What type of study is this?

This is a Observational study (also classified as: Human Clinical Trial, Findings Consistent with Meta-Analysis).

August 17, 2025

Neuroimaging Correlates of Post-Stroke Pain After Ischemic Stroke: Secondary Analysis of the INSPiRE-TMS Trial

ASAlina StegemannCharité - Universitätsmedizin Berlin ARAna Sofía RíosHumboldt-Universität zu Berlin AKAhmed A. KhalilHumboldt-Universität zu Berlin

Key Points

Post-stroke pain affects 47% of ischemic stroke survivors one year post-event, highlighting significant patient distress.
Multivariable regression found baseline anxiety correlated with post-stroke pain, with an odds ratio of 2.90 suggesting vulnerability.
Analysis utilized lesion symptom mapping and network mapping to explore neural correlates, including the anterior cingulate cortex and thalamus.
Findings emphasize the interaction between psychological factors and pain perception, pointing to potential therapeutic avenues.

Abstract

Abstract Background Post-stroke pain (PSP) affects nearly half of stroke survivors, severely compromising quality of life. The causes of PSP remain underexplored, although there is likely a complex interplay of lesion effects, psychological factors and mobility that play a role in the development of PSP. The aim of the study was to investigate clinical characteristics associated with PSP, as well as structural and functional correlates of PSP using lesion symptom (LSM) and network mapping (LNM). Methods We analyzed data from the INSPiRE-TMS cohort, encompassing 1,022 minor ischemic stroke patients. Pain severity and psychological factors (EQ5D-3L questionnaire) were assessed annually for up to 3 years. In a sub-group of 391 patients with available imaging data, LSM and LNM analyses were conducted to identify neural correlates of PSP. Results Overall, 47% of patients reported pain 1-year post-stroke. Multivariable regression analyses identified baseline anxiety as being associated with PSP assessed at 1-year post-stroke (OR 2.90, 95% CI 1.17–7.17, p=0.021). LSM did not identify any voxels associated with new severe pain. LNM identified a network involving anterior cingulate cortex, thalamus and insular cortex. Adjusting for anxiety highlighted distinct network contributions, suggesting interactive effects of psychological states on pain perception. Automated comparison to large metanalytical findings using Neurosynth associated the terms ‘pain’ and ‘nociception’ most strongly to the identified network. Conclusion PSP is closely associated with psychological factors such as anxiety. LNM of PSP revealed disruptions in a pain-related neural network consistent with prior pain research. These results warrant external validation and could guide future network-targeted neuromodulation therapies. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01586702 .

KI fragen

Bookmark

View Full Paper