Noninvasive Treatment of Central Post-Stroke Neuropathic Pain

Abstract

BACKGROUND: Central post-stroke pain (CPSP) is a neuropathic pain syndrome occurring after a cerebrovascular accident in 8 to 14 % of patients with stroke. This pain is largely refractory to medicinal and surgical treatments. Investigators have assayed numerous types of medicines and therapies for CPSP, but large controlled trials are lacking, and a treatment method is far from being standardized. OBJECTIVE: To review the current pharmacological treatments for CPSP and other noninvasive modality options, and to evaluate the strength of evidence on the efficacies of the treatment forms. METHODS: Search strategies with the keywords ”neuropathic pain,” ”stroke,” and ”central post-stroke pain” were used in combination with ”pharmacological treatment,” ”acupuncture,” ”neurostimulation,” ”physical therapy,” ”modality”and ”transcutaneous electrical nerve stimulation” as treatment options. The retrieved articles relating to CPSP were reviewed. RESULTS: The pathophysiology of CPSP is not well understood, but previous research has suggested central disinhibition, imbalance of stimuli, and central sensitization as underlying mechanisms. Amitriptyline and lamotrigine are recommended as first-line drugs, with mexiletine, fluvoxamine, and gabapentin as second-line drugs. There are numerous non-pharmacological therapies for CPSP, but more extensive research is required to determine their efficacies. CONCLUSIONS: CPSP patients present with diverse sensory symptoms. The pathophysiology of CPSP is still poorly understood; thus, further studies are needed to elucidate the underlying mechanisms and investigate newer therapeutic modalities.