Summary of current clinical management guideline recommendations on CPSP

Royal College of Physicians (2016) [54]

Patients with central post-stroke pain ought to receive amitryptilline, gabapentin, or pregabalin as their initial treatments.

Patients with central post-stroke pain who are unable to obtain adequate pain relief with initial pharmaceutical therapy at the maximum permissible dose should be given the option of receiving therapy with an alternative medication or medication in conjunction with the first medication.

American Heart Association/American Stroke Association (2016) [53]

Amitriptyline and lamotrigine are acceptable first-line medications (Class IIa, LoE B)

Second-line therapies could include phenytoin, gabapentin, pregabalin, or carbamazepine (Class IIb, LoE B)

The efficacy of transcutaneous electrical nerve stimulation (TENS) as a therapy is yet to be proven (Class III, LoE B)

Motor cortex stimulation may be appropriate in the management of persistent central post-stroke pain that is unresponsive to other therapies in carefully selected patients (Class IIb, LoE B)

The efficacy of deep brain stimulation as a therapy is yet to be proven (Class III, LoE B)

Canadian Stroke Best Practice (2020) [55]

Anticonsulvant (such as gabapentin or pregabalin) should be the initial therapy for central nervous system pain (LoE C)

As a second-line treatment, tricyclic antidepressant (e.g., amitryptiline) or a Serotonin-norepinephrine Reuptake Inhibitor (especially duloxetine) should be administered to patients (LoE C)

Opioids and tramadol can be used to treat patients unresponsive to first- and second-line treatment (LoE C)

CPSP: central post-stroke pain, LoE: level of evidence.

Korean J Pain 2023;36:408~424
© Korean J Pain