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Non-Invasive Neuromodulation in Diabetic Peripheral Neuropathy: a meta-analysis (5484)
Improving Delivery of Care and Novel Treatments for Pain and Palliative Patients 1
April 14, 2020 issue 94 (15_supplement) 5484
https://doi.org/10.1212/WNL.94.15_supplement.54
Author
Kevin Pacheco-Barrios, Huiyan Zeng, Ying Cao, Ying Li, Jimming Zhang, Caifeng Yang, and Felipe Fregni
Abstract
Objective
Background
DPN is a common complication of diabetes and typically accompanied by painful symptoms. A large number of therapeutic agents have been tried for symptomatic relief, but with varying results. The use of NINM is a potential treatment option for DPN.
Design/Methods
The search was carried out in Medline, Web of Science, Scopus, Lilacs, Embase, Pedro, and China National Knowledge Infrastructure database until Aug 30th 2019. Randomized clinical trials and quasi-experimental studies reporting the effect of NINM in DPN subjects were selected and revised. This process was carried out in duplicate. Hedge’s effect sizes of QST outcomes and their 95% confidence intervals (95% CI) were calculated, and random-effects meta-analyses were performed.
Results
Twenty studies met the inclusion criteria, of which 18 were controlled trials and 2 were quasi-experiments. The pooled analysis of controlled trials found a significant reduction of central NINM techniques such as tDCS and TMS on pain score (SMD=−0.75, 95% CI=−1.35 to−0.14), but not by peripheral NINMs, such as TENS (SMD=−0.58, 95% CI=−1.23 to 0.07). Subgroup results show that NINMs achieved an analgesic effect with treatment protocols more than three times a week and in the DPN population who were resistant or intolerant to analgesic medications.
Conclusions
Meta-analytic results indicate a significant effect of central NINMs in neuropathic pain reduction among patients with DPN. For DPN patients with resistant pain or intolerant to analgesics, NINM techniques could be an alternative option. Due to the limited number of studies that included a long follow-up, more evidence is required before treatment recommendations can be made.
Disclosure