Somatosensory Profile of Central Post Stroke Pain of Thalamic Origin: Findings of a Quantitative Sensory Testing Study

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-08-15 DOI:10.1002/ejp.70104

Kristel Berati, Lukas Enz, Priska Zuber, Katarina Alexandra Ebner, Shaumiya Sellathurai, Kean Schoenholzer, Federico Burguet Villena, Laura Gaetano, Ludwig Kappos, Stefano Magon, Till Sprenger, Athina Papadopoulou

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Abstract

Introduction

Central post stroke pain (CPSP) is attributed to vascular lesions of the central somatosensory system, including the thalamus.

Objective

A better characterisation of clinical findings in patients with CPSP after thalamic stroke can facilitate research and treatment of this refractory pain syndrome. We aimed to quantify somatosensory abnormalities in CPSP patients after thalamic stroke.

Methods

Sixteen patients with CPSP after thalamic stroke, 14 patients with a history of thalamic stroke without any pain (stroke control patients, SCP) and 12 healthy controls (HC) underwent detailed clinical examination, standardised quantitative sensory testing (QST) and a pain questionnaire. QST results were compared to age and sex adjusted reference data to obtain z-scores. Group comparisons were performed with one-way analysis of variance.

Results

Temperature perception did not differ in CPSP patients, apart from thermal sensory limen (higher in CPSP vs. HC but no difference vs. SCP). Patients with CPSP showed higher mechanical detection thresholds compared to SCP (Δ = 1.26, p = 0.017, no difference vs. HC) and they were more sensitive to mechanical pain than SCP (lower mechanical pain thresholds vs. SCP: Δ = −1.32, p = 0.014, no difference vs. HC).

Conclusion

Our results indicate somatosensory abnormalities in patients with CPSP after thalamic stroke, associated with the perception of mechanical stimuli. A short somatosensory screening including mechanical perception may contribute to an accurate diagnosis of this debilitating condition.

Significance Statement

Thalamic CPSP is very rare, thus our data contribute to the clinical and sensory phenotyping of patients suffering from this debilitating condition. We did not find abnormalities in thermal measures, but only mechanical thresholds in our cohort, suggesting that not only changes in temperature perception are necessary for the development of pain after thalamic stroke. Our findings suggest that a short QST protocol including mechanical testing using von Frey filaments and pin-prick-stimulators may be useful in the diagnosis of thalamic CPSP.

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丘脑源性中枢性脑卒中后疼痛的体感特征：一项定量感觉测试研究的结果

中枢性卒中后疼痛（CPSP）是由包括丘脑在内的中枢性体感觉系统的血管病变引起的。目的更好地描述丘脑卒中后CPSP患者的临床表现，以促进这种难治性疼痛综合征的研究和治疗。我们的目的是量化丘脑卒中后CPSP患者的体感觉异常。方法对16例丘脑卒中后CPSP患者、14例丘脑卒中无疼痛史患者（卒中对照组，SCP）和12例健康对照（HC）进行详细的临床检查、标准化定量感觉测试（QST）和疼痛问卷调查。将QST结果与年龄和性别调整后的参考数据进行比较以获得z分数。组间比较采用单因素方差分析。结果CPSP患者的温度感知无显著差异，除了热感觉阈值（CPSP高于HC，但与SCP无显著差异）。CPSP患者的机械检测阈值高于SCP （Δ = 1.26, p = 0.017，与HC相比无差异），对机械痛的敏感性高于SCP（机械痛阈值低于SCP： Δ = - 1.32, p = 0.014，与HC相比无差异）。结论丘脑卒中后CPSP患者躯体感觉异常与机械刺激感知有关。包括机械知觉在内的短暂体感筛查可能有助于准确诊断这种衰弱性疾病。丘脑CPSP是非常罕见的，因此我们的数据有助于临床和感觉表型患者遭受这种衰弱的条件。在我们的队列中，我们没有发现热测量的异常，但只有机械阈值，这表明不仅温度感知的变化是丘脑卒中后疼痛发展所必需的。我们的研究结果表明，一个简短的QST方案，包括使用von Frey细丝和针刺刺激器进行机械测试，可能有助于丘脑CPSP的诊断。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.