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

Linjia Wang,1, Jiangyi Dou,1, Yue Yang,2, Di Qin,1 Benhua Yu,1 Xiaoqing Li,1 Jian Ying,3 Lili Zhu,1 Nan Jiang,4 Yuan Zhou,1 Ling Zhao,5 Xi Zhou,1 Chunyan Gou1 1Acupuncture Department, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, People’s Republic of China; 2Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Chengdu, 610041, People’s Republic of China; 3Oncology Department, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, People’s Republic of China; 4Acupuncture Department, Zigong Hospital of Traditional Chinese Medicine, Zigong, 643000, People’s Republic of China; 5School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, People’s Republic of ChinaThese authors contributed equally to this workCorrespondence: Chunyan Gou; Xi Zhou, Email gouchunyan1977@163.com; 17902767@qq.comPurpose: Central post-stroke pain (CPSP) severely impairs survivors’ quality of life, and pharmacological therapies are often limited by resistance and safety. Acupuncture-related therapies (AT) shows potential, but evidence is fragmented. This umbrella review synthesizes existing systematic reviews/meta-analyses (SRs/MAs) to evaluate the efficacy and safety of AT for CPSP.Patients and Methods: This umbrella review included SRs/MAs of randomized controlled trials comparing AT with pharmacotherapy, placebo, or conventional therapy for CPSP. AT methods included traditional acupuncture methods such as manual acupuncture (MA) and electroacupuncture, as well as non‑pharmacological physical interventions such as repetitive transcranial magnetic stimulation (rTMS). The outcomes included pain, limb function, psychological status, quality of life, and adverse events (AEs). Methodological quality, reporting quality, risk of bias, and evidence certainty of the SRs/MAs were assessed using the AMSTAR 2, PRISMA-A, ROBIS, and GRADE tools.Results: A total of 9 SRs/MAs were included in this review. The reporting quality was relatively complete overall (median PRISMA-A score: 23.5/27). The methodological quality and certainty of evidence were predominantly low or critically low, with publication bias and risk of bias as the major downgrading factors. In terms of efficacy, AT significantly reduced pain scores versus control therapies (e.g. Visual analogue scale/ Numeric rating scale, mean difference MD=− 1.11, 95% confidence intervalsCI − 1.41,-0.81, p< 0.00001), improved limb function (e.g. Modified Rankin Scale, MD=− 0.62, 95% CI − 0.92,-0.32, p< 0.00001), and enhanced quality of life (e.g. MOS 36-Item short-form health survey score, MD=6.77, 95% CI 2.50,11.04, p=0.002). Psychological outcomes did not show consistent improvement (e.g. Hamilton anxiety scale, MD=− 0.96, 95% CI − 2.94,1.02, p=0.34). AEs were mostly mild and transient, although rTMS was associated with the highest incidence (61.08%).Conclusion: AT can alleviate pain and improve limb function and quality of life in CPSP, though its effect on psychological symptoms remains unclear. The treatment is generally safe; however, rTMS carries a high risk of AEs. These findings require confirmation through rigorous, high-quality studies.Plain Language Summary: We collected and analyzed the findings from nine published reviews of clinical trials on acupuncture-related therapies (one type of complementary and alternative medicine) for central post-stroke pain (CPSP)—a common and severe pain condition after stroke that greatly affects daily life. Our work showed that acupuncture-related therapies can meaningfully reduce pain, improve movement, and enhance quality of life for people with CPSP, although it does not appear to consistently help with emotional symptoms like anxiety or depression. Most (e.g. manual acupuncture, electroacupuncture, transcranial direct current stimulation) side effects were mild and short-lived, though one form of acupuncture-related therapies (repetitive transcranial magnetic stimulation) was linked to more side effects. While these results are promising, the overall quality of the existing evidence is still low. Our review highlights acupuncture as a generally safe and potentially useful option for survivors with CPSP, and calls for better-designed studies to provide clearer guidance for patients and clinicians in the future.Keywords: central pain, stroke complications, complementary and alternative medicine, overview