title: Management of Central Poststroke Pain: Systematic Review of Randomized Controlled Trials.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.). mullasm@mcmaster.ca.
authors.forename: Sohail M
authors.initials: SM
authors.lastname: Mulla
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Rabia
authors.initials: R
authors.lastname: Khokhar
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Zain
authors.initials: Z
authors.lastname: Izhar
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Arnav
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Rachel
authors.initials: R
authors.lastname: Couban
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: D Norman
authors.initials: DN
authors.lastname: Buckley
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Moulin
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Akbar
authors.initials: A
authors.lastname: Panju
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Sun
authors.initials: S
authors.lastname: Makosso-Kallyth
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Alparslan
authors.initials: A
authors.lastname: Turan
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
authors.affiliation: From the Departments of Clinical Epidemiology and Biostatistics (S.M.M., R.K., Z.I., L.T., G.H.G., J.W.B.), Anesthesia (D.N.B., L.T., J.W.B.), Medicine (A.P., G.H.G.), and Pediatrics (L.T.) and Michael G. DeGroote Institute for Pain Research and Care (L.W., R.C., D.N.B., A.P., S.M.K., J.W.B.), McMaster University, Hamilton, Ontario, Canada; Outcomes Research Consortium, Cleveland, OH (S.M.M.); Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (A.A.); Departments of Clinical Neurological Sciences and Oncology, Western University, London, Ontario, Canada (D.E.M.); Department of Outcomes Research, Cleveland Clinic, OH (A.T., D.I.S.); and Knowledge and Evaluation Research Unit, Divisions of Endocrinology and Diabetes, and Health Care and Policy Research, Mayo Clinic, Rochester, MN (V.M.M.).
authors.forename: Jason W
authors.initials: JW
authors.lastname: Busse
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D006801:Humans; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009437:Neuralgia / Q000209:etiology / Q000628:therapy*; D059408:Pain Management; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000150:complications*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D009292:Narcotic Antagonists
keywords: evidence-based medicine; pain management; review; stroke; therapeutics