Effects of Non-Invasive Brain Stimulation on Clinical Pain Intensity and Experimental Pain Sensitivity Among Individuals with Central Post-Stroke Pain: A Systematic Review

Figures & data

Figure 1 PRISMA flow chart for selection of studies.

Table 1 Demographic Characteristics of the Included Studies

Author, Year	Study Type	Subject Number Completing Study (Number Recruited)	Sex (M, F)	Age Range (Mean or Mean ± SD)	Type of Stroke		Time Post-Stroke (Months)	Pain Duration (Range in Months)
					Ischemic	Hemorrhagic
Bae et al, 2014^Citation20	RCT	14 (14)	7, 7	45–55 (51.7)	8	6	NR	14.6 (Mean)
De Oliveira et al, 2014^Citation21	Prospective cohort	21 (23)	11, 10	37–73 (56.3)	17	4	NR	12–144
Hasan et al, 2014^Citation22	Case series	14 (14)	10, 4	57 (median)	11	3	NR	NR
Kobayashi et al, 2015^Citation23	Cross-over	18 (18)	12, 6	39–81 (63.0 ± 9.9)	5	13	6–39	3–26
Matsumura et al, 2013^Citation24	Cross-over	20 (20)	12, 8	54–85 (63.6 ± 8.1)	7	13	NR	6–180
Ohn et al, 2012^Citation25	Case series	22 (22)	13, 9	(54.0 ± 9)	15	7	NR	21.9 ± 17.2 (Mean ± SD)

Table 2 Summary of Interventions from Included Studies

Author, Year	Type of Stimulation	Stimulation Location	Intensity	Current Flow	Frequency of Intervention	Length of Intervention	Control Group
Bae et al, 2014^Citation20	tDCS	Primary motor cortex	2 mA	20 min	3×/week	3 weeks	Sham tDCS
De Oliveira et al, 2014^Citation21	rTMS	Primary motor cortex/dorsolateral prefrontal cortex	120% RMT	10 Hz − 25 × 5 sec	1×/day	10 days	Sham rTMS
Hasan et al, 2014^Citation22	rTMS	M1 predetermined ‘hotspot’	80–90% RMT	10 Hz − 20 × 10 s	1 session/3–5 days	5 sessions	None
Kobayashi et al, 2015^Citation23	rTMS	Primary motor cortex	90% RMT	5 Hz −10 × 10 s	1×/week	12 weeks	Sham rTMS
Matsumura et al, 2013^Citation24	rTMS	Primary motor cortex	100% RMT	5 Hz −10 × 50 pulses	1 session	1 day	Sham rTMS
Ohn et al, 2012^Citation25	rTMS	Motor ‘hotspot’ of first dorsal interossei of affected hand	90% RMT	10 Hz − 50 × 5 s	1/day	5 days	None

Abbreviation: RMT, Resting Motor Threshold.

Table 3 Intervention Results from Included Studies

Author, Year	Measurement Time Point	VAS
		Within Subjects Mean Differences
		Experimental Group	Control Group
Bae et al, 2014^Citation20	Baseline, immediate post	−0.15	−0.28
	Baseline, 1 week post	−0.58	−0.42
	Baseline, 3 weeks post	−1.15*	−0.14
De Oliveira et al, 2014^Citation21	Baseline, day 10 post	−0.07	−0.10
Hasan et al, 2014^Citation22	Baseline, immediate post	−0.70*
Kobayashi et al, 2015^Citation23	Baseline, immediate post	Time course effect on VAS score F(1, 10) = −22.273**
	Baseline, weekly for 12 weeks	Time course effect on VAS score F(12, 204) = −13.476**
Matsumura et al, 2013^Citation24	Baseline, multiple time points post (0, 60, 120, 180, 240, 300 mins, and 24 hrs)	−1.18* (significant time course effect up to 300 mins)	−0.21
Ohn et al, 2012^Citation25	Baseline, immediately post	−0.90*

Notes: * p<0.05, ** p< 0.01.

Abbreviations: VAS, Visual Analog Scale.

Table 4 Intervention Results from Included Studies

Author, Year	Measurement Time Point	QST
		Within Subjects Mean Differences
		Type	Experimental Group	Control Group
Bae et al, 2014^Citation20	Baseline, immediate post	CST	0.39	0.32
		WST	−0.48	−0.49
		CPT	0.33	0.10
		WPT	−0.07	−0.41
	Baseline, 1 week post	CST	0.56*	0.40
		WST	−0.79	−0.23
		CPT	0.52*	0.10
		WPT	−0.31	−0.04
	Baseline, 3 weeks post	CST	0.76*	0.38
		WST	−2.26**	−0.37
		CPT	1.79***	0.23
		WPT	−0.37	0.15
De Oliveira et al, 2014^Citation21
Hasan et al, 2014^Citation22	Baseline, immediate post	CST	4.70*	1.10
		WST	−2.60	−0.10
		CPT	−2.10	−0.80
		WPT	0.70	0.30
		TT	−0.01	−0.01
		PT	–2.00	–0.50
Kobayashi et al, 2015^Citation23
Matsumura et al, 2013^Citation24
Ohn et al, 2012^Citation25

Notes: * p<0.05, ** p < 0.01, *** p< 0.001. A positive change represents an increase in temperature or pressure.

Abbreviations: QST, Quantitative Sensory Test; CST, cold sensation threshold; WST, warm sensation threshold; CPT, cold pain threshold; WPT, warm pain threshold; TT, tactile threshold; PT, pressure threshold.

Table 5 Quality Assessment, Modified Downs and Black Checklist. Key for Total Score: Poor <14; Fair 14–18; Excellent/Good 19–28

Author, Year	Reporting	External Validity	Internal Validity-Bias	Internal Validity-Confounding	Power	Total
Bae et al, 2014^Citation20	7	0	5	1	0	13
De Oliveira et al, 2014^Citation21	10	0	7	4	1	22
Hasan et al, 2014^Citation22	6	0	4	0	0	10
Kobayashi et al, 2014^Citation23 Study 1	8	0	5	3	0	16
Kobayashi et al, 2014^Citation23 Study 2	8	0	5	3	0	16
Matsumura et al, 2013^Citation24	7	0	3	0	0	10
Ohn et al, 2012^Citation25	8	0	4	2	1	15

Bae SH, Kim GD, Kim KY. Analgesic effect of transcranial direct current stimulation on central post-stroke pain. Tohoku J Exp Med. 2014;234(3):189–195. doi:10.1620/tjem.234.18925341455

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Hasan M, Whiteley J, Bresnahan R, et al. Somatosensory change and pain relief induced by repetitive transcranial magnetic stimulation in patients with central poststroke pain. Neuromodulation. 2014;17(8):731–736. doi:10.1111/ner.2014.17.issue-824934719

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Ohn SH, Chang WH, Park CH, et al. Neural correlates of the antinociceptive effects of repetitive transcranial magnetic stimulation on central pain after stroke. Neurorehabil Neural Repair. 2012;26(4):344–352. doi:10.1177/154596831142311021980153

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