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Altered Brain Functional Connectivity in Postherpetic Neuralgia and Its Association With Neuropathic Pain
Daeseok Oh1, Dong Ah Lee2, Ho-Joon Lee3
1Department of Anesthesiology and Pain Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
Background And Purpose:
Postherpetic neuralgia (PHN) is a chronic neuropathic pain condition that can occur after herpes zoster, but the relationship between the brain network organization and the clinical symptoms of PHN remains unclear.
Methods:
Resting-state functional magnetic resonance imaging data were acquired from 42 patients with PHN and 41 sex-matched healthy controls. Graph-theoretical analyses were used to assess global network measures including the characteristic path length, mean clustering coefficient, eccentricity, global efficiency, and local efficiency across 132 brain regions, while regional properties were evaluated using the betweenness centrality. Group comparisons were performed between healthy controls and PHN patients stratified by Douleur Neuropathique 4 (DN4) scores. Correlations with clinical variables were examined, with the results corrected for multiple comparisons using the family-wise error rate.
Results:
At the global network level, the mean clustering coefficient, eccentricity, and local efficiency were lower in patients with PHN than in healthy controls after correction for multiple comparisons (all adjusted p<0.05). Regionally, the betweenness centrality in the anterior division of the cingulate gyrus (ACC) was significantly lower in patients with PHN than in healthy controls, with this difference remaining significant after Bonferroni correction (adjusted p=0.013). In the PHN patients, local efficiency was higher in the high-DN4-score group than in the low-DN4-score group, and DN4 scores were positively correlated with local efficiency.
Conclusions:
PHN was associated with reductions in local clustering and efficiency as well as hubness of the ACC, indicating alterations to the brain network organization. Conversely, in the PHN patients, higher DN4 scores were associated with higher local efficiency. These findings suggest that symptom-informed connectomic profiling can capture clinically relevant heterogeneity that provides insights into network reorganization linked to the neuropathic symptom burden.
