Background

High-frequency rTMS over the dorsolateral prefrontal cortex (DLPFC) has demonstrated mixed effects on chronic and provoked pain.

Objectives/Methods

In this study, a meta-analysis was conducted to characterise the potential analgesic effects of high-frequency rTMS over the DLPFC on both chronic and provoked pain.

Results

A total of 626 studies were identified in a systematic search. Twenty-six eligible studies were included for the quantitative review, among which 17 modulated chronic pain and the remaining investigated the influence on provoked pain. The left side DLPFC was uniformly targeted in the chronic pain studies. While our data identified no overall effect of TMS across chronic pain conditions, there was a significant short-term analgesia in neuropathic pain conditions only (SMD = −0.87). In terms of long-lasting analgesia, there was an overall pain reduction in the midterm (SMD = −0.53, 24.6 days average) and long term (SMD = −0.63, 3 months average) post DLPFC stimulation, although these effects were not observed within specific chronic pain conditions. Surprisingly, the number of sessions was demonstrated to have no impact on rTMS analgesia. In the analysis of provoked pain, our data also indicated a significant analgesic effect following HF-rTMS over the DLPFC (SMD = −0.73). Importantly, we identified a publication bias in the studies of provoked pain but not for chronic pain conditions.

Conclusions

Overall, our findings support that HF-DLPFC stimulation is able to induce an analgesic effect in chronic pain and in response to provoked pain. These results highlight the potential of DLPFC-rTMS in the management of certain chronic pain conditions and future directions are discussed to enhance the potential long-term analgesic effects.

中文翻译：

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背外侧前额叶皮层的高频 rTMS 对慢性和诱发性疼痛的影响：系统评价和荟萃分析

背景

背外侧前额叶皮层 (DLPFC) 的高频 rTMS 已证明对慢性疼痛和诱发性疼痛有不同的影响。

目标/方法

在这项研究中，进行了一项荟萃分析，以表征高频 rTMS 对 DLPFC 对慢性和诱发性疼痛的潜在镇痛作用。

结果

在系统搜索中总共确定了 626 项研究。26 项符合条件的研究被纳入定量评价，其中 17 项调节慢性疼痛，其余研究对诱发性疼痛的影响。左侧 DLPFC 统一针对慢性疼痛研究。虽然我们的数据确定 TMS 对慢性疼痛状况没有整体影响，但仅在神经性疼痛状况下有显着的短期镇痛（SMD = -0.87）。在持久镇痛方面，DLPFC 刺激后中期（SMD = -0.53，平均 24.6 天）和长期（SMD = -0.63，平均 3 个月）的总体疼痛减轻，尽管没有观察到这些影响在特定的慢性疼痛条件下。令人惊讶的是，会议次数被证明对 rTMS 镇痛没有影响。在对诱发疼痛的分析中，我们的数据还表明 HF-rTMS 对 DLPFC 具有显着的镇痛作用（SMD = -0.73）。重要的是，我们在诱发性疼痛的研究中发现了发表偏倚，但在慢性疼痛疾病中没有发现。

结论

总体而言，我们的研究结果支持 HF-DLPFC 刺激能够在慢性疼痛和诱发疼痛中诱导镇痛作用。这些结果突出了 DLPFC-rTMS 在管理某些慢性疼痛状况方面的潜力，并讨论了未来的方向，以增强潜在的长期镇痛作用。