have increased over the years, which allows us to think about significant advances in the future. Currently, drugs such as Pregabalin and Gabapentin are used, or non-pharmacological methods such as acupuncture. Therefore, greater attention should be given to studies on treatments for this disease, aiming at the patient's well-being.

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Non-invasive neuromodulation effects on painful diabetic peripheral neuropathy: a systematic review and meta-analysis

Cited by 16 publications

References 71 publications

Does TENS Reduce the Intensity of Acute and Chronic Pain? A Comprehensive Appraisal of the Characteristics and Outcomes of 169 Reviews and 49 Meta-Analyses

Does TENS Reduce the Intensity of Acute and Chronic Pain? A Comprehensive Appraisal of the Characteristics and Outcomes of 169 Reviews and 49 Meta-Analyses

Evidence Mapping Based on Systematic Reviews of Repetitive Transcranial Magnetic Stimulation on the Motor Cortex for Neuropathic Pain

A eficácia dos tratamentos para a dor neuropática

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