Prevalence and Management Challenges in Central Post-Stroke Neuropathic Pain: A Systematic Review and Meta-analysis

Abstract

Introduction: Central post-stroke pain (CPSP) is defined as the neuropathic pain that arises either acutely or in the chronic phase of a cerebrovascular event and is a result of central lesions of the somatosensory tract. The aim of this systematic review and meta-analysis was to establish the prevalence of CPSP, to describe its characteristics, and to discuss the associated management challenges. Methods: After a systematic Medline search, we identified 69 papers eligible to be included. Results: The pooled prevalence of CPSP in patients with stroke at any location was 11% (95% CI 7-18%), which can increase to more than 50% in the subgroups of patients with medullary or thalamic strokes. CPSP onset coincides with stroke occurrence in 26% of patients (95% CI 18-35%); CPSP manifests within a month since symptom onset in 31% of patients (95% CI 22-42%), and occurs between the first month and the first year in 41% of patients (95% CI 33.9-49.0%). CPSP develops more than 12 months after stroke onset in 5% of patients (95% CI 3-8%). Conclusions: Clinicians should look for any evidence of central neuropathic pain for at least 12 months after stroke. Both pharmacological and non-pharmacological interventions can be used for the management of CPSP. Lamotrigine has the strongest evidence (Level II of evidence, derived from small randomized controlled trials) for being effective in the management of CPSP. Future research should focus on well-designed trials of pharmacological and non-pharmacological interventions aiming to relief CPSP, which is a very common but often neglected pain syndrome.

B12 as a Treatment for Peripheral Neuropathic Pain: A Systematic Review

“…Neuropathic pain can be central or peripheral in origin. Aetiologies of primarily neuropathic pain include peripheral pathologies such as chronic alcohol consumption, cancer, drug toxicity, diabetes mellitus, herpes zoster infection, traumatic nerve injuries, as well as central processes including cerebrovascular accidents, multiple sclerosis and spinal cord injuries [2][3][4][5][6][7]. Not all pain syndromes are of a single pathophysiological somatosensory origin; for example, cervical radiculopathy is a mixed pain syndrome, in which a nervous lesion causes a common neuropathic pain syndrome, but in which there are also potentially nociceptive pain elements related to noxious stimuli of skeletal and soft tissue [2,8].…”

Scoping Review of Existing Stroke Guidelines; Argument for a Value-Added Change

“…Frequency of anxiety after stroke very high at 24.2% (21.5%-26.9%) by rating scales (111) with likely increased risk of further stroke and downward spiral from the PNI point of view. Post stroke depression (PSD) is reported at 18%-33% (112) ( gross under estimation again, see the comprehensive review on pathobiology of PSD Pascoe & Crewther (113)). Post Stroke Fatigue (PSF) is reported as one of the worst symptoms by 40% of the stroke survivors with prevalence of PSF vary from 25%-85% (114,115,117).…”

Repetitive Transcranial Magnetic Stimulation for Neuropathic Pain on the Non-Motor Cortex: An Evidence Mapping of Systematic Reviews

“…2, according to AMSTAR-2 criteria, 1 Cochrane SR [23] was graded as "high." Two SRs [26,27] were graded as "low," and 20 SRs [18,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] were graded as "critically low" [22,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46]]. e SRs were downgraded mainly due to the following reasons: absence of a predesigned and registered protocol [22,29,30,34,36,40,...…”

“…All SRs [22,23, were published between 2009 and 2020. Among the 23 included SRs, 11 [23,28,31,33,37,38,40,42,44,46] conducted a metaanalysis. e number of included primary studies ranged from 5 to 131, and they were conducted between 2004 and 2020.…”