Efficacy and Safety of Acupuncture-Related Therapies for Central Post-Stroke Pain: An Umbrella Review.

Researchers reviewed nine studies examining acupuncture-related therapies for central post-stroke pain (CPSP), a debilitating chronic pain condition that affects many stroke survivors and significantly reduces quality of life. The review looked at various treatments including traditional acupuncture methods like manual acupuncture and electroacupuncture, as well as newer approaches such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation. The findings show that acupuncture-related therapies meaningfully reduced pain levels compared to conventional treatments and medications. Patients experienced an average pain reduction of 1.11 points on standard pain scales, which represents clinically significant relief. Beyond pain management, these therapies also improved physical function and mobility, helping survivors regain independence in daily activities. Quality of life scores increased by an average of 6.77 points, indicating better overall wellbeing. However, the treatments did not consistently improve emotional symptoms like anxiety or depression. Most side effects were mild and temporary, including minor bruising or discomfort at needle sites. The exception was rTMS, which had a higher rate of adverse events (61%), though most were still non-serious. It's important to note that the overall quality of the research was rated as low, meaning more rigorous studies are needed to confirm these benefits. For stroke survivors experiencing persistent pain, acupuncture-related therapies appear to be a generally safe option worth discussing with your healthcare team. If you choose to pursue acupuncture, seek treatment from a licensed acupuncturist with experience treating stroke patients.

This umbrella review synthesized 9 systematic reviews/meta-analyses evaluating acupuncture-related therapies (AT) for central post-stroke pain (CPSP). Interventions included manual acupuncture, electroacupuncture, and rTMS, compared against pharmacotherapy, placebo, or conventional therapy. Quality assessment using AMSTAR 2, PRISMA-A, ROBIS, and GRADE revealed predominantly low or critically low methodological quality and evidence certainty, with publication bias being the primary downgrading factor. Effect sizes demonstrated significant pain reduction (VAS/NRS: MD=-1.11, 95% CI [-1.41,-0.81], p<0.00001), improved functional outcomes (Modified Rankin Scale: MD=-0.62, 95% CI [-0.92,-0.32], p<0.00001), and enhanced quality of life (SF-36: MD=6.77, 95% CI [2.50,11.04], p=0.002). Psychological outcomes showed inconsistent results. Adverse events were generally mild and transient, except for rTMS (61.08% incidence). Clinical takeaway: AT demonstrates therapeutic potential for CPSP management with acceptable safety profiles, though high-quality RCTs are needed to strengthen evidence before definitive clinical recommendations.