Structural network dysfunction and aberrant SC-FC coupling correlate with central post-stroke pain of thalamic origin
J Pain. 2026 Jun 2:106341. doi: 10.1016/j.jpain.2026.106341. Online ahead of print.
ABSTRACT
Central post-stroke pain (CPSP) of thalamic origin is one of the most frequent subtypes in all kinds of CPSP, and often be refractory to treatments and affect the long-term prognosis of thalamic stroke patients, while the mechanism remains unclear. We aim to investigate brain network alterations in patients with CPSP after thalamic stroke and explore whether these changes underlie clinical symptoms.Ninety-two participants were finally enrolled in this observational study (26 had CPSP of thalamic origin, 41.9%) and 30 were healthy controls (HCs). Structural (SC) and functional connectivity (FC) networks were constructed using diffusion spectrum imaging (DSI) and resting-state functional imaging (fMRI), respectively. Brain network topological characteristic and structural-functional connectivity (SC-FC) couplings at a multi-modular level were obtained through graph theoretical.Compared with non-CPSP patients, distinct SC topological changes were found in CPSP patients, characterized as a higher clustering coefficient (Cp), global efficiency (Eg), local efficiency (Eloc), and lower characteristic path length (Lp) and normalized characteristic path length (Lambda) values (PBonferroni<0.05). CPSP patients had significantly lower SC-FC couplings at the global and the structural Hub-modular levels. Further, we found significant and various correlations between pain severity and structural Lp, Eloc, global and Hub-modular SC-FC couplings (PAdjusted<0.05).Thalamic stroke-induced distinct structural network dysfunction and diverse SC-FC decoupling may be a novel neural mechanism for the occurrence of CPSP. Our results may provide new insights for future refined targeted neuromodulation therapies and individualized rehabilitative strategies in patients with CPSP.
PERSPECTIVE: Central post-stroke pain (CPSP) following thalamic stroke reflects large-scale brain network dysfunction. We identify distinct structural network reorganization and impaired structure-function coupling in CPSP patients, correlating with clinical pain. These findings provide a novel pathophysiological framework and potential network-based biomarkers for this treatment-resistant neuropathic pain condition.
PMID:42235904 | DOI:10.1016/j.jpain.2026.106341