Rehabilitative Interventions for Central Neuropathic Pain: A Systematic Review With Meta-Analysis

Objective(s) (1) synthesise the findings of studies evaluating physiotherapy interventions for managing pain and quality of life in cNeP and (2) evaluate the implications of the study findings for clinical practice and research for the management of cNeP. Data Sources Databases were searched from inception until July 2020. Study Selection RCTs that utilised the visual analogue scale (VAS) to measure pain and the 36-item short-form health survey (SF36) to evaluate quality of life were included in the review. Data Extraction Methodological quality was assessed using the Physiotherapy Evidence Database Scale and the quality of evidence assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Data Synthesis 54 randomised controlled trials (RCTs) met inclusion. 24 trials were included in the meta-analysis. GRADE evidence quality of included trial comparisons ranged from moderate to very low; Meta-analyses of trials examining non-invasive neurostimulation revealed significant reductions in pain intensity due to spinal cord injury (SCI) (Hedges’ g = – 0.59; p = 0.01), fibromyalgia (Hedges’s g = – 1.50; p = 0.00), and phantom limb pain (mean difference = – 1.57, p = 0.02). The pooled analysis of trials utilising acupuncture, transcutaneous electrical nerve stimulation (TENS), and mirror therapy showed a significant reduction in pain intensity in stroke (mean difference = – 1.46; p < 0.001), multiple sclerosis (Hedges’s g = – 0.32; p = 0.01), and complex regional pain syndrome (Type 1) (mean difference = – 2.55; p < 0.001), respectively. Conclusions Evidence supports the use of non-invasive neurostimulation for the treatment of pain associated with SCI, fibromyalgia, and phantom limb pain. Benefits were also identified for acupuncture, TENS, and mirror therapy for the management of pain in stroke, multiple sclerosis, and complex regional pain syndrome, respectively.