Background & Aims
Central post-stroke pain (CPSP), previously known as Dejerine & Roussy Syndrome, is a debilitating neurological condition, often refractory to treatment, that negatively affects patients’ quality of life and hinderin their rehabilitation. The pain associated with this condition is neuropathic in nature, affecting up to 12% of stroke survivors, with its mechanism of action still not fully understood.
Understanding the neuroimaging signatures associated with this condition is crucial for both diagnosis and potential therapeutic interventions. This systematic review aims to provide a comprehensive overview of the neuroimaging findings related to post-stroke pain in order to clarify its pathophysiological mechanism and guide future research in search of a treatment for these patients.
Methods
The protocol of this review is registered in PROSPERO, with the following registration number: CRD42023467331.
The team followed the methodological guidelines of Preferred Reporting Items for Systematic Reviews (PRISMA). The search equation was developed in consultation with a medical librarian with expertise in systematic review searching, in accordance with the Population-Intervention-Comparison-Outcomes (PICO) method.
Results
This systematic review identified twelve studies that addressed CPSP and brain imaging[10-12,14-22, 25]. Ten studies used MRI to examine the patients’ brains, one study used PET and MRI and one study used SPECT and MRI¬. Three studies[11,14,15] report CPSP cases in patients who suffered stroke outside the thalamic region. Those studies appear to diverge from the general consensus on the matter. This may be justified by the studies’ limitations (table 2). One plausible reason for these results is that two of the three studies did not have a control group and rank high on potential patient selection bias. Additionally, one of the studies[15] did not examine which specific thalamic nuclei were affected and one study[14] had a small sample size. All three studies had a wide variability in stroke detection and CPSP diagnosis, thus suggesting that there is a high risk of Flow and Timing bias [28].
Conclusions
There were identified some limitations in this systematic review. We reviewed articles only in English, potentially leaving out some valuable information that could influence the results. We also only used three major databases, potentially missing out on some articles, although almost 300 articles were initially identified. A third limitation is publication bias, as almost half the studies show a high risk of patient selection bias, potentially creating bias in results.
In conclusion, we have determined that there seems to be a link between damage to the lateral thalamus or the spinothalamic tract and risk of developing CPSP.
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Presenting Author
Teresa Lapa
Poster Authors
Andriy Buzhanskyy
Medical
FCS-UBI
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Neuropathic Pain - Central