Physiotherapy interventions may relieve pain in individuals with central neuropathic pain: a systematic review and meta-analysis of randomised controlled trials

Abstract

Objectives: To evaluate the effectiveness of any form of physiotherapy intervention for the management of central neuropathic pain (cNeP) due to any underlying cause. Methods: Multiple databases were searched from inception until August 2021. Randomised controlled trials evaluating physiotherapy interventions compared to a control condition on pain among people with cNeP were included. Methodological quality and the quality of evidence were assessed using the Physiotherapy Evidence Database Scale and the Grading of Recommendations, Assessment, Development, and Evaluation tool, respectively. Results: The searches yielded 2661 studies, of which 23 randomised controlled trials met the inclusion criteria and were included in the meta-analyses. Meta-analyses of trials examining non-invasive neurostimulation revealed significant reductions in pain severity due to spinal cord injury (SCI; standardised mean difference (SMD): −0.59 (95% confidence interval [CI]: −1.07, −0.11), p = 0.02) and phantom limb pain (weighted mean difference (WMD): −1.57 (95% CI: −2.85, −0.29), p = 0.02). The pooled analyses of trials utilising acupuncture, transcutaneous electrical nerve stimulation (TENS), and mirror therapy showed significant reductions in pain severity among individuals with stroke (WMD: −1.46 (95% CI: −1.97, −0.94), p < 0.001), multiple sclerosis (SMD: −0.32 (95% CI: −0.57, −0.06), p = 0.01), and phantom limb pain (SMD: −0.74 (95% CI: −1.36, −0.11), p = 0.02), respectively. Exercise was also found to significantly reduce pain among people with multiple sclerosis (SMD: −1.58 (95% CI: −2.85, −0.30), p = 0.02). Conclusion: Evidence supports the use of non-invasive neurostimulation for the treatment of pain secondary to SCI and phantom limb pain. Beneficial pain management outcomes were also identified for acupuncture in stroke, TENS in multiple sclerosis, and mirror therapy in phantom limb pain.

Phantom Limb Pain: Current Concepts and Treatment Strategies

“…However, it may not eliminate the pain completely, and success rates vary. Some studies have reported significant reductions in pain intensity for a subset of patients [58,59]. Mirror therapy utilizes the reflection of the intact limb in a mirror to create the illusion of the missing limb's presence.…”

“…It is believed to balance the flow of energy and promote healing. Acupuncture has been explored as a potential therapy for phantom limb pain, and some individuals have reported reduced pain levels and improved overall well-being after acupuncture sessions [59,61]. The success rates of acupuncture vary among…”

“…However, among the therapies mentioned, mirror therapy has shown promising results in multiple studies and is considered one of the most effective treatments for phantom limb pain. Mirror therapy can help alleviate pain, improve functional outcomes, and promote cortical reorganization [58,59,57]. Mirror therapy utilizes the brain's neuroplasticity to retrain neural pathways and reduce pain perception.…”