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Maladaptive Reorganization in Pain-Related Brain Network Contributing To the Central Post-Stroke Pain

Author(s): Xiaoyun Li, Yi Feng, Fei Gao


The underlying pathophysiological mechanisms of central post-stroke pain (CPSP) have not been well understood.

Case report
We collected data from a male CPSP patient with ischemic stroke lesions in the left secondary somatosensory cortex and left posterior insula for the investigation of behavioral-anatomicalfunctional alterations in CPSP, using somatosensory testing, diffusion tensor imaging (DTI), and resting-state functional magnetic resonance imaging (fMRI) techniques. Behavioral results showed that the patient was unable to detect non-nociceptive somatosensory stimuli delivered to the affected hand. Neuroimaging results displayed that compared to healthy
controls, the CPSP patient showed (1) the disrupted microstructure (eg, axonal demyelination) in the spino-thalamo-cortical pathway, (2) the hyperactivity in the pain-related brain region (eg, anterior cingulate cortex, ACC) associated with central sensitization, and (3) the dysfunction of pain inhibitory pathways (eg, decreased functional connectivity between ACC and the right dorsolateral prefrontal cortex).

These findings revealed a unique pattern of widespread structural and functional plasticity in the CPSP patient accompanied with somatosensory abnormalities, supporting the maladaptive reorganization model of pain networks in CPSP.

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