Can noninvasive Brain Stimulation Improve Pain and Depressive Symptoms in Patients With Neuropathic Pain? A Systematic Review and Meta-Analysis

Chengfei Gao; Qixiu Zhu; Zhengyu Gao; Jinpeng Zhao; Min Jia; Tieshan Li

doi:10.1016/j.jpainsymman.2022.05.002

Can noninvasive Brain Stimulation Improve Pain and Depressive Symptoms in Patients With Neuropathic Pain? A Systematic Review and Meta-Analysis

J Pain Symptom Manage. 2022 Oct;64(4):e203-e215. doi: 10.1016/j.jpainsymman.2022.05.002. Epub 2022 May 10.

Authors

Chengfei Gao¹, Qixiu Zhu¹, Zhengyu Gao¹, Jinpeng Zhao², Min Jia³, Tieshan Li⁴

Affiliations

¹ Department of Rehabilitation Medicine (C.G., Q.Z., Z.G., T.L.), The Affiliated Hospital of Qingdao University, Qingdao, Shandong Provience, China.
² Department of Cardiothoracic Surgery (J.Z.), Yantai Municipal Laiyang Central Hospital, Yantai, Shandong Provience, China.
³ Department of Rehabilitation Medicine (M.J.), Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, Shandong Provience, China.
⁴ Department of Rehabilitation Medicine (C.G., Q.Z., Z.G., T.L.), The Affiliated Hospital of Qingdao University, Qingdao, Shandong Provience, China. Electronic address: tieshanl@qdu.edu.cn.

PMID: 35550165
DOI: 10.1016/j.jpainsymman.2022.05.002

Abstract

Context: Noninvasive brain stimulations (NIBS) have been increasingly applied to the patients with neuropathic pain (NP), while the effectiveness of NIBS in the management of NP is still conflicting.

Objectives: To examine the effectiveness of NIBS on pain and depression symptoms of patients with NP.

Methods: A comprehensive literature retrieval was performed on MEDLINE, Embase, PsycINFO, PEDro, and CENTRAL from the establishment of the databases to June 2021. Randomized controlled trials comparing NIBS with sham stimulation were included.

Results: A total of thirteen trials comprising 498 participants met the inclusion criteria. The pooled analysis found a significant effect on the improvement of pain scores at post-treatment, favoring NIBS over sham stimulation (SMD = -0.60; 95% CI: -1.00 to -0.20; P = 0.004). Subgroup analysis showed that only transcranial direct current stimulation (tDCS) (SMD = -0.38; 95% CI: -0.71 to -0.04; P = 0.030) and high-frequency repetitive transcranial magnetic stimulation (H-rTMS) (SMD = -0.95; 95% CI: -1.85 to -0.04; P = 0.040) had positive effects on pain reduction among all types of NIBS. The favorable effects of NIBS remained significant at follow-up visit (SMD = -0.51; 95% CI: -0.79 to -0.23; P = 0.000), while only H-rTMS was found in subgroup analyses to significantly improve pain scales of the patients (SMD = -0.54; 95% CI: -0.85 to -0.24; P = 0.000). Additionally, overall NIBS showed no beneficial effect over sham stimulation in reducing depression symptoms of NP patients either at post-treatment (SMD = -0.19; 95% CI: -0.39 to 0.01; P = 0.061) or at follow-up visit (SMD = -0.18; 95% CI: -0.45 to 0.10; P = 0.202).

Conclusion: This meta-analysis revealed the analgesic effect of NIBS on patients with NP, while no beneficial effect was observed on reducing concomitant depression symptoms. The findings recommended the clinical application of NIBS in patients with NP.

Keywords: Noninvasive brain stimulation; depression; meta-analysis; neuropathic pain; systematic review.

Publication types

Meta-Analysis
Review
Systematic Review
Research Support, U.S. Gov't, P.H.S.
Research Support, Non-U.S. Gov't

MeSH terms

Analgesics
Brain
Depression* / therapy
Humans
Neuralgia* / therapy
Pain
Pain Management*
Transcranial Direct Current Stimulation*
Transcranial Magnetic Stimulation

Substances

Analgesics