Nonpharmacological therapies for central poststroke pain

Abstract

Background: Central poststroke pain (CPSP) is a neuropathic pain syndrome that can occur after a cerebrovascular accident. It has negative effects on mood, sleep, rehabilitation, and quality of life in stroke patients. This systematic review assessed the efficacy and safety of nonpharmacological therapies for treating CPSP. Methods: The Cochrane, PubMed, Embase, and Web of Science databases were systematically searched for studies from inception to August 2020. Two authors worked independently and in duplicate to identify suitable studies. Results: Eleven studies were identified. Pain related to CPSP was ameliorated by precentral gyrus stimulation ( P = .01), caloric vestibular stimulation ( P = 0.004), transcranial direct current stimulation ( P < .05), and bee venom acupuncture point injection ( P = .009). Acupuncture ( P = .72) and electroacupuncture therapies (P > .05 ) were as effective for thalamic pain as oral carbamazepine treatment. Motor cortex stimulation, but not deep brain stimulation (DBS), was effective for treating refractory CPSP, and appeared to be more effective than thalamic stimulation for controlling bulbar pain secondary to Wallenberg syndrome. However, DBS in the ventral striatum or anterior limb of the internal capsule improved depression ( P = .020) and anxiety in patients with refractory CPSP. Some serious adverse events were reported in response to invasive electrical brain stimulation, but most of these effects recovered with treatment. Conclusions: Nonpharmacological therapies appear to be effective in CPSP, but the evidence is relatively weak. Invasive electrical brain stimulation can be accompanied by serious adverse events, but most patients recover from these effects.

Central Post-Stroke Pain: An Integrative Review of Somatotopic Damage, Clinical Symptoms, and Neurophysiological Measures

“…Thus, the motivation to understand dysfunctional neurophysiological processes grows to guide the search for complementary nonpharmacological options. The above-mentioned background gives support to explore how non-pharmacological approaches, such as non-invasive or invasive brain stimulation (43), or other therapeutic approaches, such as hypnotherapy, mindfulness, or cognitive-behavioral therapy, can change pain sensitivity. In a pragmatic view, advancement in the therapeutic field may be more likely to occur if we improve the capacity to characterize the phenotypes of CPSP and evaluate the dysfunction in neuroplasticity processes by neurophysiological measures.…”

Corneal Confocal Microscopy to Image Small Nerve Fiber Degeneration: Ophthalmology Meets Neurology

“…Central post-stroke pain has been estimated to occur in 8–55% of stroke patients and may be constant or intermittent neuropathic pain accompanied by dysesthesia of temperature and/or pressure sensations within the area of the body corresponding to the stroke lesion ( 97 ). The etiology of this condition is poorly understood and it is often resistant to conventional pharmacological treatment options ( 98 ). Corneal nerve loss has been demonstrated in patients with Transient Ischemic Attack (TIA), minor stroke ( 99 ) and major stroke ( 100 ), with greater severity in patients with recurrent stroke ( 101 ) and it is associated with the presence of white matter hyperintensities, markers of small vessel disease ( 102 ).…”

Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain on the Non-Motor Cortex: An Evidence Mapping of Systematic Reviews

“…2, according to AMSTAR-2 criteria, 1 Cochrane SR [23] was graded as "high." Two SRs [26,27] were graded as "low," and 20 SRs [18,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] were graded as "critically low" [22,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]]. e SRs were downgraded mainly due to the following reasons: absence of a predesigned and registered protocol [22,29,30,34,36,40,...…”

“…Of all SRs, 13 [23,27,28,30,32,36,38,41,42,45,46] included only RCTs; 12 SRs [22,23,29,31,34,36,39,40,42,[44][45][46] included patients with NP with different causes; and 11 were specially conducted on NP with specific etiologies or due to a single disease. One SR [28] included pain after spinal cord injury (SCI); 4 SRs [26,30,33,43] included central poststroke pain after stroke (CPSP); 4 SRs [31,37,38,41] included migraine, 1 SR [35] included headache, and 1 SR [27] included orofacial pain (OFP). As for the intervention, 9 SRs [22,29,34,36,38,40,[44][45][46] only assessed TMS; 8 SRs [23,26,28,35,…”

“…One SR [28] included pain after spinal cord injury (SCI); 4 SRs [26,30,33,43] included central poststroke pain after stroke (CPSP); 4 SRs [31,37,38,41] included migraine, 1 SR [35] included headache, and 1 SR [27] included orofacial pain (OFP). As for the intervention, 9 SRs [22,29,34,36,38,40,[44][45][46] only assessed TMS; 8 SRs [23,26,28,35,37,39,41] also assessed other non-invasive stimulations; 1 SR [31] assessed neuromodulation techniques; 1 SR [30] assessed non-pharmacological interventions; 3 SRs [32,33,42] assessed pharmacological and non-pharmacological management of NP; and 1 SR [43] assessed non-invasive physical modalities.…”