Noninvasive motor cortex stimulation effects on quantitative sensory testing in healthy and chronic pain subjects: a systematic review and meta-analysis
| Autor: | Maria Alejandra Luna-Cuadros, Kevin Pacheco-Barrios, Judah L Barouh, Marina Gnoatto-Medeiros, Alejandra Cardenas-Rojas, Ludmilla Candido-Santos, Felipe Fregni, Wolnei Caumo, Piero F Mejia-Pando, Stefano Giannoni-Luza, Alice Barra |
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| Rok vydání: | 2020 |
| Předmět: |
Population
Article law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial 030202 anesthesiology law Threshold of pain medicine education education.field_of_study business.industry Chronic pain medicine.disease Confidence interval Anesthesiology and Pain Medicine medicine.anatomical_structure Neurology Anesthesia Meta-analysis Brain stimulation Neurology (clinical) business 030217 neurology & neurosurgery Motor cortex |
| Zdroj: | Pain |
| ISSN: | 1872-6623 0304-3959 |
| DOI: | 10.1097/j.pain.0000000000001893 |
| Popis: | One of the potential mechanisms of motor cortex stimulation by noninvasive brain stimulation (NIBS) effects on pain is through the restoration of the defective endogenous inhibitory pain pathways. However, there are still limited data on quantitative sensory testing (QST), including conditioned pain modulation (CPM), supporting this mechanism. This systematic review and meta-analysis aimed to evaluate the effects of noninvasive motor cortex stimulation on pain perception as indexed by changes in QST outcomes. Database searches were conducted until July 2019 to include randomized controlled trials that performed sham-controlled NIBS on the motor cortex in either the healthy and/or pain population and assessed the QST and CPM. Quality of studies was assessed through the Cochrane tool. We calculated the Hedge's effect sizes of QST and CPM outcomes and their 95% confidence intervals (95% CIs) and performed random-effects meta-analyses. Thirty-eight studies were included (1178 participants). We found significant increases of pain threshold in healthy subjects (ES = 0.16, 95% CI = 0.02-0.31, I2 = 22.2%) and pain populations (ES = 0.48, 95% CI = 0.15-0.80, I2 = 68.8%), and homogeneous higher CPM effect (pain ratings reduction) in healthy subjects (ES = -0.39, 95% CI = -0.64 to -0.14, I2 = 17%) and pain populations (ES = -0.35, 95% CI = -0.60 to -0.11, I2 = 0%) in the active NIBS group compared with sham. These results support the idea of top-down modulation of endogenous pain pathways by motor cortex stimulation as one of the main mechanisms of pain reduction assessed by QST, which could be a useful predictive and prognostic biomarker for chronic pain personalized treatment with NIBS. |
| Databáze: | OpenAIRE |
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