Papers of the Week

Central post stroke 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 in the effectiveness of available pharmacological, physical, psychological, and neuromodulation intervention 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 aetiology, pain characteristics, pain reduction scores, and secondary outcome metrics. Forty two original studies were included with a total of 1451 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 = -0.36, 96.0% Confidence Interval [-0.68, -0.03], physical interventions did not show a significant effect (SMD = -0.55, [-1.28, 0.18]), and neuromodulation treatments had a moderate effect (SMD -0.64, [-1.08, -0.19]). 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, findings from which largely supported meta-analyses results. Duloxetine, Amitriptyline and repetitive Transcranial Magnetic Stimulation (rTMS) had the most robust evidence for their effectiveness in alleviating CPSP induced pain. Further multi-centre placebo-controlled research is needed to ascertain the effectiveness of physical therapies, such as acupuncture and virtual reality, and invasive and non-invasive 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.