Management of Central Poststroke Pain: Systematic Review and Meta-analysis

Tamasauskas, Arnas, Silva-Passadouro, Barbara, Fallon, Nicholas ORCID: 0000-0003-1451-6983, Frank, Bernhard ORCID: 0000-0001-5405-4942, Laurinaviciute, Svajune, Keller, Simon ORCID: 0000-0001-5247-9795 and Marshall, Andrew ORCID: 0000-0001-8273-7089 (2025) Management of Central Poststroke Pain: Systematic Review and Meta-analysis JOURNAL OF PAIN, 26. 104666-. ISSN 1526-5900, 1528-8447

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Abstract

Central poststroke pain (CPSP) is a neuropathic pain condition prevalent in 8 to 35% of stroke patients. This systematic review and meta-analysis aimed to provide insight into the effectiveness of available pharmacological, physical, psychological, and neuromodulation interventions in reducing pain in CPSP patients (PROSPERO Registration: CRD42022371835). Secondary outcomes included mood, sleep, global impression of change, and physical responses. Data extraction included participant demographics, stroke etiology, pain characteristics, pain reduction scores, and secondary outcome metrics. Forty-two original studies were included, with a total of 1,451 participants. No studies providing psychological therapy to CPSP patients were identified. Twelve studies met requirements for a random-effects meta-analyses that found pharmacological therapy to have a small effect on mean pain score (SMD = −.36, 96.0% confidence interval [−.68, −.03]), physical interventions did not show a significant effect (SMD = −.55 [−1.28, .18]), and neuromodulation treatments had a moderate effect (SMD = −.64 [−1.08, −.19]). Fourteen studies were included in proportional meta-analysis with pharmacological studies having a moderate effect (58.3% mean pain reduction [−36.51, −80.15]) and neuromodulation studies a small effect (31.1% mean pain reduction [−43.45, −18.76]). Sixteen studies were included in the narrative review, the findings from which largely supported meta-analysis results. Duloxetine, amitriptyline, and repetitive transcranial magnetic stimulation had the most robust evidence for their effectiveness in alleviating CPSP-induced pain. Further multicenter placebo-controlled research is needed to ascertain the effectiveness of physical therapies, such as acupuncture and virtual reality, and invasive and noninvasive neuromodulation treatments. Perspective: This article presents a top-down and bottom-up overview of evidence for the effectiveness of different pharmacological, physical, and neuromodulation treatments of CPSP. This review could provide clinicians with a comprehensive understanding of the effectiveness and tolerability of different treatment types.

Item Type:	Article
Uncontrolled Keywords:	Central poststroke pain, neuropathic pain, thalamic pain, pharmacological review, neuromodulation review
Depositing User:	Symplectic Admin
Date Deposited:	13 Sep 2024 10:43
Last Modified:	16 Jun 2026 05:01
DOI:	10.1016/j.jpain.2024.104666
Open Access URL:	http://dx.doi.org/10.1016/j.jpain.2024.104666
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3184476
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