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Nociception—the ability to feel pain—is essential for an organism’s survival and overall well-being. Noxious stimuli such as piercing pain from a sharp object, heat from an open flame, or contact with corrosive chemicals are first detected by sensory receptors, called nociceptors, located on nerve endings. Nociceptors express ion channels that convert noxious stimuli into electrical signals. When these signals reach the brain via sensory neurons, they are perceived as pain.
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Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
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Pain serves as a critical warning signal that alerts the body to potential or actual harm. When mechanical pressure on the skin is intense, such as from a sharp pinch, the sensation transitions from touch to pain. Similarly, extreme temperatures, like a hot pot handle, convert the sensation of heat into pain. Pain can also result from overstimulation of other senses, such as blinding light, loud noise, or the intense heat from habañero peppers. This ability to sense pain is essential for...
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Pathological features of post-stroke pain: a comprehensive analysis for subtypes.

Yuki Igawa1,2, Michihiro Osumi1,3, Yusaku Takamura3

  • 1Graduate School of Health Science, Kio University, Kitakatsuragi-gun, Nara 635-0832, Japan.

Brain Communications
|May 2, 2025
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Summary

Central post-stroke pain is linked to cold sensory deficits and neuropathic pain symptoms. Non-central post-stroke pain is associated with joint pain and lower neuropathic pain scores. Brain imaging reveals specific lesion areas and white matter disconnections correlating with these pain types.

Keywords:
CPSPPSPcomprehensive assessmentpathological feature

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Area of Science:

  • Neuroscience
  • Pain Medicine
  • Neurology

Background:

  • Post-stroke pain is a complex condition with diverse nociceptive and neuropathic components.
  • Accurate assessment and differentiation of pain subtypes are crucial for effective treatment.

Purpose of the Study:

  • To comprehensively assess central and non-central post-stroke pain.
  • To analyze the relationship between clinical pain features, brain lesion locations, and white matter structural disconnections.

Main Methods:

  • A multicenter, cross-sectional study involving 70 patients (24 central post-stroke pain, 26 non-central post-stroke pain, 20 no-pain controls).
  • Utilized pain questionnaires, quantitative sensory testing, voxel-based lesion-symptom mapping, and voxel-based disconnection-symptom mapping.
  • Multiple logistic regression analysis identified associations between pathological features and pain characteristics.

Main Results:

  • Central post-stroke pain correlated with cold hypoesthesia/hyperalgesia and higher Neuropathic Pain Symptom Inventory scores.
  • Non-central post-stroke pain was associated with joint pain and lower Neuropathic Pain Symptom Inventory scores.
  • Lesion mapping identified specific brain areas (putamen, insula) and white matter tracts (cingulum, superior longitudinal fasciculus) linked to distinct sensory dysfunctions.

Conclusions:

  • Clinical assessments combined with neuroimaging can differentiate post-stroke pain subtypes.
  • Findings aid in optimizing diagnosis and guiding precision treatments for post-stroke pain.
  • Understanding the neuroanatomical correlates of pain subtypes is essential for targeted therapeutic strategies.