Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados

Detalhes bibliográficos
Autor(a) principal: Carvalho, Carolina Dias de
Data de Publicação: 2023
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações da UFPB
Texto Completo: https://repositorio.ufpb.br/jspui/handle/123456789/30492
Resumo: Background: In the literature, the analgesic effects of Transcranial Direct Current Stimulation (tDCS) in populations with chronic pain have been well reported. In Neuropathic Pain the results are still contrasting, with previous reviews showing small effect sizes and a considerable level of heterogeneity. The objective of the present study is to evaluate the effectiveness of treatment with tDCS in patients with chronic neuropathic pain on pain intensity, disability and psychosocial factors and to determine the predictors of this effectiveness when considering the influence exerted by sample characteristics, study design and parameters of the intervention. Methodology: A systematic search of the electronic databases of MEDLINE, CINAHL, EMBASE and CENTRAL conducted from June to July 2021 was carried out. Controlled clinical trials involving patients with chronic neuropathic pain who applied tDCS were included. The effect was measured using the standardized mean difference (SMD) with a 95% confidence interval, calculated with the values obtained after the intervention between the active and control groups. The level of evidence was assessed with GRADE (Grading of Recommendations Assessment, Development and Evolution) to explore potential moderating factors, we performed meta-regression analyses. Results: Based on 16 controlled clinical trials, mostly with low risk of bias, in a total of 432 individuals, tDCS was superior to simulation in improving pain (SMD = -0.41; 95% CI (-0.72 , -0.11); p=0.007). The meta-analysis did not show statistical significance in favor of active intervention to improve disability, as well as psychosocial outcomes. These results were based on a low level of evidence. Meta-regression analyzes showed that the duration of pain is negatively correlated with the effect size [diff SMD=0.003 (0.001; 0.012), p=0.02], R²= 1.00. The stimulation target was responsible for 86% of the variability, while the randomization description was responsible for 15% of the heterogeneity [diff SMD=0.385 (-1.749; -0.239), p=0.009], as was the study design [ diff SMD=0.380 (-0.033; 1.457), p=0.03]. Conclusion: tDCS may have beneficial effects on the outcome of pain intensity. The duration of symptoms, place of application of tDCS and methodological quality are moderators of the effects of tDCS. Future studies are needed to improve the quality of evidence.
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spelling Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizadosFisioterapia - ReabilitaçãoDor neuropáticaEstimulação transcraniana por corrente contínuaDor crônicaPhysiotherapy - RehabilitationNeuropathic painTranscranial direct current stimulationChronic painCNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONALBackground: In the literature, the analgesic effects of Transcranial Direct Current Stimulation (tDCS) in populations with chronic pain have been well reported. In Neuropathic Pain the results are still contrasting, with previous reviews showing small effect sizes and a considerable level of heterogeneity. The objective of the present study is to evaluate the effectiveness of treatment with tDCS in patients with chronic neuropathic pain on pain intensity, disability and psychosocial factors and to determine the predictors of this effectiveness when considering the influence exerted by sample characteristics, study design and parameters of the intervention. Methodology: A systematic search of the electronic databases of MEDLINE, CINAHL, EMBASE and CENTRAL conducted from June to July 2021 was carried out. Controlled clinical trials involving patients with chronic neuropathic pain who applied tDCS were included. The effect was measured using the standardized mean difference (SMD) with a 95% confidence interval, calculated with the values obtained after the intervention between the active and control groups. The level of evidence was assessed with GRADE (Grading of Recommendations Assessment, Development and Evolution) to explore potential moderating factors, we performed meta-regression analyses. Results: Based on 16 controlled clinical trials, mostly with low risk of bias, in a total of 432 individuals, tDCS was superior to simulation in improving pain (SMD = -0.41; 95% CI (-0.72 , -0.11); p=0.007). The meta-analysis did not show statistical significance in favor of active intervention to improve disability, as well as psychosocial outcomes. These results were based on a low level of evidence. Meta-regression analyzes showed that the duration of pain is negatively correlated with the effect size [diff SMD=0.003 (0.001; 0.012), p=0.02], R²= 1.00. The stimulation target was responsible for 86% of the variability, while the randomization description was responsible for 15% of the heterogeneity [diff SMD=0.385 (-1.749; -0.239), p=0.009], as was the study design [ diff SMD=0.380 (-0.033; 1.457), p=0.03]. Conclusion: tDCS may have beneficial effects on the outcome of pain intensity. The duration of symptoms, place of application of tDCS and methodological quality are moderators of the effects of tDCS. Future studies are needed to improve the quality of evidence.NenhumaContextualização: Na literatura tem sido bem relatado os efeitos analgésicos da Estimulação Transcraniana por Corrente Contínua (ETCC) em populações com dor crônica. Na Dor Neuropática os resultados ainda são contrastantes, com revisões anteriores mostrando tamanhos de efeito pequenos e com nível considerável de heterogeneidade. O objetivo do presente estudo é avaliar a eficácia do tratamento com a ETCC em pacientes com dor neuropática crônica na intensidade da dor, incapacidade e fatores psicossociais e determinar os preditores dessa eficácia ao considerar a influência exercida pelas características da amostra, desenho do estudo e parâmetros da intervenção. Metodologia: Uma busca sistemática nos bancos de dados eletrônicos da MEDLINE, CINAHL, EMBASE e CENTRAL conduzida no período de junho a julho de 2021 foi realizada. Ensaios clínicos controlados envolvendo pacientes com dor neuropática crônica que aplicassem a ETCC, foram incluídos. A mensuração do efeito foi por meio da diferença média padronizada (SMD) com intervalo de confiança de 95%, calculados com os valores obtidos pós intervenção entre os grupos ativo e controle. O nível de evidência foi avaliado com o GRADE (Grading of Recommendations Assessment, Development and Evoluation) para explorar os potenciais fatores moderadores realizamos análises de meta-regressão. Resultados: Com base em 16 ensaios clínicos controlados em sua maioria de baixo risco de viés, num total de 432 indivíduos, a ETCC foi superior a simulação para melhora da dor (SMD = -0,41; 95% IC (-0,72, -0,11); p=0,007). A meta-análise não apresentou significância estatística favorável à intervenção ativa para melhorar a incapacidade, assim quanto aos desfechos psicossociais. Esses resultados foram baseados em baixo nível de evidência. As análises de meta-regressão mostraram que o tempo de duração da dor está correlacionado negativamente com o tamanho de efeito [diff SMD=0,003 (0,001; 0,012), p=0,02], R²= 1,00. O alvo da estimulação foi responsável por 86% da variabilidade, enquanto que a descrição da randomização foi responsável por 15% da heterogeneidade [diff SMD=0,385 (-1,749; -0,239), p=0,009], assim como o desenho do estudo [diff SMD=0,380 (-0,033; 1,457), p=0,03]. Conclusão: A ETCC pode ter efeitos benéficos sobre o desfecho da intensidade da dor. A duração dos sintomas, local de aplicação da ETCC e qualidade metodológica apresentam são moderadores dos efeitos da ETCC. Estudos futuros são necessários para melhorar a qualidade de evidência.Universidade Federal da ParaíbaBrasilFisioterapiaPrograma de Pós-Graduação em FisioterapiaUFPBKamonseki, Danilo Harudyhttp://lattes.cnpq.br/3862220756233320Carvalho, Carolina Dias de2024-06-26T11:43:08Z2023-11-012024-06-26T11:43:08Z2023-08-30info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesishttps://repositorio.ufpb.br/jspui/handle/123456789/30492porAttribution-NoDerivs 3.0 Brazilhttp://creativecommons.org/licenses/by-nd/3.0/br/info:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UFPBinstname:Universidade Federal da Paraíba (UFPB)instacron:UFPB2024-06-27T06:08:39Zoai:repositorio.ufpb.br:123456789/30492Biblioteca Digital de Teses e Dissertaçõeshttps://repositorio.ufpb.br/PUBhttp://tede.biblioteca.ufpb.br:8080/oai/requestdiretoria@ufpb.br|| diretoria@ufpb.bropendoar:2024-06-27T06:08:39Biblioteca Digital de Teses e Dissertações da UFPB - Universidade Federal da Paraíba (UFPB)false
dc.title.none.fl_str_mv Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados
title Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados
spellingShingle Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados
Carvalho, Carolina Dias de
Fisioterapia - Reabilitação
Dor neuropática
Estimulação transcraniana por corrente contínua
Dor crônica
Physiotherapy - Rehabilitation
Neuropathic pain
Transcranial direct current stimulation
Chronic pain
CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL
title_short Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados
title_full Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados
title_fullStr Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados
title_full_unstemmed Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados
title_sort Preditores do tratamento com estimulação transcraniana por corrente contínua em pacientes com dor neuropática: metanálise e meta-regressão de ensaios clínicos randomizados
author Carvalho, Carolina Dias de
author_facet Carvalho, Carolina Dias de
author_role author
dc.contributor.none.fl_str_mv Kamonseki, Danilo Harudy
http://lattes.cnpq.br/3862220756233320
dc.contributor.author.fl_str_mv Carvalho, Carolina Dias de
dc.subject.por.fl_str_mv Fisioterapia - Reabilitação
Dor neuropática
Estimulação transcraniana por corrente contínua
Dor crônica
Physiotherapy - Rehabilitation
Neuropathic pain
Transcranial direct current stimulation
Chronic pain
CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL
topic Fisioterapia - Reabilitação
Dor neuropática
Estimulação transcraniana por corrente contínua
Dor crônica
Physiotherapy - Rehabilitation
Neuropathic pain
Transcranial direct current stimulation
Chronic pain
CNPQ::CIENCIAS DA SAUDE::FISIOTERAPIA E TERAPIA OCUPACIONAL
description Background: In the literature, the analgesic effects of Transcranial Direct Current Stimulation (tDCS) in populations with chronic pain have been well reported. In Neuropathic Pain the results are still contrasting, with previous reviews showing small effect sizes and a considerable level of heterogeneity. The objective of the present study is to evaluate the effectiveness of treatment with tDCS in patients with chronic neuropathic pain on pain intensity, disability and psychosocial factors and to determine the predictors of this effectiveness when considering the influence exerted by sample characteristics, study design and parameters of the intervention. Methodology: A systematic search of the electronic databases of MEDLINE, CINAHL, EMBASE and CENTRAL conducted from June to July 2021 was carried out. Controlled clinical trials involving patients with chronic neuropathic pain who applied tDCS were included. The effect was measured using the standardized mean difference (SMD) with a 95% confidence interval, calculated with the values obtained after the intervention between the active and control groups. The level of evidence was assessed with GRADE (Grading of Recommendations Assessment, Development and Evolution) to explore potential moderating factors, we performed meta-regression analyses. Results: Based on 16 controlled clinical trials, mostly with low risk of bias, in a total of 432 individuals, tDCS was superior to simulation in improving pain (SMD = -0.41; 95% CI (-0.72 , -0.11); p=0.007). The meta-analysis did not show statistical significance in favor of active intervention to improve disability, as well as psychosocial outcomes. These results were based on a low level of evidence. Meta-regression analyzes showed that the duration of pain is negatively correlated with the effect size [diff SMD=0.003 (0.001; 0.012), p=0.02], R²= 1.00. The stimulation target was responsible for 86% of the variability, while the randomization description was responsible for 15% of the heterogeneity [diff SMD=0.385 (-1.749; -0.239), p=0.009], as was the study design [ diff SMD=0.380 (-0.033; 1.457), p=0.03]. Conclusion: tDCS may have beneficial effects on the outcome of pain intensity. The duration of symptoms, place of application of tDCS and methodological quality are moderators of the effects of tDCS. Future studies are needed to improve the quality of evidence.
publishDate 2023
dc.date.none.fl_str_mv 2023-11-01
2023-08-30
2024-06-26T11:43:08Z
2024-06-26T11:43:08Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
format masterThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://repositorio.ufpb.br/jspui/handle/123456789/30492
url https://repositorio.ufpb.br/jspui/handle/123456789/30492
dc.language.iso.fl_str_mv por
language por
dc.rights.driver.fl_str_mv Attribution-NoDerivs 3.0 Brazil
http://creativecommons.org/licenses/by-nd/3.0/br/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Attribution-NoDerivs 3.0 Brazil
http://creativecommons.org/licenses/by-nd/3.0/br/
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Universidade Federal da Paraíba
Brasil
Fisioterapia
Programa de Pós-Graduação em Fisioterapia
UFPB
publisher.none.fl_str_mv Universidade Federal da Paraíba
Brasil
Fisioterapia
Programa de Pós-Graduação em Fisioterapia
UFPB
dc.source.none.fl_str_mv reponame:Biblioteca Digital de Teses e Dissertações da UFPB
instname:Universidade Federal da Paraíba (UFPB)
instacron:UFPB
instname_str Universidade Federal da Paraíba (UFPB)
instacron_str UFPB
institution UFPB
reponame_str Biblioteca Digital de Teses e Dissertações da UFPB
collection Biblioteca Digital de Teses e Dissertações da UFPB
repository.name.fl_str_mv Biblioteca Digital de Teses e Dissertações da UFPB - Universidade Federal da Paraíba (UFPB)
repository.mail.fl_str_mv diretoria@ufpb.br|| diretoria@ufpb.br
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