Dissecting neuropathic from poststroke pain: the white matter within.
Marcelo Delboni LemosIsabelle FaillenotLeandro Tavares LucatoManoel Jacobsen TeixeiraLuciana Mendonça BarbosaEduardo Joaquim Lopes AlhoAdriana Bastos ConfortoAntonia Lilian de Lima RodriguesRicardo GalhardoniValquiria A da SilvaClarice ListikJefferson RosiRoland PeyronLuis Garcia-LarreaDaniel Ciampi de AndradePublished in: Pain (2022)
Poststroke pain (PSP) is a heterogeneous term encompassing both central neuropathic (ie, central poststroke pain [CPSP]) and nonneuropathic poststroke pain (CNNP) syndromes. Central poststroke pain is classically related to damage in the lateral brainstem, posterior thalamus, and parietoinsular areas, whereas the role of white matter connecting these structures is frequently ignored. In addition, the relationship between stroke topography and CNNP is not completely understood. In this study, we address these issues comparing stroke location in a CPSP group of 35 patients with 2 control groups: 27 patients with CNNP and 27 patients with stroke without pain. Brain MRI images were analyzed by 2 complementary approaches: an exploratory analysis using voxel-wise lesion symptom mapping, to detect significant voxels damaged in CPSP across the whole brain, and a hypothesis-driven, region of interest-based analysis, to replicate previously reported sites involved in CPSP. Odds ratio maps were also calculated to demonstrate the risk for CPSP in each damaged voxel. Our exploratory analysis showed that, besides known thalamic and parietoinsular areas, significant voxels carrying a high risk for CPSP were located in the white matter encompassing thalamoinsular connections (one-tailed threshold Z > 3.96, corrected P value <0.05, odds ratio = 39.7). These results show that the interruption of thalamocortical white matter connections is an important component of CPSP, which is in contrast with findings from nonneuropathic PSP and from strokes without pain. These data can aid in the selection of patients at risk to develop CPSP who could be candidates to pre-emptive or therapeutic interventions.
Keyphrases
- white matter
- chronic pain
- pain management
- neuropathic pain
- multiple sclerosis
- magnetic resonance imaging
- end stage renal disease
- physical activity
- high resolution
- spinal cord injury
- chronic kidney disease
- machine learning
- postoperative pain
- resting state
- spinal cord
- big data
- patient reported outcomes
- brain injury
- electronic health record
- patient reported
- gestational age