Noninvasive Brain Stimulation Does Not Improve Neuropathic Pain in Individuals With Spinal Cord Injury

Yu, Binbin; Qiu, Huaide; Li, Jiahui; Zhong, Caiyun; Li, Jianan

doi:10.1097/phm.0000000000001421

Cited by 21 publications

(20 citation statements)

References 29 publications

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“…2, according to AMSTAR-2 criteria, 1 Cochrane SR [23] was graded as "high." Two SRs [26,27] were graded as "low," and 20 SRs [18,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] were graded as "critically low" [22,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]]. e SRs were downgraded mainly due to the following reasons: absence of a predesigned and registered protocol [22,29,30,34,36,40,...…”

Section: Studies Selectedmentioning

confidence: 99%

“…All SRs [22,23, were published between 2009 and 2020. Among the 23 included SRs, 11 [23,28,31,33,37,38,40,42,44,46] conducted a metaanalysis. e number of included primary studies ranged from 5 to 131, and they were conducted between 2004 and 2020.…”

Section: Characteristics Of Srsmentioning

confidence: 99%

“…Of all SRs, 13 [23,27,28,30,32,36,38,41,42,45,46] included only RCTs; 12 SRs [22,23,29,31,34,36,39,40,42,[44][45][46] included patients with NP with different causes; and 11 were specially conducted on NP with specific etiologies or due to a single disease. One SR [28] included pain after spinal cord injury (SCI); 4 SRs [26,30,33,43] included central poststroke pain after stroke (CPSP); 4 SRs [31,37,38,41] included migraine, 1 SR [35] included headache, and 1 SR [27] included orofacial pain (OFP). As for the intervention, 9 SRs [22,29,34,36,38,40,[44][45][46] only assessed TMS; 8 SRs [23,26,28,35,…”

Section: Characteristics Of Srsmentioning

confidence: 99%

“…One SR [28] included pain after spinal cord injury (SCI); 4 SRs [26,30,33,43] included central poststroke pain after stroke (CPSP); 4 SRs [31,37,38,41] included migraine, 1 SR [35] included headache, and 1 SR [27] included orofacial pain (OFP). As for the intervention, 9 SRs [22,29,34,36,38,40,[44][45][46] only assessed TMS; 8 SRs [23,26,28,35,37,39,41] also assessed other non-invasive stimulations; 1 SR [31] assessed neuromodulation techniques; 1 SR [30] assessed non-pharmacological interventions; 3 SRs [32,33,42] assessed pharmacological and non-pharmacological management of NP; and 1 SR [43] assessed non-invasive physical modalities.…”

Section: Characteristics Of Srsmentioning

confidence: 99%

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Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain on the Non-Motor Cortex: An Evidence Mapping of Systematic Reviews

Zang

Zhang

Lai

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Objective. This study was aimed to summarize and analyze the quality of the available evidence in systematic reviews (SRs) of repetitive transcranial magnetic stimulation (rTMS) on the non-motor cortex (non-M1) for neuropathic pain (NP) through an evidence mapping approach. Methods. We follow the Global Evidence Mapping (GEM) methodology. Searches were conducted in PubMed, EMBASE, Epistemonikos, and the Cochrane Library. The study type was restricted to SRs with or without meta-analysis. All literature published before January 23, 2021, were included. The methodological quality of the included SRs was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). Data were extracted according to a defined population-intervention-comparison-outcome (PICO) framework from primary studies that included SRs. The same PICO was categorized into PICOs according to interventions (stimulation target, frequency, number of sessions (short: 1–5 sessions, medium: 5–10 sessions, and long: >10 sessions)) and comparison (sham rTMS or other targets). The evidence mapping was presented in tables and a bubble plot. Results. A total of 23 SRs were included. According to the AMSTAR-2, 20 SRs scored “very low” in terms of methodological quality, 2 SRs scored “low,” and 1 SR scored “high.” A total of 17 PICOs were extracted. The dorsolateral prefrontal cortex (DLPFC) is the most studied of the non-motor cortex targets. PICOs of DLPFC, premotor cortex (PMC), frontal cortex, and secondary somatosensory cortex (S2) were mainly categorized with a “potentially better” conclusion. High-frequency (5–20 Hz) rTMS of non-M1 usually lead to “potentially better” conclusions. Conclusions. DLPFC, PMC, frontal cortex, and S2 seem to be promising new targets for rTMS treatment of certain NP. Evidence mapping is a useful and reliable methodology to identify and present the existing evidence gap that more research efforts are necessary in order to highlight the optimal stimulation protocols for non-M1 targets and standardize parameters to fill the evidence gaps of rTMS. Further investigation is advised to improve the methodological quality and the reporting process of SRs.

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Section: Studies Selectedmentioning

confidence: 99%

Section: Characteristics Of Srsmentioning

confidence: 99%

Section: Characteristics Of Srsmentioning

confidence: 99%

Section: Characteristics Of Srsmentioning

confidence: 99%

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Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain on the Non-Motor Cortex: An Evidence Mapping of Systematic Reviews

Zang

Zhang

Lai

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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show abstract

“…According to a meta-analysis on the treatment of neuropathic pain associated with spinal cord injury, by Gao et al from 2017, patients who received rTMS obtained greater pain reduction than those who received sham rTMS intervention (placebo), although the results did not reach statistical significance [40]. The result of a more recent meta-analysis based on 11 randomized clinical trials on this subject shows no significant effect of rTMS on neuropathic pain compared to placebo [41].…”

Section: Transcranial Magnetic Stimulationmentioning

confidence: 99%

Neuromodulation in the treatment of symptoms of spinal cord injury

Niemirski¹,

Machowiec²,

Komisarczuk³

et al. 2020

J Educ Health Sport

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Introduction and purpose: Spinal cord injury may be associated with loss of motor and sensory functions, autonomic system functions and chronic pain. The development of technology has enabled the emergence of invasive and non-invasive methods of electrical and magnetic stimulation of the nervous system, which show a growing potential in the treatment of these symptoms in human and animal studies. The purpose of the study is a presentation of the most current studies about the selected methods of neuromodulation of the nervous system in the treatment of symptoms of spinal cord injury. Description of the state of knowledge: Neuromodulatory methods improve the functioning of patients affected by spinal cord injury. Studies on epidural stimulation of the spinal cord, transcranial magnetic stimulation, transcranial direct current stimulation transcutaneous spinal cord, and use of neuromodulation methods in combination with brain-machine interfaces stimulation show a reduction of chronic pain resistant to pharmacotherapy, improvement of motor limb function, respiratory function and bladder function. However, there are few large randomized studies with higher evidence strength. Conclusions: Neuromodulation is effective in the treatment of symptoms of spinal cord injury. Promising results should lead to further research to increase the strength of evidence for the effectiveness of these therapies, improve technology and a deeper understanding of the mechanisms behind their effectiveness.

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Modulation of central pain mechanisms using high‐definition transcranial direct current stimulation: A double‐blind, sham‐controlled study

Kold

Graven‐Nielsen

2022

European Journal of Pain

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Background:The use of high-definition transcranial direct current stimulation (HD-tDCS) has shown analgesic effects in some chronic pain patients, but limited anti-nociceptive effects in healthy asymptomatic subjects. Methods: This double-blinded sham-controlled study assessed the effects of HD-tDCS applied on three consecutive days on central pain mechanisms in healthy participants with (N = 40) and without (N = 40) prolonged experimental pain induced by intramuscular injection of nerve growth factor into the right hand on Day 1. Participants were randomly assigned to Sham-tDCS (N = 20 with pain, N = 20 without) or Active-tDCS (N = 20 with pain, N = 20 without) targeting simultaneously the primary motor cortex and dorsolateral prefrontal cortex for 20 min with 2 mA stimulation intensity. Central pain mechanisms were assessed by cuff algometry on the legs measuring pressure pain sensitivity, temporal summation of pain (TSP) and conditioned pain modulation (CPM), at baseline and after HD-tDCS on Day 2 and Day 3. Based on subject's assessment of received HD-tDCS (sham or active), they were effectively blinded. Results: Compared with Sham-tDCS, Active-tDCS did not significantly reduce the average NGF-induced pain intensity. Tonic pain-induced temporal summation at Day 2 and Day 3 was significantly lower in the NGF-pain group under Active-tDCS compared to the pain group with Sham-tDCS (p ≤ 0.05). No significant differences were found in the cuff pressure pain detection/tolerance thresholds or CPM effect across the 3 days of HD-tDCS in any of the four groups. Conclusion: HD-tDCS reduced the facilitation of TSP caused by tonic pain suggesting that efficacy of HD-tDCS might depend on the presence of sensitized central pain mechanisms.

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Noninvasive Brain Stimulation Does Not Improve Neuropathic Pain in Individuals With Spinal Cord Injury

Cited by 21 publications

References 29 publications

Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain on the Non-Motor Cortex: An Evidence Mapping of Systematic Reviews

Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain on the Non-Motor Cortex: An Evidence Mapping of Systematic Reviews

Neuromodulation in the treatment of symptoms of spinal cord injury

Modulation of central pain mechanisms using high‐definition transcranial direct current stimulation: A double‐blind, sham‐controlled study

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