Zhang Tianwei, Zhai Junying, Cheng Ling, Jiang Kaixin, Wang Dayang, Shi Huawei, Wang Bin, Chen Xing, Dong Xinglu, Zhou Li
Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Beijing University of Chinese Medicine, Beijing, China.
Front Neurol. 2025 Apr 30;16:1528956. doi: 10.3389/fneur.2025.1528956. eCollection 2025.
Post-stroke thalamic pain (PS-TP), a common form of central pain, is characterized by hyperalgesia and abnormal sensations in the contralateral affected area. Acupuncture treatment has shown increasing promise in treating PS-TP in recent years. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of acupuncture treatment for PS-TP.
According to the established search strategy, randomized controlled trials (RCTs) of acupuncture therapy for PS-TP were retrieved from eight Chinese and English databases as well as two clinical trial registration platforms, up to February 2024. Outcome measures included the total efficacy rate, visual analogue scale (VAS), present pain intensity score (PPI), pain rating index (PRI), β-endorphin (β-EP), substance P (SP) and adverse reactions. Sensitivity analysis and subgroup analysis were conducted to identify the sources of heterogeneity. We evaluated the evidence quality of outcomes via the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) rating system and performed trial sequential analyses using TSA software.
The final inclusion comprised 12 articles, which involved 953 patients. Meta-analysis results indicated that acupuncture treatment for PS-TP was more effective than conventional medical treatment in reducing VAS scores [MD = -1.11, 95% CI (-1.33, -0.88), p = 0.002], PPI scores [MD = -0.65, 95% CI (-1.13, -0.16), p = 0.009], and PRI scores [MD = -1.02, 95% CI (-1.41, -0.63), p < 0.00001]. Additionally, acupuncture treatment for PS-TP was superior to the conventional medical treatment in increasing plasma β-EP levels [MD = 8.83, 95% CI (5.42, 12.25), p < 0.00001], and reducing SP levels [MD = -4.75, 95% CI (-7.11, -2.40), p < 0.0001]. Regarding the total efficacy rate, acupuncture treatment was superior to the conventional medical treatment in treating PS-TP [RR = 1.24, 95% CI (1.17, 1.31), p < 0.00001]. The incidence of adverse events was lower in acupuncture treatment than in conventional medical treatment [RR = 0.43, 95% CI (0.14, 1.32), p = 0.03]. The GRADE assessment indicated that the quality of evidence for all outcome measures ranged from moderate to very low. Trial sequential analysis (TSA) results provided compelling evidence for the efficacy of acupuncture in treating PS-TP.
Acupuncture treatment emerges as a potentially efficacious and safe treatment option for PS-TP. In the future, more large-sample, high-quality RCTs are needed to provide primarily high-level evidence in evidence-based medicine regarding the safety and sustained effects of acupuncture treatment for PS-TP.
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024498698, identifier CRD42024498698.
中风后丘脑痛（PS-TP）是中枢性疼痛的一种常见形式，其特征为对侧受累区域的痛觉过敏和异常感觉。近年来，针灸治疗在PS-TP的治疗中显示出越来越大的前景。本系统评价和荟萃分析旨在评估针灸治疗PS-TP的疗效和安全性。
根据既定的检索策略，截至2024年2月，从八个中英文数据库以及两个临床试验注册平台检索了针灸治疗PS-TP的随机对照试验（RCT）。结局指标包括总有效率、视觉模拟评分法（VAS）、当前疼痛强度评分（PPI）、疼痛评级指数（PRI）、β-内啡肽（β-EP）、P物质（SP）和不良反应。进行敏感性分析和亚组分析以确定异质性来源。我们通过推荐分级评估、制定和评价（GRADE）评级系统评估结局的证据质量，并使用TSA软件进行试验序贯分析。
最终纳入12篇文章，涉及953例患者。荟萃分析结果表明，针灸治疗PS-TP在降低VAS评分[MD = -1.11，95%CI（-1.33，-0.88），p = 0.002]、PPI评分[MD = -0.65，95%CI（-1.13，-0.16），p = 0.009]和PRI评分[MD = -1.02，95%CI（-1.41，-0.63），p < 0.00001]方面比传统药物治疗更有效。此外，针灸治疗PS-TP在提高血浆β-EP水平[MD = 8.83，95%CI（5.42，12.25），p < 0.00001]和降低SP水平[MD = -4.75，95%CI（-7.11，-2.40），p < 0.0001]方面优于传统药物治疗。关于总有效率，针灸治疗在治疗PS-TP方面优于传统药物治疗[RR = 1.24，95%CI（1.17，1.31），p < 0.00001]。针灸治疗的不良事件发生率低于传统药物治疗[RR = 0.43，95%CI（0.14，1.32），p = 0.03]。GRADE评估表明，所有结局指标的证据质量从中等到非常低不等。试验序贯分析（TSA）结果为针灸治疗PS-TP的疗效提供了有力证据。
针灸治疗是一种对PS-TP可能有效且安全的治疗选择。未来，需要更多大样本、高质量的RCT，以在循证医学中提供关于针灸治疗PS-TP的安全性和持续效果的主要高级别证据。
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024498698，标识符CRD42024498698 。
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