Management of Central Post-Stroke Pain: Systematic Review and Meta-Analysis

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. 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. Twelve studies met requirements for a random-effects meta-analysis which found: neuromodulation to be the most effective with a moderate effect on pain scores (SMD = -0.60, 95% confidence interval [-0.97, -0.23]), followed by physical interventions with moderate effect (SMD = -0.55, [-1.28, 0.18), and pharmacological interventions with a small effect on pain (SMD = -0.36, [-0.68, -0.03]). Fourteen studies were included in proportional meta-analysis with pharmacological studies having a moderate effect (58.34% mean reduction, [36.50, 80.18]), and neuromodulation studies a small effect (31.70% mean reduction, [21.44, 41.96]). Sixteen studies were included in the narrative review. While the overall medium risk of bias limits generalisation of findings, fluvoxamine and repetitive transcranial magnetic stimulation was found to have consistently good pain alleviation and relatively low risk of side effects. Anticonvulsants were found to have a significant effect on pain reduction, but were found to have the most side effects. Virtual reality and acupuncture show promising results, but lack rigorous methodological investigation to understand their full effect. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This study was funded by Medical Research Council as part of Discovery Medicine North PhD Stundetship ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: N/A I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors