Background & Aims
Post-stroke pain can be broadly divided into nociceptive pain and neuropathic pain. These pain subtypes can be comprehensively assessed using several clinical tools, such as pain-related questionnaires, quantitative somatosensory tests, and brain imaging. In the present study, we conducted a comprehensive assessment of patients with central post-stroke pain (CPSP) and non-CPSP and analyzed their clinical features. We also performed a detailed analysis of the relationships between brain lesion areas, the broadly influenced brain connectivity, and somatosensory dysfunctions.
Methods
In the present cross-sectional, multicenter study, the patients with post-stroke in the subacute or chronic phase, were divided into CPSP, non-CPSP, and no-pain groups. All patients performed the comprehensive pain evaluation including bedside quantitative sensory testing (bedside-QST), pain questionnaires, and imaging analysis to capture the clinical and pathological features and distinguish between the CPSP and non-CPSP. Multiple logistic regression analysis was used to explore the relationships between each pathological feature (for the CPSP and non-CPSP groups) and pain-related factors or the results of bedside-QST. Relationships between somatosensory dysfunctions and brain lesion areas were analyzed using voxel-based lesion–symptom mapping. In addition, the broad brain connection from the lesion was also performed using the disconnection map analysis to detect association with the abnormal sensation.
Results
Data from 50 individuals (17 with CPSP, 20 with non-CPSP, and 13 with no pain) were included. All pathology feature models indicated that CPSP was associated with cold hypoesthesia at 8?C and higher Neuropathic Pain Symptom Inventory scores (for spontaneous and evoked pain items only), whereas non-CPSP was associated with joint pain and lower Neuropathic Pain Symptom Inventory scores. In the voxel-based lesion–symptom mapping, the extracted lesion areas indicated voxels were significantly associated with cold allodynia at 22?C, heat hypoesthesia at 45?C, and the wind-up ratio with pinprick stimulus. These extracted areas were mainly in the putamen, insular cortex, and internal and external capsules. Whereas, the white matter disconnection was also significantly associated with the cold allodynia at 22 ?C and the wind-up ratio. These extracted disconnections disturbed the projection to the amygdala and prefrontal cortex.
Conclusions
The present study aimed to capture the varied pathological features of PSP. Our findings indicate that CPSP patients have pain and abnormal sensations (particularly the abnormal thermal sensation to relation the spinothalamic tract) caused by the imbalance of sensory input disturbance with cortical/subcortical lesions and output disturbance with the disconnection of pain modulation. Whereas non-CPSP patients have peripheral tissue problems related to the musculoskeletal pain factors. Our data are useful for a better understanding of post-stroke pain.
References
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Presenting Author
Yuki Igawa
Poster Authors
Yuki Igawa
MSc
Graduate School of Kio University
Lead Author
Michihiro Osumi
Kio university
Lead Author
Hidekazu Uchisawa
Nishiyamato Rehabilitation Hospital
Lead Author
Shinya Iki
Kawaguchi Neurosurgery Rehabilitation Clinic
Lead Author
Takeshi Fuchigami
Kishiwada Rehabilitation Hospital
Lead Author
Shinji Uragami
Hoshigaoka Medical Center
Lead Author
Yuki Nishi
Nagasaki University
Lead Author
Nobuhiko Mori
Osaka University Graduate School of Medicine
Lead Author
Koichi Hosomi
Osaka University
Lead Author
Shu Morioka
Kio University
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Neuropathic Pain - Central