The comparative evidence of efficacy of non-invasive brain and nerve stimulation in diabetic neuropathy: a systematic review and network meta-analysis.
Ping-Tao Tseng, Bing-Yan Zeng, Chih-Wei Hsu and 8 others
PMID 40253366WHAT IT FOUND
TENS was the only stimulation method associated with less pain than sham or standard care in diabetic neuropathy.
Other brain and nerve methods did not show this benefit in the main analysis.
Key findings
01TENS was associated with significantly greater reduction in pain severity and significantly greater improvement in sleep disruption than control.
02No non-invasive brain stimulation method showed a significant pain difference compared with control in the brain stimulation subgroup.
03No stimulation treatment had a significantly different dropout rate compared with control.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Some comparisons relied on a single trial, including the quality-of-life finding for 10 Hz rTMS over left motor cortex and the long-term pain finding for FREMS. Treatment durations varied across trials, and some analyses may be underpowered because of differences in stimulation target regions. Pain scales differed across trials, so the review used standardized scores rather than one raw pain scale. Some risk-of-bias items were unclear or high.
The easy way to misread this
Do not conclude that all non-invasive stimulation methods relieve diabetic neuropathy pain. Only TENS was significantly better than sham or standard care for pain, and brain stimulation methods did not show a significant pain benefit.