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Abstract Details

Non-Invasive Neuromodulation in Diabetic Peripheral Neuropathy: a meta-analysis
Pain
P11 - Poster Session 11 (8:00 AM-9:00 AM)
6-002
This systematic review aims to evaluate non-invasive neuromodulation (NINM) effects on Diabetic peripheral neuropathy (DPN) subjects measured by pain rating scales. 
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. 
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. 
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. 
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. 
Authors/Disclosures
Kevin Pacheco-Barrios, MD (Neuromodulation Center, Harvard Medical School)
PRESENTER 		Dr. Pacheco-Barrios has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Felipe Fregni (Spaulding Rehabilitation Hospital) Felipe Fregni has nothing to disclose.