Journal Article

DZNE-2026-00746

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Neuroimaging Correlates of Post-Stroke Pain After Ischemic Stroke: Secondary Analysis of the INSPiRE-TMS Trial.

Stegemann, A. ; Rios, A. S. ; Khalil, A. ; Grittner, U. ; Temuulen, U. ; Ganeshan, R. ; Braemswig, T. B. ; Horn, A. ; Ihl, T. ; Audebert, H. J. ; Kufner, A. ; Endres, M. (Last author)DZNE*

2026
Wiley-Liss New York, NY

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Please use a persistent id in citations: doi:10.1002/hbm.70602

Abstract: Post-stroke pain (PSP) affects nearly half of stroke survivors, severely compromising quality of life. The causes of PSP remain underexplored, although there is likely a complex interplay of lesion effects, psychological factors, and mobility that play a role in its development. The aim of the study was to investigate clinical characteristics associated with PSP, as well as structural and functional correlates of PSP using lesion symptom (LSM) and network mapping (LNM). We analyzed data from the INSPiRE-TMS cohort, encompassing 1022 minor ischemic stroke patients. Pain severity and psychological factors (EQUATION 5D-3L questionnaire) were assessed annually for up to 3 years. In a sub-group of 391 patients with available imaging data, LSM and LNM analyses were conducted to identify neural correlates of PSP. Overall, 47% of patients reported pain 1-year post-stroke. Multivariable regression analyses identified baseline anxiety as associated with PSP assessed at 1-year post-stroke (OR 2.90, 95% CI 1.17-7.17, p = 0.021). LSM did not identify any voxels associated with new severe pain. LNM identified a network involving the anterior cingulate cortex, thalamus, and insular cortex. Adjusting for anxiety highlighted distinct network contributions, suggesting interactive effects of psychological states on pain perception. Automated comparison to large metanalytical findings using Neurosynth associated the terms 'pain' and 'nociception' most strongly to the identified network. PSP is closely associated with psychological factors such as anxiety. LNM of PSP revealed disruptions in a pain-related neural network consistent with prior pain research. These results warrant external validation and could guide future network-targeted neuromodulation therapies. Trial Registration: ClinicalTrials.gov identifier: NCT01586702.

Keyword(s): Humans (MeSH) ; Female (MeSH) ; Male (MeSH) ; Ischemic Stroke: complications (MeSH) ; Ischemic Stroke: diagnostic imaging (MeSH) ; Ischemic Stroke: physiopathology (MeSH) ; Middle Aged (MeSH) ; Aged (MeSH) ; Magnetic Resonance Imaging (MeSH) ; Anxiety: physiopathology (MeSH) ; Anxiety: diagnostic imaging (MeSH) ; Anxiety: etiology (MeSH) ; Pain: etiology (MeSH) ; Pain: diagnostic imaging (MeSH) ; Pain: physiopathology (MeSH) ; Nerve Net: diagnostic imaging (MeSH) ; Nerve Net: physiopathology (MeSH) ; Thalamus: diagnostic imaging (MeSH) ; Thalamus: physiopathology (MeSH) ; Stroke: complications (MeSH) ; Stroke: physiopathology (MeSH) ; Stroke: diagnostic imaging (MeSH) ; Neuroimaging (MeSH) ; Brain Mapping (MeSH) ; Insular Cortex: diagnostic imaging (MeSH) ; Insular Cortex: physiopathology (MeSH) ; chronic pain ; lesion mapping ; post‐stroke pain ; stroke

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Contributing Institute(s):

1. Interdisciplinary Dementia Research (AG Endres)

Research Program(s):

1. 353 - Clinical and Health Care Research (POF4-353) (POF4-353)

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