Network Meta-analysis of Randomized Controlled Trials Assessing Neuromodulation Therapies for Painful Diabetic Neuropathy

Abstract Introduction Neuromodulation therapies (including non-invasive and invasive neuromodulation) are being used to treat painful diabetic neuropathy (PDN). Methods A systematic search of the PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases was conducted, from their incepti...

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Main Authors: Li Li, Xueqin Luo, Yong Liu, Yongjie Jiang, Yankun Chen, Yangmei Chen, Jinping Wang
Format: Article
Language:English
Published: Adis, Springer Healthcare 2025-05-01
Series:Neurology and Therapy
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Online Access:https://doi.org/10.1007/s40120-025-00759-1
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author Li Li
Xueqin Luo
Yong Liu
Yongjie Jiang
Yankun Chen
Yangmei Chen
Jinping Wang
author_facet Li Li
Xueqin Luo
Yong Liu
Yongjie Jiang
Yankun Chen
Yangmei Chen
Jinping Wang
author_sort Li Li
collection DOAJ
description Abstract Introduction Neuromodulation therapies (including non-invasive and invasive neuromodulation) are being used to treat painful diabetic neuropathy (PDN). Methods A systematic search of the PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases was conducted, from their inception until 1 October 2024, to identify randomized controlled trials (RCTs) on neuromodulation therapies for PDN. Data were collected on pain intensity of various adjunctive therapies for PDN, including transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation, repetitive transcranial magnetic stimulation, pulsed electromagnetic field therapy, spinal cord stimulation (SCS), transcranial direct current stimulation, frequency rhythmic electrical modulation system, mesodiencephalic modulation, and sham. Results The data from an aggregate of 12 separate studies, comprising a total sample size of 922 participants, was subject to analysis. All seven neuromodulation therapies exhibited better outcomes in pain intensity compared to the Sham intervention, with TENS achieving the highest ranking, followed by SCS. At the final follow-up time point, statistically significant reductions in pain intensity (vs. Sham) was only observed for SCS. Conclusion The results of this network meta-analysis should facilitate the development of clinical guidance and enhance the decision-making process for both patients and healthcare professionals, thereby identifying the most appropriate PDN treatment options. Trial Registration PROSPERO: CRD42024597208.
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spelling doaj-art-e3654101dcd94d5abe81ae8df8b6c8292025-08-20T03:06:31ZengAdis, Springer HealthcareNeurology and Therapy2193-82532193-65362025-05-011441355138210.1007/s40120-025-00759-1Network Meta-analysis of Randomized Controlled Trials Assessing Neuromodulation Therapies for Painful Diabetic NeuropathyLi Li0Xueqin Luo1Yong Liu2Yongjie Jiang3Yankun Chen4Yangmei Chen5Jinping Wang6Department of Pain and Rehabilitation, The Second Affiliated (Xinqiao) Hospital, The Army (Third Military) Medical UniversityDepartment of Pain and Rehabilitation, The Second Affiliated (Xinqiao) Hospital, The Army (Third Military) Medical UniversityDepartment of Pain and Rehabilitation, The Second Affiliated (Xinqiao) Hospital, The Army (Third Military) Medical UniversityDepartment of Medical Records, Heze Municipal HospitalDepartment of Neurology, Heze Municipal HospitalDepartment of Neurology, The Second Affiliated Hospital of Chongqing Medical UniversityDepartment of the Chongqing Emergency Medical Center, Chongqing University Central HospitalAbstract Introduction Neuromodulation therapies (including non-invasive and invasive neuromodulation) are being used to treat painful diabetic neuropathy (PDN). Methods A systematic search of the PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases was conducted, from their inception until 1 October 2024, to identify randomized controlled trials (RCTs) on neuromodulation therapies for PDN. Data were collected on pain intensity of various adjunctive therapies for PDN, including transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation, repetitive transcranial magnetic stimulation, pulsed electromagnetic field therapy, spinal cord stimulation (SCS), transcranial direct current stimulation, frequency rhythmic electrical modulation system, mesodiencephalic modulation, and sham. Results The data from an aggregate of 12 separate studies, comprising a total sample size of 922 participants, was subject to analysis. All seven neuromodulation therapies exhibited better outcomes in pain intensity compared to the Sham intervention, with TENS achieving the highest ranking, followed by SCS. At the final follow-up time point, statistically significant reductions in pain intensity (vs. Sham) was only observed for SCS. Conclusion The results of this network meta-analysis should facilitate the development of clinical guidance and enhance the decision-making process for both patients and healthcare professionals, thereby identifying the most appropriate PDN treatment options. Trial Registration PROSPERO: CRD42024597208.https://doi.org/10.1007/s40120-025-00759-1Pain managementChronic painNeuromodulationElectrical stimulationDiabetic polyneuropathy
spellingShingle Li Li
Xueqin Luo
Yong Liu
Yongjie Jiang
Yankun Chen
Yangmei Chen
Jinping Wang
Network Meta-analysis of Randomized Controlled Trials Assessing Neuromodulation Therapies for Painful Diabetic Neuropathy
Neurology and Therapy
Pain management
Chronic pain
Neuromodulation
Electrical stimulation
Diabetic polyneuropathy
title Network Meta-analysis of Randomized Controlled Trials Assessing Neuromodulation Therapies for Painful Diabetic Neuropathy
title_full Network Meta-analysis of Randomized Controlled Trials Assessing Neuromodulation Therapies for Painful Diabetic Neuropathy
title_fullStr Network Meta-analysis of Randomized Controlled Trials Assessing Neuromodulation Therapies for Painful Diabetic Neuropathy
title_full_unstemmed Network Meta-analysis of Randomized Controlled Trials Assessing Neuromodulation Therapies for Painful Diabetic Neuropathy
title_short Network Meta-analysis of Randomized Controlled Trials Assessing Neuromodulation Therapies for Painful Diabetic Neuropathy
title_sort network meta analysis of randomized controlled trials assessing neuromodulation therapies for painful diabetic neuropathy
topic Pain management
Chronic pain
Neuromodulation
Electrical stimulation
Diabetic polyneuropathy
url https://doi.org/10.1007/s40120-025-00759-1
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