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rTMS and SCS show consistent effectiveness in reducing chronic pancreatic pain and opioid use, while other neuromodulation techniques yield mixed results.
Chronic pancreatic pain is one of the most severe types of visceral pain, often leading to poor treatment responses and a heavy reliance on opioids. A systematic review by Maria F Andrade et al. sought to explore the potential of neuromodulation techniques as alternative therapies for chronic pancreatic pain, given their ability to activate descending pain inhibitory systems. A literature search was carried out using Embase, MEDLINE, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify studies on neurostimulation techniques for prolonged pancreatic discomfort.
The included studies focused on pain outcomes and opioid use. The risk of bias was examined via the Jadad scale. Findings were grouped by the target of neurostimulation (cortex, spinal cord, or peripheral nerves) and described qualitatively, including effect sizes of pain-linked outcomes.
Overall, 22 studies (1 survey, 7 randomized clinical trials [RCTs], and 14 case series) involving 257 volunteers were incorporated. Pain, measured using the visual analogue scale (VAS), numeric rating scale (NRS), and pressure pain threshold, alongside opioid consumption were the most commonly assessed endpoints.
Key findings:
Thus, rTMS and SCS were found to be the most promising neurostimulation techniques for tackling chronic pancreatic pain, showing consistent evidence of efficacy. However, the need for more robust studies, especially RCTs for SCS, was clear. The lack of significant findings for VNS and tDCS pointed to a gap in the literature, urging further investigation into these techniques. An important takeaway was the consistent trend of decreased opioid consumption across many of the included studies. Moreover, adverse effects were infrequent, making these techniques relatively safe.
Neuromodulation
Effect of Neurostimulation on Chronic Pancreatic Pain: A Systematic Review
Maria F Andrade et al.
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