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| Les deux révisions précédentes Révision précédente Prochaine révision | Révision précédente | ||
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acupuncture:evaluation:neuro-psychiatrie:07. douleur centrale post-avc [15 May 2023 18:13] Nguyen Johan [1. Systematic Reviews and Meta-Analysis] |
acupuncture:evaluation:neuro-psychiatrie:07. douleur centrale post-avc [23 May 2025 16:30] (Version actuelle) Nguyen Johan [1.1. Tamasauskas 2025] |
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| ===== Systematic Reviews and Meta-Analysis===== | ===== Systematic Reviews and Meta-Analysis===== | ||
| - | | ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture | | ||
| - | | ☆☆ | Evidence for effectiveness of acupuncture | | ||
| - | | ☆ | Limited evidence for effectiveness of acupuncture | | ||
| - | | Ø | No evidence or insufficient evidence | | ||
| - | Li 2023 | + | |
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| + | ==== Tamasauskas 2025 ==== | ||
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| + | Tamasauskas A, Silva-Passadouro B, Fallon N, Frank B, Laurinaviciute S, Keller S, Marshall A. Management of Central Poststroke Pain: Systematic Review and Meta-analysis. J Pain. 2025 Jan;26:104666. https://doi.org/10.1016/j.jpain.2024.104666 | ||
| + | ^Background| Central poststroke pain (CPSP) is a neuropathic pain condition prevalent in 8 to 35% of stroke patients. | | ||
| + | ^Methods|This systematic review and meta-analysis aimed to provide insight into the effectiveness of available pharmacological, physical, psychological, and neuromodulation interventions in reducing pain in CPSP patients (PROSPERO Registration: CRD42022371835). Secondary outcomes included mood, sleep, global impression of change, and physical responses. Data extraction included participant demographics, stroke etiology, pain characteristics, pain reduction scores, and secondary outcome metrics. | | ||
| + | ^Results|Forty-two original studies were included, with a total of 1,451 participants. No studies providing psychological therapy to CPSP patients were identified. Twelve studies met requirements for a random-effects meta-analyses that found pharmacological therapy to have a small effect on mean pain score (SMD = -.36, 96.0% confidence interval [-.68, -.03]), physical interventions did not show a significant effect (SMD = -.55 [-1.28, .18]), and neuromodulation treatments had a moderate effect (SMD = -.64 [-1.08, -.19]). Fourteen studies were included in proportional meta-analysis with pharmacological studies having a moderate effect (58.3% mean pain reduction [-36.51, -80.15]) and neuromodulation studies a small effect (31.1% mean pain reduction [-43.45, -18.76]). Sixteen studies were included in the narrative review, the findings from which largely supported meta-analysis results. Duloxetine, amitriptyline, and repetitive transcranial magnetic stimulation had the most robust evidence for their effectiveness in alleviating CPSP-induced pain. Further multicenter placebo-controlled research is needed to ascertain the effectiveness of physical therapies, such as **acupuncture** and virtual reality, and invasive and noninvasive neuromodulation treatments.| | ||
| + | ^PERSPECTIVE| This article presents a top-down and bottom-up overview of evidence for the effectiveness of different pharmacological, physical, and neuromodulation treatments of CPSP. This review could provide clinicians with a comprehensive understanding of the effectiveness and tolerability of different treatment types.| | ||
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| + | ==== Zhang 2025 ==== | ||
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| + | Zhang T, Zhai J, Cheng L, Jiang K, Wang D, Shi H, Wang B, Chen X, Dong X, Zhou L. Acupuncture effects of post-stroke thalamic pain: a systematic review and meta-analysis of randomized controlled trials. Front Neurol. 2025 Apr 30;16:1528956. https://doi.org/10.3389/fneur.2025.1528956 | ||
| + | ^Backgound| Post-stroke thalamic pain (PS-TP), a common form of central pain, is characterized by hyperalgesia and abnormal sensations in the contralateral affected area. Acupuncture treatment has shown increasing promise in treating PS-TP in recent years. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of acupuncture treatment for PS-TP.| | ||
| + | ^Methods| According to the established search strategy, randomized controlled trials (RCTs) of acupuncture therapy for PS-TP were retrieved from eight Chinese and English databases as well as two clinical trial registration platforms, up to February 2024. Outcome measures included the total efficacy rate, visual analogue scale (VAS), present pain intensity score (PPI), pain rating index (PRI), β-endorphin (β-EP), substance P (SP) and adverse reactions. Sensitivity analysis and subgroup analysis were conducted to identify the sources of heterogeneity. We evaluated the evidence quality of outcomes via the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) rating system and performed trial sequential analyses using TSA software.| | ||
| + | ^Results| The final inclusion comprised **12 articles, which involved 953 patients**. Meta-analysis results indicated that acupuncture treatment for PS-TP was more effective than conventional medical treatment in reducing VAS scores [MD = -1.11, 95% CI (-1.33, -0.88), p = 0.002], PPI scores [MD = -0.65, 95% CI (-1.13, -0.16), p = 0.009], and PRI scores [MD = -1.02, 95% CI (-1.41, -0.63), p < 0.00001]. Additionally, acupuncture treatment for PS-TP was superior to the conventional medical treatment in increasing plasma β-EP levels [MD = 8.83, 95% CI (5.42, 12.25), p < 0.00001], and reducing SP levels [MD = -4.75, 95% CI (-7.11, -2.40), p < 0.0001]. Regarding the total efficacy rate, acupuncture treatment was superior to the conventional medical treatment in treating PS-TP [RR = 1.24, 95% CI (1.17, 1.31), p < 0.00001]. The incidence of adverse events was lower in acupuncture treatment than in conventional medical treatment [RR = 0.43, 95% CI (0.14, 1.32), p = 0.03]. The GRADE assessment indicated that the quality of evidence for all outcome measures ranged from moderate to very low. Trial sequential analysis (TSA) results provided compelling evidence for the efficacy of acupuncture in treating PS-TP.| | ||
| + | ^Conclusion| Acupuncture treatment emerges as a potentially efficacious and safe treatment option for PS-TP. In the future, more large-sample, high-quality RCTs are needed to provide primarily high-level evidence in evidence-based medicine regarding the safety and sustained effects of acupuncture treatment for PS-TP.| | ||
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| + | ==== Cheng 2024 ==== | ||
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| + | Cheng X, Zhang X, Ji J. Acupuncture treatment for central post-stroke pain: a systematic review and meta-analysis. J Acupunct Tuina Sci. 2024;22:341-52. https://doi.org/10.1007/s11726-024-1453-1 | ||
| + | ^Objective|. To evaluate the efficacy and safety of acupuncture in the treatment of central post-stroke pain (CPSP). | | ||
| + | ^Methods|. Randomized controlled trials of acupuncture treatment for CPSP in PubMed, Excerpta Medica Database (EMBASE), Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform (Wanfang), Chongqing VIP Database (VIP), and China Biology Medicine Disc (CBM) were retrieved by computer. The retrieval time was from each database’s inception to July 2023. Meta-analysis was performed using RevMan 5.3 software; GRADEprofiler 3.6.1 software was used to evaluate the quality of evidence. Dichotomous variables were analyzed by the risk ratio (RR). Continuous data were analyzed by mean difference (MD) with a confidence interval (CI) of 95%.| | ||
| + | ^ Results| A total of **14 studies** were included, comprising a total of **1 045 patients**. The findings of the meta-analysis showed that compared with Western medication in treating CPSP, the acupuncture treatment had a higher clinical effective rate [RR=1.09, 95%CI (1.01, 1.19), Z=2.08, P<0.05], a lower visual analog scale (VAS) score [MD=−0.75, 95%CI (−1.18, −0.32), Z=3.41, P<0.001], a lower pain rating index (PRI) score [MD=−1.72, 95%CI (−2.76, −0.68), Z=3.24, P<0.05], a higher plasma β-endorphin (β-EP) level [MD=5.81, 95%CI (3.00, 8.62), Z=4.05, P<0.001], and a lower adverse reaction rate [RR=0.05, 95%CI (0.01, 0.18), Z=4.35, P<0.001]. There was no statistical difference in the present pain intensity (PPI) score between the two treatments [MD=−0.26, 95%CI (−0.54, 0.02), Z=1.79, P>0.05]. Compared with Western medication in treating CPSP, acupuncture plus Western medication had a higher clinical effective rate [RR=1.18, 95%CI (1.05, 1.34), Z=2.75, P<0.05], a lower VAS score [MD=−1.04, 95%CI (−1.26, −0.82), Z=9.25, P<0.001], and a lower Pittsburgh sleep quality index (PSQI) score [MD=−2.67, 95%CI (−4.80, −0.54), Z=2.46, P<0.05]. The results of the evidence quality grade evaluation showed that there was no moderate- or high-quality evidence for acupuncture or acupuncture plus Western medication compared with Western medication in the treatment of CPSP.| | ||
| + | ^Conclusion| Acupuncture has certain therapeutic advantages over Western medication in the treatment of CPSP. It can effectively relieve pain and improve sleep, with fewer adverse reactions and better safety. However, high-quality randomized controlled trials are still needed for further study and verification.| | ||
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| + | ==== Li 2023 ==== | ||
| Li W, Chen S. Acupuncture for thalamic pain after stroke: A systematic review and meta-analysis. Medicine (Baltimore). 2023 Mar 3;102(9):e33006. https://doi.org/10.1097/MD.0000000000033006. | Li W, Chen S. Acupuncture for thalamic pain after stroke: A systematic review and meta-analysis. Medicine (Baltimore). 2023 Mar 3;102(9):e33006. https://doi.org/10.1097/MD.0000000000033006. | ||
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| ^Results|A total of **11 papers **were included. Meta-analysis showed that acupuncture appeared to be more effective than drugs for treatment of thalamic pain, as assessed by the visual analog scale [mean difference (MD) = -1.06, 95% confidence interval (CI) (-1.20, -0.91), P < .00001], the present pain intensity score [MD = -0.27, 95% CI (-0.43, -0.11), P = .001], the pain rating index [MD = -1.02, 95% CI (-1.41, -0.63), P < .00001], and the total efficiency [risk ratio = 1.31, 95% CI (1.22,1.41), P < .00001]. Meta-analysis results show that there is no significant difference in safety between acupuncture and drug therapy [risk ratio = 0.50, 95% CI (0.30,0.84), P = .009].| | ^Results|A total of **11 papers **were included. Meta-analysis showed that acupuncture appeared to be more effective than drugs for treatment of thalamic pain, as assessed by the visual analog scale [mean difference (MD) = -1.06, 95% confidence interval (CI) (-1.20, -0.91), P < .00001], the present pain intensity score [MD = -0.27, 95% CI (-0.43, -0.11), P = .001], the pain rating index [MD = -1.02, 95% CI (-1.41, -0.63), P < .00001], and the total efficiency [risk ratio = 1.31, 95% CI (1.22,1.41), P < .00001]. Meta-analysis results show that there is no significant difference in safety between acupuncture and drug therapy [risk ratio = 0.50, 95% CI (0.30,0.84), P = .009].| | ||
| ^Conclusion|Studies have shown that acupuncture in the treatment of thalamic pain is effective, and it does not prove to have a higher safety than drug treatment, therefore a large-scale multicenter randomized controlled trials study is needed to further prove.| | ^Conclusion|Studies have shown that acupuncture in the treatment of thalamic pain is effective, and it does not prove to have a higher safety than drug treatment, therefore a large-scale multicenter randomized controlled trials study is needed to further prove.| | ||
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| + | ==== Yang 2023 ==== | ||
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| + | Yang J, Li X, Li C, He K, Wu Y, Lin H, Xie X, Zhang F, Hao H, Tian G. Comparative efficacy and safety of acupuncture and Western medicine for poststroke thalamic pain. Anat Rec (Hoboken). 2023 Dec;306(12):3050-3059. https://doi.org/10.1002/ar.24902 | ||
| + | ^Background|Poststroke thalamic pain (PSTP) is one of the most common sequelae following stroke. Analgesics, antidepressants, anticonvulsants, and surgical treatment are conventional treatment methods of PSTP, but these methods have limited efficacy, cost more, and cause a likelihood of adverse reactions. Clinical studies have shown that acupuncture has a significant analgesic effect on PSTP without obvious side effects. But, there is a lack of high-quality evidence concerning its effectiveness and safety to support its use. | | ||
| + | ^Methods|Therefore, this study aimed to evaluate the clinical efficacy and safety of acupuncture versus Western medicine for the treatment of PSTP to provide evidence to support clinical PSTP treatment. Searches were conducted to identify randomized controlled trials investigating the use of acupuncture for PSTP across six databases, including PubMed, the Cochrane Library, EMBASE, the China National Knowledge Infrastructure, Wan Fang Database, and the Chinese Scientific Journal Database VIP. RevMan 5.3 software was used for the meta-analysis. | | ||
| + | ^Results|The results showed that compared with Western medicine, acupuncture had a higher total effective rate for the treatment of PSTP, reduced visual analog scale scores, increased beta-endorphin content, and decreased incidence of adverse reactions. However, the sample sizes of the included studies were insufficient, and the quality of the articles was relatively poor. In future studies, the clinical study design should be standardized and the sample size should be expanded to validate these results.| | ||
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