Opioids in Post-stroke Pain: A Systematic Review and Meta-Analysis

Area of Science:

• Neurology
• Pain Management
• Pharmacology

Background:

• Post-stroke pain is a common and debilitating sequela of stroke.
• The effectiveness of opioid medications for managing post-stroke pain remains uncertain.
• A significant knowledge gap exists regarding optimal post-stroke pain management strategies.

Purpose of the Study:

• To systematically review and assess the efficacy of opioids in treating post-stroke pain syndromes.
• To evaluate the impact of opioids on pain reduction and associated symptoms in stroke survivors.

Main Methods:

• A comprehensive literature search was performed across major medical databases (PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library) until August 31, 2020.
• Included were clinical trials on opioids and opioid antagonists for post-stroke pain; studies on other medications or non-pharmacological treatments were excluded.
• Eight eligible studies, including placebo-controlled and dose-response trials, were selected for qualitative and narrative analysis, with risk of bias assessment.

Main Results:

• Seven of eight studies indicated a slight overall analgesic effect of opioids, with variable impacts on mood and quality of life.
• Meta-analysis of randomized controlled trials showed inconclusive results due to the small number of studies and participants.
• The quality of evidence was assessed using the GRADE system, highlighting limitations in current research.

Conclusions:

• The limited number and heterogeneity of existing studies do not provide strong support for opioid efficacy in post-stroke pain.
• Further large-scale, double-blind randomized clinical trials are necessary to objectively assess pain and related outcomes.
• Current evidence is insufficient to guide clinical practice regarding opioid use for post-stroke pain.