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Central poststroke pain
Douleur centrale post-AVC : évaluation de l'acupuncture
1. Systematic Reviews and Meta-Analysis
1.1. Xu 2020
Xu XM, Luo H, Rong BB, Zheng XM, Wang FT, Zhang SJ, Li ZX. Nonpharmacological therapies for central poststroke pain: A systematic review. Medicine (Baltimore). 2020;99(42). [212867].doi
| Background | Central poststroke pain (CPSP) is a neuropathic pain syndrome that can occur after a cerebrovascular accident. It has negative effects on mood, sleep, rehabilitation, and quality of life in stroke patients. This systematic review assessed the efficacy and safety of nonpharmacological therapies for treating CPSP. |
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| Methods | The Cochrane, PubMed, Embase, and Web of Science databases were systematically searched for studies from inception to August 2020. Two authors worked independently and in duplicate to identify suitable studies. |
| Results | Eleven studies were identified. Pain related to CPSP was ameliorated by precentral gyrus stimulation (P = .01), caloric vestibular stimulation (P = 0.004), transcranial direct current stimulation (P < .05), and bee venom acupuncture point injection (P = .009). Acupuncture (P = .72) and electroacupuncture therapies (P > .05) were as effective for thalamic pain as oral carbamazepine treatment. Motor cortex stimulation, but not deep brain stimulation (DBS), was effective for treating refractory CPSP, and appeared to be more effective than thalamic stimulation for controlling bulbar pain secondary to Wallenberg syndrome. However, DBS in the ventral striatum or anterior limb of the internal capsule improved depression (P = .020) and anxiety in patients with refractory CPSP. Some serious adverse events were reported in response to invasive electrical brain stimulation, but most of these effects recovered with treatment. |
| Conclusions | Nonpharmacological therapies appear to be effective in CPSP, but the evidence is relatively weak. Invasive electrical brain stimulation can be accompanied by serious adverse events, but most patients recover from these effects. |
1.2. Mulla 2015 Ø
Mulla SM, Wang L, Khokhar R, Izhar Z, Agarwal A, Couban R, Buckley DN, Moulin DE, Panju A, Makosso-Kallyth S, Turan A, Montori VM, Sessler DI, Thabane L, Guyatt GH, Busse JW. management of central poststroke pain: systematic review of randomized controlled trials. Stroke. 2015. 46(10):2853-60. [183348].
| Background and purpose | Central poststroke pain is a chronic neuropathic disorder that follows a stroke. Current research on its management is limited, and no review has evaluated all therapies for central poststroke pain. |
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| Methods | We conducted a systematic review of randomized controlled trials to evaluate therapies for central poststroke pain. We identified eligible trials, in any language, by systematic searches of AMED, CENTRAL, CINAHL, DARE, EMBASE, HealthSTAR, MEDLINE, and PsychINFO. Eligible trials (1) enrolled ≥10 patients with central poststroke pain; (2) randomly assigned them to an active therapy or a control arm; and (3) collected outcome data ≥14 days after treatment. Pairs of reviewers, independently and in duplicate, screened titles and abstracts of identified citations, reviewed full texts of potentially eligible trials, and extracted information from eligible studies. We used a modified Cochrane tool to evaluate risk of bias of eligible studies, and collected patient-important outcomes according to recommendations by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. We conducted, when possible, random effects meta-analyses, and evaluated our certainty in treatment effects using the Grading of Recommendations Assessment, Development, and Evaluation System. |
| Results | Eight eligible English language randomized controlled trials (459 patients) tested anticonvulsants, an antidepressant, an opioid antagonist, repetitive transcranial magnetic stimulation, and acupuncture. Results suggested that all therapies had little to no effect on pain and other patient-important outcomes. Our certainty in the treatment estimates ranged from very low to low. |
| Conclusions | Our findings are inconsistent with major clinical practice guidelines; the available evidence suggests no beneficial effects of any therapies that researchers have evaluated in randomized controlled trials. |
