Effectiveness of noninvasive brain stimulation for patients with central poststroke pain: a systematic review and meta analysis of randomized controlled trials.

Abstract

To systematically evaluate the effects of noninvasive brain stimulation (NIBS) on pain intensity, psychological symptoms, and quality of life in patients with central poststroke pain (CPSP). A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. Databases including PubMed, Embase, Cochrane Library, Web of Science, and CNKI were searched through April 2025. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated, and subgroup analyses were performed by stimulation target and modality. Thirteen RCTs involving 430 participants were included. Compared with sham stimulation, NIBS significantly reduced pain intensity (SMD = -0.64, 95% CI: -1.24 to -0.05, p = 0.035). Subgroup analyses showed greater pain reduction when stimulation targeted the primary motor cortex (M1) (SMD = -1.07, 95% CI: -1.62 to -0.52) and when using transcranial direct current stimulation (tDCS) (SMD = -1.08, 95% CI: -1.99 to -0.17). However, no significant effects were observed on depression, anxiety, or quality of life. NIBS, particularly M1 stimulation and tDCS, may provide analgesic benefits for CPSP but appears ineffective for psychosocial outcomes. Larger, well-designed trials are required to validate stimulation-specific efficacy and clarify the broader therapeutic role of NIBS in CPSP.