Non-invasive brain stimulation improves pain in patients with central post-stroke pain: a systematic review and meta-analysis

ABSTRACT

Background

Central post-stroke pain (CPSP) significantly interferes with the quality of life and psychological well-being of stroke patients. Non-invasive brain stimulation (NIBS) has attracted significant attention as an emerging method for treating patients with CPSP.

Objective

To compare the clinical efficacy of noninvasive brain stimulation on pain, and psychological status of patients with central post-stroke pain using meta-analysis.

Methods

A computerized search of multiple databases was performed for identification of randomized controlled trials involving NIBS-led treatment of CPSP patients. Two researchers worked independently on literature screening, data extraction, and quality assessment. Research was conducted from inception of the database until October 2023. RevMan 5.0 and Stata 15.0 software were used to conduct statistical analysis.

Results

Sixteen papers with 807 patients were finally included. The results showed that NIBS reduced patients’ pain intensity [SMD = −0.39, 95% CI (−0.54, −0.24), p < 0.01] and was more effective in short-term CPSP patients. However, the included studies did not show a significant impact on psychological status, particularly depression. Subgroup analysis suggested that the M1 stimulation point was more effective than other stimulation points [SMD = −0.45, 95% CI (−0.65, −0.25), p < 0.001]. Other stimulation modalities also demonstrated favorable outcomes when compared to rTMS [SMD = −0.67, 95% CI (−1.09, −0.25), p < 0.01].

Conclusion

NIBS has a positive impact on pain relief in patients with CPSP, but does not enhance patients’ psychological well-being in terms of anxiety or depression. Furthermore, large-sample, high-quality, and multi-center RCTs are needed to explore the benefits of different stimulation durations and parameters in patients with CPSP. The current study has been registered with Prospero under the registration number CRD42023468419.

KEYWORDS:

• Stroke
• central post-stroke pain
• elderly
• non-invasive brain stimulation
• meta-analysis

Acknowledgment

The authors would like to express their gratitude to Levi Lee and EditSprings (https://www.editsprings.cn) for the expert linguistic services provided.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/10749357.2024.2359341

Disclosure statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Data available

All relevant data for this article can be obtained by contacting the corresponding author

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.