Management of Central Poststroke Pain: Systematic Review of Randomized Controlled Trials

• Published in: Stroke (1970) 2015-10, Vol.46 (10), p.2853-2860
• Main Authors: Mulla, Sohail M, Wang, Li, Khokhar, Rabia, Izhar, Zain, Agarwal, Arnav, Couban, Rachel, Buckley, D Norman, Moulin, Dwight E, Panju, Akbar, Makosso-Kallyth, Sun, Turan, Alparslan, Montori, Victor M, Sessler, Daniel I, Thabane, Lehana, Guyatt, Gordon H, Busse, Jason W
• Format: Article
• Language: English
• Subjects: Acupuncture Therapy - methods; Anticonvulsants - therapeutic use; Antidepressive Agents - therapeutic use; Humans; Narcotic Antagonists - therapeutic use; Neuralgia - etiology; Neuralgia - therapy; Pain Management; Randomized Controlled Trials as Topic; Stroke - complications; Transcranial Magnetic Stimulation - methods; Treatment Outcome
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.115.010259

BACKGROUND AND PURPOSE—Central poststroke pain is a chronic neuropathic disorder that follows a stroke. Current research on its management is limited, and no review has evaluated all therapies for central poststroke pain. METHODS—We conducted a systematic review of randomized controlled trials to evaluate therapies for central poststroke pain. We identified eligible trials, in any language, by systematic searches of AMED, CENTRAL, CINAHL, DARE, EMBASE, HealthSTAR, MEDLINE, and PsychINFO. Eligible trials (1) enrolled ≥10 patients with central poststroke pain; (2) randomly assigned them to an active therapy or a control arm; and (3) collected outcome data ≥14 days after treatment. Pairs of reviewers, independently and in duplicate, screened titles and abstracts of identified citations, reviewed full texts of potentially eligible trials, and extracted information from eligible studies. We used a modified Cochrane tool to evaluate risk of bias of eligible studies, and collected patient-important outcomes according to recommendations by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. We conducted, when possible, random effects meta-analyses, and evaluated our certainty in treatment effects using the Grading of Recommendations Assessment, Development, and Evaluation System. RESULTS—Eight eligible English language randomized controlled trials (459 patients) tested anticonvulsants, an antidepressant, an opioid antagonist, repetitive transcranial magnetic stimulation, and acupuncture. Results suggested that all therapies had little to no effect on pain and other patient-important outcomes. Our certainty in the treatment estimates ranged from very low to low. CONCLUSIONS—Our findings are inconsistent with major clinical practice guidelines; the available evidence suggests no beneficial effects of any therapies that researchers have evaluated in randomized controlled trials.