Reduced Grey Matter in Caudate and Accumbens Nuclei Precedes Central Post Stroke Pain

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Abstract Central Post Stroke Pain (CPSP) is a common, debilitating sequela of stroke that can occur within weeks to months after stroke onset, yet mechanistic insight and predictive biomarkers are lacking. To address this gap, we longitudinally studied patients with acute somatosensory stroke using structural and functional magnetic resonance imaging and assessed them for subsequent pain development. In the acute stage, patients who later developed CPSP had reduced grey matter concentration (GMC) in bilateral caudate nuclei and nuclei accumbens (NAc) and reduced functional connectivity from the contralesional caudate to the supplementary motor area (SMA) compared to those who remained pain-free. Reduced GMC of the contralesional caudate and reduced functional connectivity to SMA persisted after pain onset, furthermore, NAc exhibited reduced functional connectivity to bilateral sensorimotor cortices and SMA. Our findings provide evidence for neural changes that may predispose stroke patients to develop CPSP and point towards potential targets for pain prevention.

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