Comparison of the effects of acupuncture and drug treatment for central post-stroke pain: A systematic review and network meta-analysis of randomized trials.

BACKGROUND AND PURPOSE: Central post-stroke pain (CPSP), a chronic neuropathic pain syndrome severely impairing quality of life, has no established optimal therapy, though randomized controlled trials have evaluated the effects of drug therapy, acupuncture, and their combination.

METHODS

The primary outcomes were pain scores and the number of adverse reactions. The primary analyses involved network plotting to illustrate the structure of the network with P-scores to encapsulate the ranking of interventions. Results were obtained through direct comparisons within studies and indirect comparisons across studies. The Cochrane tool (ROB 2.0) was utilized to evaluate risk of bias.

RESULTS

Bayesian ranking identified Xingnao Kaiqiao acupuncture combined with pregabalin (82.47 %) as the most effective, followed by carbamazepine with gabapentin (80.9 %), Xingnao Kaiqiao acupuncture (79.31 %), Tiaoshen Zhitong acupuncture (72.69 %) and pregabalin (69.2 %). Based on direct and indirect evidence from the NMA, Xingnao Kaiqiao acupuncture combined with pregabalin showed the greatest efficacy compared to placebo (-2.68, 95 % CI: -5.29 to -0.14). Tiaoshen Zhitong acupuncture outperformed carbamazepine (-1.74, 95 % CI: -3.20 to -0.23) and placebo (-2.06, 95 % CI: -4.05 to -0.03), while pregabalin demonstrated superior analgesic effects compared to carbamazepine (-1.54, 95 % CI: -2.40 to -0.64), gabapentin (-1.49, 95 % CI: -2.45 to -0.51), and placebo (-1.86, 95 % CI: -3.21 to -0.53).

CONCLUSION

For CPSP treatment, Xingnao Kaiqiao acupuncture combined with pregabalin was most effective, followed by Xingnao Kaiqiao acupuncture, Tiaoshen Zhitong acupuncture, and pregabalin. Treatment strategies may vary regionally; however, combining Xingnao Kaiqiao acupuncture with pregabalin could represent the most effective approach, providing clinical recommendations.