Estimulação magnética transcraniana para dor neuropática de origem oncológica e não oncológica: uma revisão sistemática
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Objetivo: avaliar o efeito da terapia de Estimulação Magnética Transcraniana Repetitiva (EMTr) no tratamento da dor neuropática de origem oncológica e não oncológica, uma vez que a EMTr é uma alternativa inovadora para o manejo da dor neuropática e é uma técnica de estimulação cerebral. invasivo que induz correntes elétricas no tecido nervoso do córtex.
Métodos: a busca bibliográfica foi realizada nas bases de dados CENTRAL, MEDLINE, Embase, PsycINFO, SCOPUS e LILACS. Os critérios de inclusão foram 1) população: homens e mulheres entre 18 e 85 anos, com dor neuropática oncológica e não oncológica; 2) intervenção: tratada com estimulação magnética transcraniana; 3) comparação: grupos de controle inativos e intervenções ativas paralelas; e 4) desfecho: o desfecho primário foi a modulação da dor. Os desfechos secundários foram qualidade de vida e efeitos adversos. O risco de viés e a qualidade da evidência também foram avaliados.
Resultados: A busca retornou 1.116 artigos, dos quais 21 atenderam aos critérios PICO. 12 estudos controlados aleatorizados (ECAS) e 9 estudos observacionais. A amostra total foi de 911 pacientes, o número de sessões varia de uma única sessão até 15 sessões, com média de 3.5 sessões. O acompanhamento foi realizado entre o dia 7 e 311.8 dias, com média de 45 dias. A redução da dor foi relatada em todos os 21 estudos.
Conclusão: A EMTr pode ser uma opção terapêutica eficaz no tratamento da dor neuropática oncológica e não oncológica. Encontramos evidências de qualidade moderada para modulação da dor; para qualidade de vida, os resultados são incertos na determinação de alterações, pois a evidência é muito baixa. Esforços adicionais de pesquisa são necessários para reduzir preconceitos e melhorar a qualidade dos estudos.
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