Title
Neuromodulation techniques in phantom limb pain: A systematic review and meta-analysis
Date Issued
01 January 2020
Access level
open access
Resource Type
journal article
Publisher(s)
Oxford University Press
Abstract
Objective. To evaluate the effects of neuromodulation techniques in adults with phantom limb pain (PLP). Methods. A systematic search was performed, comprising randomized controlled trials (RCTs) and quasi-experimental (QE) studies that were published from database inception to February 2019 and that measured the effects of neuromodulation in adults with PLP. Hedge's g effect size (ES) and 95% confidence intervals were calculated, and randomeffects meta-analyses were performed. Results. Fourteen studies (nine RCTs and five QE noncontrolled studies) were included. The meta-analysis of RCTs showed significant effects for i) excitatory primary motor cortex (M1) stimulation in reducing pain after stimulation (ES =-1.36, 95% confidence interval [CI] =-2.26 to-0.45); ii) anodal M1 transcranial direct current stimulation (tDCS) in lowering pain after stimulation (ES =-1.50, 95% CI =-2.05 to 0.95), and one-week follow-up (ES =-1.04, 95% CI =-1.64 to 0.45). The meta-analysis of noncontrolled QE studies demonstrated a high rate of pain reduction after stimulation with transcutaneous electrical nerve stimulation (rate = 67%, 95% CI = 60% to 73%) and at one-year follow-up with deep brain stimulation (rate = 73%, 95% CI = 63% to 82%). Conclusions. The evidence from RCTs suggests that excitatory M1 stimulation-specifically, anodal M1 tDCS-has a significant short-term effect in reducing pain scale scores in PLP. Various neuromodulation techniques appear to have a significant and positive impact on PLP, but due to the limited amount of data, it is not possible to draw more definite conclusions.
Start page
2310
End page
2322
Volume
21
Issue
10
Language
English
OCDE Knowledge area
Neurología clínica
Scopus EID
2-s2.0-85094933237
PubMed ID
Source
Pain Medicine (United States)
ISSN of the container
15262375
Sponsor(s)
Funding sources: This study was supported by an National Institutes of Health (NIH) RO1 grant (1R01HD082302-01A1 to Felipe Fregni).
Sources of information: Directorio de Producción Científica Scopus