Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis
Objectives: To conduct a systematic review and meta-analysis to examine the effect of transcranial direct current stimulation (tDCS) on reducing neuropathic pain intensity in individuals with spinal cord injury (SCI). Methods: Medline, CINAHL, EMBASE and PsycINFO databases were searched for all rele...
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| Veröffentlicht in: | Spinal cord 2015-11, Vol.53 (11), p.780-785 |
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| creator | Mehta, S McIntyre, A Guy, S Teasell, R W Loh, E |
| description | Objectives:
To conduct a systematic review and meta-analysis to examine the effect of transcranial direct current stimulation (tDCS) on reducing neuropathic pain intensity in individuals with spinal cord injury (SCI).
Methods:
Medline, CINAHL, EMBASE and PsycINFO databases were searched for all relevant articles published from 1980 to November 2014. Trials were included if (i) tDCS intervention group and a placebo control group were present; (ii) at least 50% of participants in the study had an SCI and there were at least three participants; (iii) participants were aged 18 years or older; and (iv) persistent pain for at least 3 months. Studies were excluded if: (i) the tDCS intervention group was compared with an active treatment group; (ii) there was insufficient reporting detail to enable pooling of data; and (iii) it was a nonclinical trial (that is, reviews, epidemiology, basic sciences). A standardized mean difference (SMD)±s.e. and 95% confidence interval (CI) was calculated for each outcome of interest and the results were pooled using a fixed or random effects model, as appropriate. Effect sizes were interpreted as: small >0.2, moderate >0.5, large >0.8.
Results:
Five studies met inclusion criteria of which four were randomized controlled trials and one was a prospective controlled trial. The pooled analysis found a significant effect of tDCS on reducing neuropathic pain after SCI post treatment (SMD=0.510±0.202; 95% CI, 0.114–0.906;
P |
| doi_str_mv | 10.1038/sc.2015.118 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1765983117</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1765983117</sourcerecordid><originalsourceid>FETCH-LOGICAL-c490t-dff95400660e9b06563ef817136bf24d06563ba74b4ecdd08c2e3e999d77cfa93</originalsourceid><addsrcrecordid>eNqNkc1rFTEUxYNY7Ieu3EvAjVDnmUwymYk7KfUDCt206yGTuWnzmEnG3Ezh_Qn-1-b1VRFx4SYJOb97LodDyGvONpyJ7gPaTc14s-G8e0ZOuGxV1ahaPi9voepKCi2OySniljGmue5ekONacS063p6QH5fOgc3-AQIg0uhoTiagLYc3Ex19Kiq1a0oQMsXs53Uy2cdAXUw03wOdTTB3MO_lMh1gTXEx-d5buhgfqHEZEsXFh2JnYxqpD9s17T5SQ2fIpirj0w49viRHzkwIr57uM3L7-fLm4mt1df3l28Wnq8pKzXI1OqcbyZhSDPTAVKMEuBKlZB1cLcfHn8G0cpBgx5F1tgYBWuuxba0zWpyRdwffJcXvK2DuZ48WpskEiCv2vFWN7gTn7X-ggredkE1d0Ld_odu4phLtkWJKi1rud58fKJsiYgLXL8nPJu16zvp9mT3afl9mX8os9Jsnz3WYYfzN_mqvAO8PABYp3EH6Y-k__H4C2wqqOg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1730693249</pqid></control><display><type>article</type><title>Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis</title><source>MEDLINE</source><source>EZB Electronic Journals Library</source><source>SpringerLink Journals - AutoHoldings</source><creator>Mehta, S ; McIntyre, A ; Guy, S ; Teasell, R W ; Loh, E</creator><creatorcontrib>Mehta, S ; McIntyre, A ; Guy, S ; Teasell, R W ; Loh, E</creatorcontrib><description>Objectives:
To conduct a systematic review and meta-analysis to examine the effect of transcranial direct current stimulation (tDCS) on reducing neuropathic pain intensity in individuals with spinal cord injury (SCI).
Methods:
Medline, CINAHL, EMBASE and PsycINFO databases were searched for all relevant articles published from 1980 to November 2014. Trials were included if (i) tDCS intervention group and a placebo control group were present; (ii) at least 50% of participants in the study had an SCI and there were at least three participants; (iii) participants were aged 18 years or older; and (iv) persistent pain for at least 3 months. Studies were excluded if: (i) the tDCS intervention group was compared with an active treatment group; (ii) there was insufficient reporting detail to enable pooling of data; and (iii) it was a nonclinical trial (that is, reviews, epidemiology, basic sciences). A standardized mean difference (SMD)±s.e. and 95% confidence interval (CI) was calculated for each outcome of interest and the results were pooled using a fixed or random effects model, as appropriate. Effect sizes were interpreted as: small >0.2, moderate >0.5, large >0.8.
Results:
Five studies met inclusion criteria of which four were randomized controlled trials and one was a prospective controlled trial. The pooled analysis found a significant effect of tDCS on reducing neuropathic pain after SCI post treatment (SMD=0.510±0.202; 95% CI, 0.114–0.906;
P
<0.012); however, this effect was not maintained at follow-up (SMD=0.353±0.272; 95% CI, −0.179 to 0.886;
P
<0.194). A reduction of 1.33 units on a 10-item scale was observed post treatment. No significant adverse events were reported.
Conclusion:
Meta-analytic results indicate a moderate effect of tDCS in reducing neuropathic pain among individuals with SCI; however, the effect was not maintained at follow-up. A mean pooled decrease of 1.33 units on a 10-item scale was found post treatment. Several factors were implicated in the effectiveness of tDCS in reducing pain. Due to the limited number of studies and lack of follow-up, more evidence is required before treatment recommendations can be made.</description><identifier>ISSN: 1362-4393</identifier><identifier>EISSN: 1476-5624</identifier><identifier>DOI: 10.1038/sc.2015.118</identifier><identifier>PMID: 26193817</identifier><identifier>CODEN: SPCOFM</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/308/409 ; 692/308/575 ; Anatomy ; Animals ; Biomedical and Life Sciences ; Biomedicine ; Disease Management ; Human Physiology ; Humans ; Neuralgia - etiology ; Neuralgia - therapy ; Neurochemistry ; Neuropsychology ; Neurosciences ; review ; Spinal Cord Injuries - complications ; Transcranial Direct Current Stimulation - methods</subject><ispartof>Spinal cord, 2015-11, Vol.53 (11), p.780-785</ispartof><rights>International Spinal Cord Society 2015</rights><rights>Copyright Nature Publishing Group Nov 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c490t-dff95400660e9b06563ef817136bf24d06563ba74b4ecdd08c2e3e999d77cfa93</citedby><cites>FETCH-LOGICAL-c490t-dff95400660e9b06563ef817136bf24d06563ba74b4ecdd08c2e3e999d77cfa93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/sc.2015.118$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/sc.2015.118$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26193817$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mehta, S</creatorcontrib><creatorcontrib>McIntyre, A</creatorcontrib><creatorcontrib>Guy, S</creatorcontrib><creatorcontrib>Teasell, R W</creatorcontrib><creatorcontrib>Loh, E</creatorcontrib><title>Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis</title><title>Spinal cord</title><addtitle>Spinal Cord</addtitle><addtitle>Spinal Cord</addtitle><description>Objectives:
To conduct a systematic review and meta-analysis to examine the effect of transcranial direct current stimulation (tDCS) on reducing neuropathic pain intensity in individuals with spinal cord injury (SCI).
Methods:
Medline, CINAHL, EMBASE and PsycINFO databases were searched for all relevant articles published from 1980 to November 2014. Trials were included if (i) tDCS intervention group and a placebo control group were present; (ii) at least 50% of participants in the study had an SCI and there were at least three participants; (iii) participants were aged 18 years or older; and (iv) persistent pain for at least 3 months. Studies were excluded if: (i) the tDCS intervention group was compared with an active treatment group; (ii) there was insufficient reporting detail to enable pooling of data; and (iii) it was a nonclinical trial (that is, reviews, epidemiology, basic sciences). A standardized mean difference (SMD)±s.e. and 95% confidence interval (CI) was calculated for each outcome of interest and the results were pooled using a fixed or random effects model, as appropriate. Effect sizes were interpreted as: small >0.2, moderate >0.5, large >0.8.
Results:
Five studies met inclusion criteria of which four were randomized controlled trials and one was a prospective controlled trial. The pooled analysis found a significant effect of tDCS on reducing neuropathic pain after SCI post treatment (SMD=0.510±0.202; 95% CI, 0.114–0.906;
P
<0.012); however, this effect was not maintained at follow-up (SMD=0.353±0.272; 95% CI, −0.179 to 0.886;
P
<0.194). A reduction of 1.33 units on a 10-item scale was observed post treatment. No significant adverse events were reported.
Conclusion:
Meta-analytic results indicate a moderate effect of tDCS in reducing neuropathic pain among individuals with SCI; however, the effect was not maintained at follow-up. A mean pooled decrease of 1.33 units on a 10-item scale was found post treatment. Several factors were implicated in the effectiveness of tDCS in reducing pain. Due to the limited number of studies and lack of follow-up, more evidence is required before treatment recommendations can be made.</description><subject>692/308/409</subject><subject>692/308/575</subject><subject>Anatomy</subject><subject>Animals</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Disease Management</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Neuralgia - etiology</subject><subject>Neuralgia - therapy</subject><subject>Neurochemistry</subject><subject>Neuropsychology</subject><subject>Neurosciences</subject><subject>review</subject><subject>Spinal Cord Injuries - complications</subject><subject>Transcranial Direct Current Stimulation - methods</subject><issn>1362-4393</issn><issn>1476-5624</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkc1rFTEUxYNY7Ieu3EvAjVDnmUwymYk7KfUDCt206yGTuWnzmEnG3Ezh_Qn-1-b1VRFx4SYJOb97LodDyGvONpyJ7gPaTc14s-G8e0ZOuGxV1ahaPi9voepKCi2OySniljGmue5ekONacS063p6QH5fOgc3-AQIg0uhoTiagLYc3Ex19Kiq1a0oQMsXs53Uy2cdAXUw03wOdTTB3MO_lMh1gTXEx-d5buhgfqHEZEsXFh2JnYxqpD9s17T5SQ2fIpirj0w49viRHzkwIr57uM3L7-fLm4mt1df3l28Wnq8pKzXI1OqcbyZhSDPTAVKMEuBKlZB1cLcfHn8G0cpBgx5F1tgYBWuuxba0zWpyRdwffJcXvK2DuZ48WpskEiCv2vFWN7gTn7X-ggredkE1d0Ld_odu4phLtkWJKi1rud58fKJsiYgLXL8nPJu16zvp9mT3afl9mX8os9Jsnz3WYYfzN_mqvAO8PABYp3EH6Y-k__H4C2wqqOg</recordid><startdate>20151101</startdate><enddate>20151101</enddate><creator>Mehta, S</creator><creator>McIntyre, A</creator><creator>Guy, S</creator><creator>Teasell, R W</creator><creator>Loh, E</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20151101</creationdate><title>Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis</title><author>Mehta, S ; McIntyre, A ; Guy, S ; Teasell, R W ; Loh, E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c490t-dff95400660e9b06563ef817136bf24d06563ba74b4ecdd08c2e3e999d77cfa93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>692/308/409</topic><topic>692/308/575</topic><topic>Anatomy</topic><topic>Animals</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Disease Management</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Neuralgia - etiology</topic><topic>Neuralgia - therapy</topic><topic>Neurochemistry</topic><topic>Neuropsychology</topic><topic>Neurosciences</topic><topic>review</topic><topic>Spinal Cord Injuries - complications</topic><topic>Transcranial Direct Current Stimulation - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mehta, S</creatorcontrib><creatorcontrib>McIntyre, A</creatorcontrib><creatorcontrib>Guy, S</creatorcontrib><creatorcontrib>Teasell, R W</creatorcontrib><creatorcontrib>Loh, E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Spinal cord</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mehta, S</au><au>McIntyre, A</au><au>Guy, S</au><au>Teasell, R W</au><au>Loh, E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis</atitle><jtitle>Spinal cord</jtitle><stitle>Spinal Cord</stitle><addtitle>Spinal Cord</addtitle><date>2015-11-01</date><risdate>2015</risdate><volume>53</volume><issue>11</issue><spage>780</spage><epage>785</epage><pages>780-785</pages><issn>1362-4393</issn><eissn>1476-5624</eissn><coden>SPCOFM</coden><abstract>Objectives:
To conduct a systematic review and meta-analysis to examine the effect of transcranial direct current stimulation (tDCS) on reducing neuropathic pain intensity in individuals with spinal cord injury (SCI).
Methods:
Medline, CINAHL, EMBASE and PsycINFO databases were searched for all relevant articles published from 1980 to November 2014. Trials were included if (i) tDCS intervention group and a placebo control group were present; (ii) at least 50% of participants in the study had an SCI and there were at least three participants; (iii) participants were aged 18 years or older; and (iv) persistent pain for at least 3 months. Studies were excluded if: (i) the tDCS intervention group was compared with an active treatment group; (ii) there was insufficient reporting detail to enable pooling of data; and (iii) it was a nonclinical trial (that is, reviews, epidemiology, basic sciences). A standardized mean difference (SMD)±s.e. and 95% confidence interval (CI) was calculated for each outcome of interest and the results were pooled using a fixed or random effects model, as appropriate. Effect sizes were interpreted as: small >0.2, moderate >0.5, large >0.8.
Results:
Five studies met inclusion criteria of which four were randomized controlled trials and one was a prospective controlled trial. The pooled analysis found a significant effect of tDCS on reducing neuropathic pain after SCI post treatment (SMD=0.510±0.202; 95% CI, 0.114–0.906;
P
<0.012); however, this effect was not maintained at follow-up (SMD=0.353±0.272; 95% CI, −0.179 to 0.886;
P
<0.194). A reduction of 1.33 units on a 10-item scale was observed post treatment. No significant adverse events were reported.
Conclusion:
Meta-analytic results indicate a moderate effect of tDCS in reducing neuropathic pain among individuals with SCI; however, the effect was not maintained at follow-up. A mean pooled decrease of 1.33 units on a 10-item scale was found post treatment. Several factors were implicated in the effectiveness of tDCS in reducing pain. Due to the limited number of studies and lack of follow-up, more evidence is required before treatment recommendations can be made.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>26193817</pmid><doi>10.1038/sc.2015.118</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; EZB Electronic Journals Library; SpringerLink Journals - AutoHoldings |
| subjects | 692/308/409 692/308/575 Anatomy Animals Biomedical and Life Sciences Biomedicine Disease Management Human Physiology Humans Neuralgia - etiology Neuralgia - therapy Neurochemistry Neuropsychology Neurosciences review Spinal Cord Injuries - complications Transcranial Direct Current Stimulation - methods |
| title | Effectiveness of transcranial direct current stimulation for the management of neuropathic pain after spinal cord injury: a meta-analysis |
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