Dissecting central post-stroke pain: a controlled symptom-psychophysical characterization

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorBARBOSA, Luciana Mendonca
dc.contributor.authorSILVA, Valquiria Aparecida da
dc.contributor.authorRODRIGUES, Antonia Lilian de Lima
dc.contributor.authorFERNANDES, Diego Toledo Reis Mendes
dc.contributor.authorOLIVEIRA, Rogerio Adas Ayres de
dc.contributor.authorGALHARDONI, Ricardo
dc.contributor.authorYENG, Lin Tchia
dc.contributor.authorROSI JUNIOR, Jefferson
dc.contributor.authorCONFORTO, Adriana Bastos
dc.contributor.authorLUCATO, Leandro Tavares
dc.contributor.authorLEMOS, Marcelo Delboni
dc.contributor.authorPEYRON, Roland
dc.contributor.authorGARCIA-LARREA, Luis
dc.contributor.authorTEIXEIRA, Manoel Jacobsen
dc.contributor.authorANDRADE, Daniel Ciampi de
dc.date.accessioned2022-06-20T15:28:21Z
dc.date.available2022-06-20T15:28:21Z
dc.date.issued2022
dc.description.abstractDissection of distinct post-stroke pain syndromes evidenced that the neuropathic pain inventory, the presence of cold thermal deficit and the finding of allodynia on bedside examination, explained 77% of the occurrence of neuropathic central post-stroke pain, a new finding that has clear diagnostic potential. Central post-stroke pain affects up to 12% of stroke survivors and is notoriously refractory to treatment. However, stroke patients often suffer from other types of pain of non-neuropathic nature (musculoskeletal, inflammatory, complex regional) and no head-to-head comparison of their respective clinical and somatosensory profiles has been performed so far. We compared 39 patients with definite central neuropathic post-stroke pain with two matched control groups: 32 patients with exclusively non-neuropathic pain developed after stroke and 31 stroke patients not complaining of pain. Patients underwent deep phenotyping via a comprehensive assessment including clinical exam, questionnaires and quantitative sensory testing to dissect central post-stroke pain from chronic pain in general and stroke. While central post-stroke pain was mostly located in the face and limbs, non-neuropathic pain was predominantly axial and located in neck, shoulders and knees (P < 0.05). Neuropathic Pain Symptom Inventory clusters burning (82.1%, n = 32, P < 0.001), tingling (66.7%, n = 26, P < 0.001) and evoked by cold (64.1%, n = 25, P < 0.001) occurred more frequently in central post-stroke pain. Hyperpathia, thermal and mechanical allodynia also occurred more commonly in this group (P < 0.001), which also presented higher levels of deafferentation (P < 0.012) with more asymmetric cold and warm detection thresholds compared with controls. In particular, cold hypoesthesia (considered when the threshold of the affected side was <41% of the contralateral threshold) odds ratio (OR) was 12 (95% CI: 3.8-41.6) for neuropathic pain. Additionally, cold detection threshold/warm detection threshold ratio correlated with the presence of neuropathic pain (rho = -0.4, P < 0.001). Correlations were found between specific neuropathic pain symptom clusters and quantitative sensory testing: paroxysmal pain with cold (rho = -0.4; P = 0.008) and heat pain thresholds (rho = 0.5; P = 0.003), burning pain with mechanical detection (rho = -0.4; P = 0.015) and mechanical pain thresholds (rho = -0.4, P < 0.013), evoked pain with mechanical pain threshold (rho = -0.3; P = 0.047). Logistic regression showed that the combination of cold hypoesthesia on quantitative sensory testing, the Neuropathic Pain Symptom Inventory, and the allodynia intensity on bedside examination explained 77% of the occurrence of neuropathic pain. These findings provide insights into the clinical-psychophysics relationships in central post-stroke pain and may assist more precise distinction of neuropathic from non-neuropathic post-stroke pain in clinical practice and in future trials.eng
dc.description.indexPubMedeng
dc.description.sponsorshipPain Centre Research Fund from the Department of Neurology, Universidade de Sao Paulo, Brazil
dc.identifier.citationBRAIN COMMUNICATIONS, v.4, n.3, article ID fcac090, 16p, 2022
dc.identifier.doi10.1093/braincomms/fcac090
dc.identifier.eissn2632-1297
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/47151
dc.language.isoeng
dc.publisherOXFORD UNIV PRESSeng
dc.relation.ispartofBrain Communications
dc.rightsopenAccesseng
dc.rights.holderCopyright OXFORD UNIV PRESSeng
dc.subjectcentral post-stroke paineng
dc.subjectpost-stroke paineng
dc.subjectneuropathic pain phenotypingeng
dc.subjectcentral neuropathic paineng
dc.subjectquantitative sensory testingeng
dc.subject.otherperipheral neuropathic paineng
dc.subject.otherpost-stroke paineng
dc.subject.othertranscranial magnetic stimulationeng
dc.subject.otherdeep brain-stimulationeng
dc.subject.otherquality-of-lifeeng
dc.subject.otherlong-term paineng
dc.subject.othersensory abnormalitieseng
dc.subject.otherdouble-blindeng
dc.subject.othermultiple-sclerosiseng
dc.subject.othera-deltaeng
dc.subject.wosBiochemistry & Molecular Biologyeng
dc.subject.wosChemistry, Multidisciplinaryeng
dc.titleDissecting central post-stroke pain: a controlled symptom-psychophysical characterizationeng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.affiliation.countryFrança
hcfmusp.affiliation.countryisofr
hcfmusp.author.externalOLIVEIRA, Rogerio Adas Ayres de:Univ Sao Paulo, LIM 62 Univ, Discipline Neurosurg HC FMUSP, Pain Ctr, Sao Paulo, Brazil
hcfmusp.author.externalPEYRON, Roland:UCBL1, UJM, CNRS, INSERM,U1028,UMR5292,Lyon Neurosci Res Ctr CRNL,N, F-6900 Lyon, France
hcfmusp.author.externalGARCIA-LARREA, Luis:UCBL1, UJM, CNRS, INSERM,U1028,UMR5292,Lyon Neurosci Res Ctr CRNL,N, F-6900 Lyon, France
hcfmusp.citation.scopus11
hcfmusp.contributor.author-fmusphcLUCIANA MENDONCA BARBOSA
hcfmusp.contributor.author-fmusphcVALQUIRIA APARECIDA DA SILVA
hcfmusp.contributor.author-fmusphcANTONIA LILIAN DE LIMA RODRIGUES
hcfmusp.contributor.author-fmusphcDIEGO TOLEDO REIS MENDES FERNANDES
hcfmusp.contributor.author-fmusphcRICARDO GALHARDONI
hcfmusp.contributor.author-fmusphcLIN TCHIA YENG
hcfmusp.contributor.author-fmusphcJEFFERSON ROSI JUNIOR
hcfmusp.contributor.author-fmusphcADRIANA BASTOS CONFORTO
hcfmusp.contributor.author-fmusphcLEANDRO TAVARES LUCATO
hcfmusp.contributor.author-fmusphcMARCELO DELBONI LEMOS
hcfmusp.contributor.author-fmusphcMANOEL JACOBSEN TEIXEIRA
hcfmusp.contributor.author-fmusphcDANIEL CIAMPI ARAUJO DE ANDRADE
hcfmusp.description.articlenumberfcac090
hcfmusp.description.issue3
hcfmusp.description.volume4
hcfmusp.origemWOS
hcfmusp.origem.pubmed35528229
hcfmusp.origem.scopus2-s2.0-85136127118
hcfmusp.origem.wosWOS:000790931800001
hcfmusp.publisher.cityOXFORDeng
hcfmusp.publisher.countryENGLANDeng
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