Noninvasive brain stimulation reduces pain intensity in central poststroke pain with a pooled effect size of -0.64
Photo by National Cancer Institute / Unsplash
Key Takeaway
Consider noninvasive brain stimulation for pain in central poststroke pain, but note lack of benefit for psychosocial outcomes.
This systematic review and meta-analysis assessed the efficacy of noninvasive brain stimulation for central poststroke pain. The study included 430 patients and compared active stimulation against sham stimulation. The primary outcome was pain intensity, while secondary outcomes included psychological symptoms, quality of life, depression, and anxiety.
The pooled analysis showed a significant reduction in pain intensity with an effect size of -0.64 (95% confidence interval: -1.24 to -0.05, P = 0.035). Subgroup analyses revealed greater pain reduction for primary motor cortex stimulation (effect size: -1.07; 95% CI: -1.62 to -0.52) and transcranial direct current stimulation (effect size: -1.08; 95% CI: -1.99 to -0.17).
No significant effects were observed for depression, anxiety, or quality of life. Adverse events, serious adverse events, discontinuations, and tolerability were not reported. The authors acknowledge that larger, well-designed trials are required to validate stimulation-specific efficacy and clarify the broader therapeutic role of noninvasive brain stimulation in central poststroke pain. Funding or conflicts of interest were not reported.
View Original Abstract ↓
OBJECTIVE: The aim of the study was to systematically evaluate the effects of noninvasive brain stimulation on pain intensity, psychological symptoms, and quality of life in patients with central poststroke pain.
DESIGN: A systematic review and meta-analysis of randomized controlled trials was conducted. Databases including PubMed, Embase, Cochrane Library, Web of Science, and CNKI were searched through April 2025. Standardized mean differences with 95% confidence intervals were calculated, and subgroup analyses were performed by stimulation target and modality.
RESULTS: Thirteen randomized controlled trials involving 430 participants were included. Compared with sham stimulation, noninvasive brain stimulation significantly reduced pain intensity (standardized mean difference = -0.64, 95% confidence interval: -1.24 to -0.05, P = 0.035). Subgroup analyses showed greater pain reduction when stimulation targeted the primary motor cortex (M1) (standardized mean difference = -1.07, 95% confidence interval: -1.62 to -0.52) and when using transcranial direct current stimulation (standardized mean difference = -1.08, 95% confidence interval: -1.99 to -0.17). However, no significant effects were observed on depression, anxiety, or quality of life.
CONCLUSIONS: Noninvasive brain stimulation, particularly M1 stimulation and transcranial direct current stimulation, may provide analgesic benefits for central poststroke pain but appears ineffective for psychosocial outcomes. Larger, well-designed trials are required to validate stimulation-specific efficacy and clarify the broader therapeutic role of noninvasive brain stimulation in central poststroke pain.
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