Evidence‐Based Umbrella Review of Non‐Invasive Neuromodulation in Chronic Neuropathic Pain

European Journal of Pain, Journal Year: 2025, Volume and Issue: 29(2)

Published: Jan. 21, 2025

ABSTRACT Background and Objective Non‐invasive neuromodulation techniques (NIN), such as transcranial Direct Current Stimulation (tDCS) repetitive Transcranial Magnetic (rTMS), have been extensively researched for their potential to alleviate pain by reversing neuroplastic changes associated with neuropathic (NP), a prevalent complex condition. However, treating NP remains challenging due the numerous variables involved, different techniques, dosages aetiologies. It is necessary provide insights clinicians public healthcare managers support clinical decision‐making. This umbrella review aims consolidate existing evidence on effectiveness of various NIN in managing chronic NP. Databases Data Treatment A systematic search was conducted PubMed/MEDLINE database, including meta‐analyses controlled trials comparing sham interventions treatment. The quality included studies assessed using AMSTAR‐2 tool GRADE system, effect sizes adjusted standard mean difference (SMD). Results 22 comprising 8151 participants from 214 trials. most investigated were tDCS rTMS, primary targets being motor cortex dorsolateral prefrontal cortex. findings suggest that excitatory protocols, particularly high‐frequency rTMS anodal tDCS, are effective reducing intensity individuals overall rated low, primarily heterogeneity among small sample sizes. Conclusion show promise NP, benefits reduction. further high‐quality research needed establish optimal protocols long‐term effects. Significance Statement paper consolidates regarding non‐invasive treatment pain, differentiating based aetiology provides easy access this critical information. also highlights key aspects require field pain.

Language: Английский

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The role of spinal neurons targeted by corticospinal neurons in central poststroke neuropathic pain

CNS Neuroscience & Therapeutics, Journal Year: 2024, Volume and Issue: 30(6)

Published: June 1, 2024

Abstract Background Central poststroke pain (CPSP) is one of the primary sequelae following stroke, yet its underlying mechanisms are poorly understood. Methods By lesioning lateral thalamic nuclei, we first established a CPSP model that exhibits mechanical and thermal hypersensitivity. Innocuous stimuli lesion evoked robust neural activation in somatosensory corticospinal neurons (CSNs), as well deep dorsal horn, where low threshold mechanosensory afferents terminate. In this study, used viral‐based mapping intersectional functional manipulations to decipher role CSNs their spinal targets pathophysiology. Results We mapped post‐synaptic lumbar innervating using an anterograde trans‐synaptic AAV1‐based strategy showed these interneurons were activated by innocuous tactile post‐thalamic lesion. Functionally, tetanus toxin‐based chronic inactivation targeted prevented development CPSP. Consistently, transient chemogenetic silencing alleviated hypersensitivity aversion linked contrast, was insufficient induce allodynia typically observed Conclusion The required but for establishment Our study provided novel insights into potential therapeutic interventions treat refractory central neuropathic conditions.

Language: Английский

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Evidence-Based Umbrella Review of Non-Invasive Neuromodulation in Chronic Neuropathic Pain

SSRN Electronic Journal, Journal Year: 2024, Volume and Issue: unknown

Published: Jan. 1, 2024

Introduction: Non-invasive neuromodulation is extensively researched and applied as a therapeutic strategy for neuropathic pain due to its analgesic properties. Despite numerous meta-analyses guidelines addressing this area, establishing optimal care practices individuals remains pivotal. Objective: To consolidate existing knowledge evidence regarding the use of non-invasive management, we conducted umbrella review (registration number CRD42021239577). Material methods: Employing PICO strategy, systematic search was on PubMed/MEDLINE electronic database from June 2021 February 2024. Only brain stimulation (NIBS) clinical trials were included. Study selection, data extraction, quality assessment through AMSTAR GRADE performed in pairs. Results: A total 111 studies screened, with 20 two network meeting eligibility criteria inclusion review. The most commonly utilized NIBS modalities repetitive transcranial magnetic (rTMS) direct current (tDCS), predominantly targeting primary motor cortex (M1) left dorsolateral prefrontal (DLPFC). included population covered broad spectrum central peripheral conditions. According system, rated low or very low. Conclusion: techniques have demonstrated efficacy management among pain. Significant gaps literature been identified, presenting opportunities enhancing practice should be addressed future research.

Language: Английский

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Advancements in Modern Treatment Approaches for Central Post-Stroke Pain: A Narrative Review

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(18), P. 5377 - 5377

Published: Sept. 11, 2024

Central post-stroke pain (CPSP) poses a multifaceted challenge in medical practice, necessitating thorough and multidisciplinary approach for its diagnosis treatment. This review examines current methods addressing CPSP, highlighting both pharmacological non-pharmacological therapies. It covers the mechanisms clinical effectiveness of these treatments managing CPSP emphasizes importance personalized treatment plans, given varied causes CPSP.

Language: Английский

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