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

PURPOSE: 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 intervals[CI] [-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.