Brain Networks Serving Pain Control-A Lesion Network Mapping Study in Acute Ischemic Stroke

All healthy controls had effective CPM without body side differences, while about 1/3 of stroke patients had no CPM on both body sides. In patients, a stronger inhibition took place on the contralesional side. Compared to the mean scores of the healthy controls, CPM scores indicated significantly less pain inhibition in patients.
CPM performance after acute lesion was predominantly associated with the somatosensory-motor, default mode and salience ventral attentional networks for CPM at the contralesional body side, and with the somatosensory-motor and the limbic networks for CPM at the ipsilesional body side. We then followed the lesion-network connectivity approach utilized by Boes et al.[2]. Individual lesions were seeded in rs-fMRIs of controls and whole brain connectivity was estimated for each patient. Network maps were then overlaid. For specifying the network which is responsible for deficient (absent) CPM, an analysis was performed on data of patients having a CPM score ? 0 (n = 24). We identified brain areas that are well known to be involved in pain control like the orbitofrontal cortex or the cingulate but also to less familiar brain regions like the cerebellum.