Systematic Review. Motor cortex stimulation and neuropathic pain

Introdução: Aproximadamente um em cada cinco adultos sofre de dor crônica. O tratamento da dor neuropática (DN) continua a ser controverso, bem como uma questão de saúde econômica e um desafio aos cuidados de saúde. Quando os tratamentos farmacológicos e de reabilitação falham, uma das opções é a estimulação do córtex motor (ECM). Objetivo: Rever as evidências científicas disponíveis relativas ao ECM e ao manejo da DN. Métodos: Realizamos uma pesquisa na base de dados PubMed, Embase e Cochrane Library de 1990 a 2021. A estratégia da pesquisa concentrou-se nas seguintes palavras-chave: “neuropathic pain”, “chronic pain”, “motor cortex stimulation” e “neuromodulation.” Foram incluídos estudos que forneceram dados sobre a eficácia imediata e a longo prazo do procedimento, o alvo de estimulação anatômica, a percentagem de controle da dor e a causa da DN. Estudos com menos de 5 pacientes, relatos de caso e outras revisões sistemáticas não foram incluídos. Resultados: As causas mais frequentes de DN foram dor de membro fantasma e dor no pós- choque central. A melhoria da dor variou entre 35 e 80%. ECM não demonstrou eficácia no tratamento de DN refratária no membro superior. Conclusão: Com base nesta revisão crítica, notou-se que ECM é uma técnica cirúrgica ainda não amplamente utilizada e que a sua eficácia não foi totalmente comprovada. Portanto, é essencial que sejam realizados mais estudos com maior número de pacientes.

Introduction: Approximately one in five adults suffers from chronic pain. The treatment of neuropathic pain (NP) continues to be controversial as well as an economic health issue and a challenge to health care. When pharmacological and rehabilitation treatments fail, one of the options is Motor Cortex Stimulation (MCS). Objective: To review the evidence regarding MCS and the management of NP. Methods: We conducted a search on PubMed, Embase, and Cochrane Library database from 1990 to 2021. The strategy of the search was concentrated in the following keywords: “neuropathic pain”, “chronic pain”, “motor cortex stimulation”, and “neuromodulation.” Studies that provided data regarding the immediate and long-term effectiveness of the procedure, anatomic stimulation target, percentage of pain control, and cause of the NP were included. Studies with less than five patients, case reports and other systematic reviews were not included. Results: The most frequent causes of NP were phantom limb pain and central post-stroke pain. Pain improvement varied between 35% and 80%. MCS failed to show effectiveness for the treatment of refractory upper limb NP. Conclusion: Based on this critical review, it was noticed that MCS is a surgical technique still not widely used and its efficacy has not been fully proven. So, it is essential more studies with a larger number of patients to be performed.

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