1000 Section - Pharmacological Management of Central Post-Stroke Pain: A Systematic Review of Randomized Controlled Trials

Wednesday, May 20, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

LA

Luiza S. Akai, n/a

Medical student
Faculty of Medicine of the University of São Paulo (FMUSP)
São Paulo, Sao Paulo, Brazil

Co-Author/Coautor(s)

GS

Gabrielle T I Sigaki, MD

Researcher
Instituto de Medicina Física e Reabilitação, Hospital das Clínicas HCFMUSP, Faculdade da Universidade de São Paulo, São Paulo, SP, BR.
São Paulo, Sao Paulo, Brazil
Marta Imamura, MD, PhD (she/her/hers)

Associate Professor
Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR.
Sao Paulo / Sao Paulo, Sao Paulo, Brazil

Objectives : Central post-stroke pain (CPSP) is a disabling complication that significantly affects quality of life and restricts functional recovery after stroke. Although multiple pharmacological therapies are used in practice, the supporting evidence remains limited. This systematic review aimed to summarize the efficacy and safety of pharmacological treatments for CPSP in adults, synthesizing data from randomized controlled trials (RCTs).

Design: A systematic search was conducted in PubMed, Embase and Web of Science using predefined PICOS criteria. Eligible studies were RCTs including adults ( >/= 18 years) with CPSP treated with pharmacological interventions compared with placebo, active comparator or usual care. Primary outcomes were pain reduction and functional improvement; secondary outcomes included quality of life and adverse events. Nine RCTs fulfilled inclusion criteria, evaluating antidepressants, anticonvulsants, gabapentinoids, opioids and opioid-modulating agents, with treatment durations ranging from two to twelve weeks.

Results: Amitriptyline showed the most consistent analgesic effect. Lamotrigine demonstrated moderate but alongside good tolerability. Duloxetine produced significant reductions in pain intensity and disability, indicating short-term effectiveness comparable to tricyclic antidepressants. Pregabalin did not significantly reduce pain severity but improved associated symptoms such as sleep disturbance and anxiety. Levetiracetam and naloxone did not demonstrate meaningful analgesic effects, and carbamazepine yielded only modest, non-significant improvement. Overall, adverse events were mild to moderate, with lamotrigine and duloxetine presenting the most favorable efficacy-tolerability balance.

Conclusion: Current evidence supports amitriptyline, lamotrigine and duloxetine as the most promising pharmacological options for CPSP. Lamotrigine and duloxetine appear to offer superior tolerability. However, the small samples and short duration of available RCTs underscore the need for larger, longer-term studies to refine comparative effectiveness and guide individualized treatment strategies for this complex condition.