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Nonpharmacological therapies for central poststroke pain: A systematic review.

ABSTRACT: BACKGROUND:Central poststroke pain (CPSP) is a neuropathic pain syndrome that can occur after a cerebrovascular accident. It has negative effects on mood, sleep, rehabilitation, and quality of life in stroke patients. This systematic review assessed the efficacy and safety of nonpharmacological therapies for treating CPSP. METHODS:The Cochrane, PubMed, Embase, and Web of Science databases were systematically searched for studies from inception to August 2020. Two authors worked independently and in duplicate to identify suitable studies. RESULTS:Eleven studies were identified. Pain related to CPSP was ameliorated by precentral gyrus stimulation (P?=?.01), caloric vestibular stimulation (P?=?0.004), transcranial direct current stimulation (P??.05) were as effective for thalamic pain as oral carbamazepine treatment. Motor cortex stimulation, but not deep brain stimulation (DBS), was effective for treating refractory CPSP, and appeared to be more effective than thalamic stimulation for controlling bulbar pain secondary to Wallenberg syndrome. However, DBS in the ventral striatum or anterior limb of the internal capsule improved depression (P?=?.020) and anxiety in patients with refractory CPSP. Some serious adverse events were reported in response to invasive electrical brain stimulation, but most of these effects recovered with treatment. CONCLUSIONS:Nonpharmacological therapies appear to be effective in CPSP, but the evidence is relatively weak. Invasive electrical brain stimulation can be accompanied by serious adverse events, but most patients recover from these effects.

SUBMITTER: Xu XM

PROVIDER: S-EPMC7572005 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Nonpharmacological therapies for central poststroke pain: A systematic review.

Xu Xiao-Min XM Luo Hua H Rong Ben-Bing BB Zheng Xiao-Mei XM Wang Feng-Tao FT Zhang Shu-Jiang SJ Li Zuo-Xiao ZX

Medicine 20201001 42

<h4>Background</h4>Central poststroke pain (CPSP) is a neuropathic pain syndrome that can occur after a cerebrovascular accident. It has negative effects on mood, sleep, rehabilitation, and quality of life in stroke patients. This systematic review assessed the efficacy and safety of nonpharmacological therapies for treating CPSP.<h4>Methods</h4>The Cochrane, PubMed, Embase, and Web of Science databases were systematically searched for studies from inception to August 2020. Two authors worked in ...[more]

PMID: 33080696

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Project description:The electrophysiological recording can be used to quantify the clinical features of central poststroke pain (CPSP) caused by different lesion locations. We aimed to explore the relationship between clinical features and lesion location in patients with CPSP using the current perception threshold (CPT) approach. Here, patients underwent the standardized CPT measure at five detection sites on both the contralesional and ipsilesional sides, using a constant alternating-current sinusoid waveform stimulus at three frequencies: 2000 Hz, 250 Hz, and 5 Hz. 57 CPSP patients were recruited in this cross-sectional study, including 13 patients with thalamic lesions and 44 patients with internal capsule lesions. Patients with a thalamic lesion had more frequent abnormal Aδ and C fibers than those with an internal capsule lesion (69.2% versus 36.4%, p value = 0.038; 53.8% versus 63.6%, p value = 0.038). The patients with internal capsule lesions had more frequent abnormal Aβ fibers than those with thalamic lesions (53.8% versus 63.6%, p value < 0.001). The sensory dysfunction in the patients with thalamic lesions was more likely to occur in the upper limbs (i.e., the shoulder (p value = 0.027) and the finger (p value = 0.040)). The lower limbs (i.e., the knee (p value = 0.040) and the toe (p value = 0.005)) were more likely to experience sensory dysfunction in the patients with internal capsule lesions. Hyperesthesia was more likely to occur in the thalamic patients, and hypoesthesia was more likely to occur in the patients with internal capsule lesions (p value < 0.001). In patients with thalamic lesions, Visual Analogue Scale (VAS) had a positive correlation with 5 Hz CPT on the shoulder (r = 0.010, p value = 0.005), 250 Hz CPT on the finger (r = 0.690, p value = 0.009) from the contralesional side, and 2000 Hz CPT on the knee (r = 0.690, p value = 0.009). In patients with internal capsule lesions, VAS had a positive correlation with 2000 Hz CPT on the knee (r = 0.312, p value = 0.039) and foot (r = 0.538, p value < 0.001). In conclusion, the abnormal fiber types, sensory dysfunction territory, and clinical signs of CPSP in thalamic stroke differ from those in internal capsule stroke. Implementation of the portable and convenient CPT protocol may help clarify the locations of different stroke lesions in various clinical settings.

Project description:Importance:Mind-body therapies (MBTs) are emerging as potential tools for addressing the opioid crisis. Knowing whether mind-body therapies may benefit patients treated with opioids for acute, procedural, and chronic pain conditions may be useful for prescribers, payers, policy makers, and patients. Objective:To evaluate the association of MBTs with pain and opioid dose reduction in a diverse adult population with clinical pain. Data Sources:For this systematic review and meta-analysis, the MEDLINE, Embase, Emcare, CINAHL, PsycINFO, and Cochrane Library databases were searched for English-language randomized clinical trials and systematic reviews from date of inception to March 2018. Search logic included (pain OR analgesia OR opioids) AND mind-body therapies. The gray literature, ClinicalTrials.gov, and relevant bibliographies were also searched. Study Selection:Randomized clinical trials that evaluated the use of MBTs for symptom management in adults also prescribed opioids for clinical pain. Data Extraction and Synthesis:Independent reviewers screened citations, extracted data, and assessed risk of bias. Meta-analyses were conducted using standardized mean differences in pain and opioid dose to obtain aggregate estimates of effect size with 95% CIs. Main Outcomes and Measures:The primary outcome was pain intensity. The secondary outcomes were opioid dose, opioid misuse, opioid craving, disability, or function. Results:Of 4212 citations reviewed, 60 reports with 6404 participants were included in the meta-analysis. Overall, MBTs were associated with pain reduction (Cohen d?=?-0.51; 95% CI, -0.76 to -0.26) and reduced opioid dose (Cohen d?=?-0.26; 95% CI, -0.44 to -0.08). Studies tested meditation (n?=?5), hypnosis (n?=?25), relaxation (n?=?14), guided imagery (n?=?7), therapeutic suggestion (n?=?6), and cognitive behavioral therapy (n?=?7) interventions. Moderate to large effect size improvements in pain outcomes were found for meditation (Cohen d?=?-0.70), hypnosis (Cohen d?=?-0.54), suggestion (Cohen d?=?-0.68), and cognitive behavioral therapy (Cohen d?=?-0.43) but not for other MBTs. Although most meditation (n?=?4 [80%]), cognitive-behavioral therapy (n?=?4 [57%]), and hypnosis (n?=?12 [63%]) studies found improved opioid-related outcomes, fewer studies of suggestion, guided imagery, and relaxation reported such improvements. Most MBT studies used active or placebo controls and were judged to be at low risk of bias. Conclusions and Relevance:The findings suggest that MBTs are associated with moderate improvements in pain and small reductions in opioid dose and may be associated with therapeutic benefits for opioid-related problems, such as opioid craving and misuse. Future studies should carefully quantify opioid dosing variables to determine the association of mind-body therapies with opioid-related outcomes.

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Nonpharmacological therapies for central poststroke pain: A systematic review.

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Nonpharmacological therapies for central poststroke pain: A systematic review.

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