Corticomotor excitability is altered in central neuropathic pain compared with non-neuropathic pain or pain-free patients

Luciana Mendonça Barbosa, Fernanda Valerio, Valquíria Aparecida da Silva, Antônia Lilian de Lima Rodrigues, Ricardo Galhardoni, Lin Tchia Yeng, Jefferson Rosi Junior, Adriana Bastos Conforto, Leandro Tavares Lucato, Manoel Jacobsen Teixeira, Daniel Ciampi de Andrade

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Abstract

Objectives: Central neuropathic pain (CNP) is associated with altered corticomotor excitability (CE), which can potentially provide insights into its mechanisms. The objective of this study is to describe the CE changes that are specifically related to CNP. Methods: We evaluated CNP associated with brain injury after stroke or spinal cord injury (SCI) due to neuromyelitis optica through a battery of CE measurements and comprehensive pain, neurological, functional, and quality of life assessments. CNP was compared to two groups of patients with the same disease: i. with non-neuropathic pain and ii. without chronic pain, matched by sex and lesion location. Results: We included 163 patients (stroke=93; SCI=70: 74 had CNP, 43 had non-neuropathic pain, and 46 were pain-free). Stroke patients with CNP had lower motor evoked potential (MEP) in both affected and unaffected hemispheres compared to non- neuropathic pain and no-pain patients. Patients with CNP had lower amplitudes of MEPs (366 μV ±464 μV) than non-neuropathic (478 ±489) and no-pain (765 μV ± 880 μV) patients, p < 0.001. Short-interval intracortical inhibition (SICI) was defective (less inhibited) in patients with CNP (2.6±11.6) compared to no-pain (0.8±0.7), p = 0.021. MEPs negatively correlated with mechanical and cold-induced allodynia. Furthermore, classifying patients' results according to normative data revealed that at least 75% of patients had abnormalities in some CE parameters and confirmed MEP findings based on group analyses. Discussion: CNP is associated with decreased MEPs and SICI compared to non-neuropathic pain and no-pain patients. Corticomotor excitability changes may be helpful as neurophysiological markers of the development and persistence of pain after CNS injury, as they are likely to provide insights into global CE plasticity changes occurring after CNS lesions associated with CNP.

Original languageEnglish
Article number102845
JournalNeurophysiologie Clinique
Volume53
Issue number3
ISSN0987-7053
DOIs
Publication statusPublished - 1 Jun 2023

Keywords

  • Central pain
  • Central post-stroke pain
  • Chronic pain
  • Cortical excitability
  • Motor evoked potentials
  • Neuropathic pain
  • Spinal cord injury
  • Transcranial magnetic stimulation

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