Différences
Ci-dessous, les différences entre deux révisions de la page.
| Les deux révisions précédentes Révision précédente Prochaine révision | Révision précédente | ||
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acupuncture:evaluation:neuro-psychiatrie:07. douleur centrale post-avc [08 Aug 2024 17:19] Nguyen Johan [1.1. Li 2023] |
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 | | ||
| Ligne 15: | Ligne 11: | ||
| - | Cheng 2024 | + | |
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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 ==== | ||
| 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 | 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). | | ^Objective|. To evaluate the efficacy and safety of acupuncture in the treatment of central post-stroke pain (CPSP). | | ||
