Neuromodulation approaches and applications in the management of post-stroke pain: a comprehensive review.

Introduction: Post-stroke pain (PSP) remains a common and profoundly debilitating consequence of stroke, both in terms of a delay in recovery and in substantially reducing quality of life. Both invasive and non-invasive brain stimulation techniques are increasingly being explored as possible treatment modalities for various forms of PSP. This literature review examines the current body of evidence for all forms of neurostimulation for PSP. Methods: In this paper, we provide a review of the most recent literature exploring neuromodulation for PSP, covering several key domains: an examination of various PSP subtypes and the underlying mechanisms; a consolidation to date of the literature examining both invasive and non-invasive neuromodulation techniques for forms of PSP, and a discussion of future directions for the field. Results: The impact of neuromodulation techniques on PSP populations, focusing primarily on spasticity and central post-stroke pain (CPSP) is discussed. Conclusion: To varying degrees, numerous invasive and non-invasive modalities are beginning to be explored for individuals suffering from PSP. While preliminary, there is promising evidence to suggest that neuromodulatory techniques may reduce or ameliorate PSP. Further evidence and large clinical trials are needed to compare these treatments to the standard of care, as well as each other, to optimize outcomes for patients. In a rapidly evolving field, this review helps to provide the current state of neuromodulation in research on PSP.