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

Researchers compared different treatments for central post-stroke pain (CPSP), a chronic pain condition that can develop after a stroke and significantly affects quality of life. This systematic review and network meta-analysis examined multiple randomized controlled trials testing various medications (pregabalin, carbamazepine, gabapentin) and acupuncture approaches for CPSP management.

The study found that combining Xingnao Kaiqiao acupuncture with pregabalin medication was the most effective treatment option, with an effectiveness rating of 82.47%. Xingnao Kaiqiao acupuncture alone ranked third (79.31%), while another acupuncture protocol called Tiaoshen Zhitong ranked fourth (72.69%). Pregabalin medication alone was fifth most effective (69.2%). When compared directly to placebo, the acupuncture-medication combination showed the greatest pain reduction.

Interestingly, the acupuncture treatments performed better than some commonly prescribed medications. Tiaoshen Zhitong acupuncture outperformed carbamazepine, and pregabalin was more effective than both carbamazepine and gabapentin when used alone.

For stroke survivors dealing with chronic pain, these findings suggest that acupuncture—either alone or combined with medication—may be a valuable treatment option. The combination approach appears particularly promising, potentially offering better pain relief than medication alone. The study also noted that treatment strategies may need to vary by region, but the evidence supports acupuncture as an effective intervention for this challenging condition.

Patients interested in acupuncture for post-stroke pain should seek treatment from a licensed acupuncturist with experience in stroke rehabilitation and pain management.

This systematic review and network meta-analysis evaluated randomized controlled trials comparing pharmacological interventions (pregabalin, carbamazepine, gabapentin, placebo) and acupuncture protocols (Xingnao Kaiqiao, Tiaoshen Zhitong) for central post-stroke pain management. Primary outcomes included pain scores and adverse reactions, analyzed using Bayesian network meta-analysis with P-scores for intervention ranking.

Xingnao Kaiqiao acupuncture combined with pregabalin demonstrated highest efficacy (P-score: 82.47%), followed by carbamazepine-gabapentin combination (80.9%), Xingnao Kaiqiao alone (79.31%), Tiaoshen Zhitong (72.69%), and pregabalin monotherapy (69.2%). Network meta-analysis showed Xingnao Kaiqiao-pregabalin combination achieved greatest pain reduction versus placebo (MD: -2.68, 95% CI: -5.29 to -0.14). Tiaoshen Zhitong outperformed carbamazepine (MD: -1.74, 95% CI: -3.20 to -0.23) and placebo. Pregabalin demonstrated superior analgesic effects versus carbamazepine (MD: -1.54, 95% CI: -2.40 to -0.64) and gabapentin.

Clinical implication: Integrating Xingnao Kaiqiao acupuncture with pregabalin represents optimal evidence-based treatment for CPSP, with acupuncture monotherapy demonstrating clinically significant analgesic effects.