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Effects of Non-Invasive Brain Stimulation on Clinical Pain Intensity and Experimental Pain Sensitivity Among Individuals with Central Post-Stroke Pain: A Systematic Review

Authors Ramger BC, Bader KA, Davies SP, Stewart DA, Ledbetter LS, Simon CB, Feld JA

Received 17 May 2019

Accepted for publication 5 October 2019

Published 13 December 2019 Volume 2019:12 Pages 3319—3329

DOI https://doi.org/10.2147/JPR.S216081

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Michael E Schatman


Benjamin Curtis Ramger,1 Kimberly Anne Bader,1 Samantha Pauline Davies,1 David Andrew Stewart,1 Leila Snow Ledbetter,2 Corey Brae Simon,1 Jody Ann Feld1

1Physical Therapy Division, Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA; 2Research and Education, Duke University Medical Center Library, Durham, NC, USA

Correspondence: Jody Ann Feld
Physical Therapy Division, Department of Orthopedic Surgery, Duke University School of Medicine, DUMC 104002, Durham, NC 27710, USA
Tel +1 919-681-1979
Email jody.feld@dm.duke.edu

Purpose: Central post-stroke pain (CPSP) is a neuropathic disorder resulting in pain and disability. An emerging treatment for CPSP is non-invasive brain stimulation including direct current stimulation [tDCS] and repetitive transcranial magnetic stimulation [rTMS]. This systematic review analyzes the efficacy and quality of non-invasive brain stimulation intervention studies for CPSP.
Methods: Studies were sought from three research databases published between 2007 and 2017. Studies were included if the sole intervention was non-invasive brain stimulation and the primary outcome either clinical or experimental pain intensity. Studies were qualitatively assessed for risk of bias.
Results: Of 1107 articles extracted, six met eligibility criteria. Five studies found a decrease in pain intensity (p<0.05) immediately and 3 weeks after rTMS or tDCS was delivered over the primary motor cortex. For experimental pain, one study found thermal pain thresholds improved for those receiving tDCS compared to sham (p<0.05), while another found normalization of the cold detection threshold only after rTMS (p<0.05). Qualitative assessment revealed only one study rated as “excellent/good” quality, while the other five were rated as “fair” or “poor”.
Conclusion: Non-invasive brain stimulation may have a therapeutic effect on pain level for individuals with CPSP, as evidenced by significant decreases in clinical and experimental pain scores. However, despite the impact of CPSP and the promise of non-invasive brain stimulation, few rigorous studies have been performed in this area. Future studies should aim to standardize treatment parameters, measure both clinical and experimental pain, and include long-term follow-up.

Keywords: stroke, pain management, transcranial direct current stimulation, transcranial magnetic stimulation

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