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

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. 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. •Tricyclic antidepressants have more robust efficacy evidence than anticonvulsants.•Opioids for central poststroke pain (CPSP) management are not supported by intervention research.•There is a distinct lack of psychological intervention studies on CPSP.•Acupuncture and virtual reality have some evidence for CPSP patient pain allevia