Effect of non-invasive brain stimulation on neuropathic pain following spinal cord injury A systematic review and meta-analysis

Medicine, 2020 · DOI: http://dx.doi.org/10.1097/MD.0000000000021507 · Published: August 21, 2020

Spinal Cord Injury Neurology Pain Management

Simple Explanation

This study investigates the effectiveness of non-invasive brain stimulation techniques, specifically repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), in relieving neuropathic pain (NP) after spinal cord injury (SCI). The researchers analyzed multiple studies to determine if these brain stimulation methods could provide pain relief for individuals with SCI-related neuropathic pain. The meta-analysis focused on studies using rTMS and tDCS, comparing their effects against sham (placebo) stimulations in SCI patients with neuropathic pain. The review aimed to consolidate the findings from various studies to provide a comprehensive understanding of the potential analgesic effects of these non-invasive brain stimulation techniques. The study concludes that rTMS shows better middle-term analgesic effect compared to sham rTMS, but no early analgesic effect on NP after SCI. The authors suggest that more extensive, blinded randomized controlled trials are necessary to further explore the analgesic effects of both rTMS and tDCS on neuropathic pain following SCI.

Study Duration

Not specified

Participants

rTMS: 62 SCI patients, sham rTMS: 65 patients; tDCS: 46 SCI patients, sham tDCS: 41 patients

Evidence Level

Systematic review and meta-analysis

Key Findings

1
rTMS did not show early analgesic effect on NP after SCI compared to sham rTMS.
2
rTMS showed better middle-term analgesic effect compared to sham rTMS.
3
No sufﬁcient evidence could be provided to make a meta-analysis for the analgesic effect of tDCS on NP following SCI over the primary motor area (M1).

Research Summary

The meta-analysis examined the effect of rTMS and tDCS on neuropathic pain following SCI, using data from multiple studies comparing these treatments to sham stimulations. The study found that rTMS did not provide early pain relief after SCI but demonstrated better analgesic effects in the middle-term compared to sham rTMS. However, there was insufficient evidence for a meta-analysis regarding the analgesic effect of tDCS on neuropathic pain following SCI. The conclusion emphasizes the need for more large-scale, blinded, randomized controlled trials to thoroughly investigate the analgesic effects of rTMS and tDCS on neuropathic pain in SCI patients.

Practical Implications

Treatment Planning

rTMS may be considered for middle-term neuropathic pain relief in SCI patients, but early pain management strategies should be different.

Future Research

Highlights the need for more rigorous studies to validate the effectiveness of rTMS and tDCS.

Clinical Practice

Clinicians should be aware of the potential benefits and limitations of rTMS for neuropathic pain management in SCI patients.

Study Limitations

1
Limited number of included studies for rTMS, hindering exploration of heterogeneity sources.
2
Limited number of included studies for tDCS, preventing analysis of short- and middle-term analgesic effects.
3
Significant heterogeneities were indicated among these included studies.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury