对于中枢中风后疼痛患者的非侵入性脑刺激的有效性:随机对照试验的系统审查和元分析
Tieshan Li1, Xianjun Zhang2, Xiaoming Yu3
1Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
American journal of physical medicine & rehabilitation
|January 27, 2026
概括
非侵入性脑刺激 (NIBS) 有效地降低了中枢中风后疼痛 (CPSP) 患者的疼痛强度,特别是当通过跨直流刺激 (tDCS) 准主要运动皮层 (M1) 时. 然而,NIBS对心理症状或生活质量没有显著影响.
科学领域:
- 神经科学是一个神经科学.
- 疼痛管理 疼痛管理
- 康复医学 康复医学 康复医学
背景情况:
- 中央中风后疼痛 (CPSP) 是由于中风引起的体感通路损伤造成的衰弱状况.
- 目前针对CPSP的治疗方法的疗效有限,并且可能会产生显著的副作用.
- 非侵入性脑刺激 (NIBS) 技术已经成为神经病痛的潜在治疗选择.
研究的目的:
- 系统地审查和分析NIBS对CPSP患者疼痛强度,心理症状和生活质量的影响.
- 确定特定的NIBS参数,如刺激目标和模式,与更高的疗效相关.
主要方法:
- 进行了随机对照试验 (RCT) 的系统审查和元分析.
- 在主要数据库 (PubMed,Embase,Cochrane图书馆,Web of Science,CNKI) 进行了搜索,截至2025年4月.
- 来自13项涉及430名参与者的RCT的数据使用标准化平均差异 (SMD) 和置信区间 (CI) 进行了分析.
主要成果:
- 与假冒刺激相比,NIBS显著降低了CPSP患者的疼痛强度 (SMD = -0.64,p = 0.035).
- 针对主运动皮质 (M1) 的刺激 (SMD = -1.07) 和使用跨直流刺激 (tDCS) (SMD = -1.08) 观察到更大的止痛效应.
- 在抑郁症,焦虑或生活质量方面没有发现显著改善.
结论:
- NIBS,特别是针对M1的tDCS,显示出作为CPSP的止痛疗法的潜力.
- NIBS似乎没有有效地解决CPSP的心理社会方面.
- 进一步的大规模,精心设计的试验是必要的,以确认有效性,并建立在CPSP管理中NIBS的最佳作用.
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