title: The Cortical Signature of Central Poststroke Pain: Gray Matter Decreases in Somatosensory, Insular, and Prefrontal Cortices.
abstract: It has been proposed that cortical structural plasticity plays a crucial role in the emergence and maintenance of chronic pain. Various distinct pain syndromes have accordingly been linked to specific patterns of decreases in regional gray matter volume (GMV). However, it is not known whether central poststroke pain (CPSP) is also associated with cortical structural plasticity. To determine this, we employed T1-weighted magnetic resonance imaging at 3 T and voxel-based morphometry in 45 patients suffering from chronic subcortical sensory stroke with (n = 23) and without CPSP (n = 22), and healthy matched controls (n = 31). CPSP patients showed decreases in GMV in comparison to healthy controls, involving secondary somatosensory cortex (S2), anterior as well as posterior insular cortex, ventrolateral prefrontal and orbitofrontal cortex, temporal cortex, and nucleus accumbens. Comparing CPSP patients to nonpain patients revealed a similar but more restricted pattern of atrophy comprising S2, ventrolateral prefrontal and temporal cortex. Additionally, GMV in the ventromedial prefrontal cortex negatively correlated to pain intensity ratings. This shows for the first time that CPSP is accompanied by a unique pattern of widespread structural plasticity, which involves the sensory-discriminative areas of insular/somatosensory cortex, but also expands into prefrontal cortex and ventral striatum, where emotional aspects of pain are processed.
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Neurology, 12200 Berlin, Germany.|Charité - Universitätsmedizin Berlin, Centre for Stroke Research, 12200 Berlin, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Krause
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Neurology, 12200 Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Asseyer
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Neurology, 12200 Berlin, Germany.|Max-Planck-Institute, Human Cognitive and Brain Sciences, 04103 Leipzig, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Taskin
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Neurology, 12200 Berlin, Germany.|Charité - Universitätsmedizin Berlin, Centre for Stroke Research, 12200 Berlin, Germany.|Charité - Universitätsmedizin Berlin, NeuroCure Cluster of Excellence, 10117 Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Flöel
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Neurology, 12200 Berlin, Germany.|Max-Planck-Institute, Human Cognitive and Brain Sciences, 04103 Leipzig, Germany.|Charité - Universitätsmedizin Berlin, NeuroCure Cluster of Excellence, 10117 Berlin, Germany.
authors.forename: A V
authors.initials: AV
authors.lastname: Witte
authors.affiliation: Charité - Universitätsmedizin Berlin, NeuroCure Cluster of Excellence, 10117 Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Mueller
authors.affiliation: Charité - Universitätsmedizin Berlin, Centre for Stroke Research, 12200 Berlin, Germany.
authors.forename: J B
authors.initials: JB
authors.lastname: Fiebach
authors.affiliation: Charité - Universitätsmedizin Berlin, Centre for Stroke Research, 12200 Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Villringer
authors.affiliation: Charité - Universitätsmedizin Berlin, NeuroCure Cluster of Excellence, 10117 Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Villringer
authors.affiliation: Charité - Universitätsmedizin Berlin, Department of Neurology, 12200 Berlin, Germany.|Charité - Universitätsmedizin Berlin, Centre for Stroke Research, 12200 Berlin, Germany.|Jüdisches Krankenhaus Berlin, Department of Neurology, 13347 Berlin, Germany.
authors.forename: G J
authors.initials: GJ
authors.lastname: Jungehulsing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000473:pathology; D002540:Cerebral Cortex / Q000473:pathology*; D005260:Female; D066128:Gray Matter / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009929:Organ Size / Q000502:physiology; D010146:Pain / Q000473:pathology*; D017397:Prefrontal Cortex / Q000473:pathology*; D013003:Somatosensory Cortex / Q000473:pathology*
keywords: MRI; cortical plasticity; pain; stroke