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Evidence-Based Umbrella Review of Non-Invasive Neuromodulation in Chronic Neuropathic Pain
Rafael Jardim Duarte-Moreira1, Lívia Shirahige2, Indira Enith Rodriguez-Prieto3
1Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, SP, Brazil.
European Journal of Pain (London, England)
|January 21, 2025
Summary
Non-invasive neuromodulation (NIN) shows promise for neuropathic pain (NP). Excitatory protocols like high-frequency rTMS and anodal tDCS effectively reduce NP intensity, though evidence quality is low, necessitating further research.
Area of Science:
- Neurology
- Pain Management
- Neuroscience
Background:
- Neuropathic pain (NP) is a complex condition challenging to treat.
- Non-invasive neuromodulation (NIN) techniques like tDCS and rTMS are explored for NP relief.
- Existing evidence on NIN for NP requires consolidation for clinical decision-making.
Purpose of the Study:
- To consolidate evidence on the effectiveness of NIN for chronic NP.
- To provide insights for clinicians and healthcare managers on NIN for NP.
- To differentiate effective NIN techniques based on pain aetiology.
Main Methods:
- Umbrella review of meta-analyses of controlled trials.
- Systematic search of PubMed/MEDLINE database.
- Quality assessment using AMSTAR-2 and GRADE; effect sizes adjusted using standard mean difference (SMD).
Main Results:
- Included 22 meta-analyses (8151 participants, 214 trials).
- High-frequency rTMS and anodal tDCS showed effectiveness in reducing NP intensity.
- Overall evidence quality was low due to heterogeneity and small sample sizes.
Conclusions:
- NIN techniques offer potential benefits for NP management.
- Further high-quality research is needed to optimize NIN protocols and assess long-term effects.
- This review aids clinicians by consolidating NIN evidence for NP treatment.
