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

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. and 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 [ = -0.39, (-0.54, -0.24),  < 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 [ = -0.45, (-0.65, -0.25),  < 0.001]. Other stimulation modalities also demonstrated favorable outcomes when compared to rTMS [ = -0.67, (-1.09, -0.25),  < 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.