Effects of joint mobilization combined with acupuncture on pain, physical function, and depression in stroke patients with chronic neuropathic pain: A randomized controlled trial

Chronic neuropathic pain is one of the most challenging complications affecting people who have suffered a stroke (CVA). This condition affects more than 80 million stroke survivors worldwide, with more than half of these patients facing significant difficulties performing daily activities due to neurological limitations. Shoulder pain, present in more than 50% of cases, and knee pain are the most frequent symptoms, directly interfering with the rehabilitation process and reducing the functional capacity of arms and legs. Beyond physical limitations, these patients frequently develop depression, which further compromises their quality of life and recovery.

Given this scenario, it becomes essential to find effective therapeutic approaches that can simultaneously control pain, improve physical function, and reduce depressive symptoms.

This study aimed to investigate whether the combination of joint mobilization with acupuncture would be more effective than joint mobilization alone in treating post-stroke patients with chronic neuropathic pain. The researchers conducted a randomized controlled clinical trial involving 69 adult patients with a stroke diagnosis at least six months prior, all presenting shoulder and knee pain for more than six months. Participants were randomly divided into three groups of 23 people each: one group received joint mobilization combined with acupuncture, another received only joint mobilization, and the third served as a control, receiving none of the interventions. For 12 weeks, the treatment groups received 30-minute joint mobilization sessions twice a week, while the group also receiving acupuncture had additional 30-minute sessions of acupuncture and moxibustion once a week.

Joint mobilization was applied to the shoulder and knee joints, using specific movement and joint distraction techniques. Acupuncture treatment used specific points around the shoulder and knee, combined with moxibustion, a technique that uses therapeutic heat.

Results demonstrated significant benefits of combined therapy. Patients receiving joint mobilization together with acupuncture showed superior improvements in pain, physical function, and depression when compared to the other groups. Specifically, there was a significant reduction in shoulder pain and disability indices, as well as in knee pain scores. Joint range of motion, especially knee flexion, improved considerably in the combined therapy group.

Regarding physical function, patients showed improvements in walking speed, gait balance, manual function, and ability to perform basic and instrumental daily activities. Depression scores also decreased significantly only in the group receiving combined treatment. Although the group receiving only joint mobilization showed some improvements compared to the control group, benefits were substantially smaller than those observed with combined therapy.

These findings have important clinical implications for both patients and healthcare professionals. For patients, results suggest that the combination of joint mobilization with acupuncture may offer a more comprehensive and effective approach to managing chronic neuropathic pain after stroke. Simultaneous improvement in pain, physical function, and mood may result in greater independence in daily activities and better quality of life. For healthcare professionals working with manual therapy and acupuncture, the study provides scientific evidence supporting the integration of these two therapeutic modalities.

Joint mobilization acts mechanically by improving joint movement and stimulating receptors that can inhibit pain, while acupuncture works by stimulating the central nervous system to raise the pain threshold and promote neurological recovery. Moxibustion complements treatment through thermal stimulation, which may have additional relaxing and analgesic effects.

The study presents some limitations that should be considered when interpreting the results. The sample was composed mainly of rural elderly individuals, which may limit the generalizability of findings to urban populations or different age groups. In addition, evaluations were performed only before and after the 12-week intervention period, and more frequent evaluations could have provided more detailed information about treatment progress. The relatively small sample size also represents a limitation, although it was statistically calculated to detect significant differences between groups.

Another point to consider is that the study was retroactively registered in clinical trial databases, although it was conducted according to rigorous ethical standards. Despite these limitations, the study offers valuable evidence on the efficacy of combined therapy and establishes a solid foundation for future research that may include larger samples, more diverse populations, and more frequent evaluations of clinical outcomes.