Objectives: Little is known about the prevalence of central poststroke pain (CPSP) according to the integrity of the spino-thalamo-cortical pathway (STP). Using diffusion tensor tractography, we investigated the prevalence of CPSP according to the integrity of the STP in patients with intracerebral hemorrhage. Methods: We recruited 52 consecutive chronic patients and 10 normal control subjects. Patients were classified into two groups according to preservation of the integrity of the STP. Each group was divided into two subgroups according to the presence of CPSP. Results: The preserved group included 34 patients [CPSP subgroup, 16 (47%) patients; non-CPSP subgroup, 18 (53%) patients], and 18 patients were enrolled into the disrupted group [CPSP subgroup, 3 (17%) patients; non-CPSP subgroup, 15 (83%) patients]. The fractional anisotropy and mean diffusivity values of the CPSP and non-CPSP subgroups of the preserved group were decreased and increased when compared with those of the control group, respectively (p < 0.05). Conclusions: We found that the prevalence of CPSP in patients with partial injury of the STP was higher than that of patients with complete injury of the STP. Partial injury of the STP appears to be more vulnerable to development of CPSP than complete injury of the STP in patients with intracerebral hemorrhage.

Andersen G, Vestergaard K, Ingeman-Nielsen M, Jensen TS: Incidence of central post-stroke pain. Pain 1995;61:187–193.
Hansson P: Post-stroke pain case study: clinical characteristics, therapeutic options and long-term follow-up. Eur J Neurol 2004;11:22–30.
Klit H, Finnerup NB, Jensen TS: Central post-stroke pain: clinical characteristics, pathophysiology, and management. Lancet Neurol 2009;8:857–868.
Kim JS: Post-stroke pain. Expert Rev Neurother 2009;9:711–721.
Kumar B, Kalita J, Kumar G, Misra UK: Central poststroke pain: a review of pathophysiology and treatment. Anesth Analg 2009;108:1645–1657.
Boivie J, Leijon G, Johansson I: Central post-stroke pain – a study of the mechanisms through analyses of the sensory abnormalities. Pain 1989;37:173–185.
Canavero S, Pagni CA, Castellano G, Bonicalzi V, Bello M, Duca S, Podio V: The role of cortex in central pain syndromes: preliminary results of a long-term technetium-99 hexamethylpropyleneamineoxime single photon emission computed tomography study. Neurosurgery 1993;32:185–191.
Cesaro P, Mann MW, Moretti JL, Defer G, Roualdes B, Nguyen JP, Degos JD: Central pain and thalamic hyperactivity: a single photon emission computerized tomographic study. Pain 1991;47:329–336.
Goto T, Saitoh Y, Hashimoto N, Hirata M, Kishima H, Oshino S, Tani N, Hosomi K, Kakigi R, Yoshimine T: Diffusion tensor fiber tracking in patients with central post-stroke pain: correlation with efficacy of repetitive transcranial magnetic stimulation. Pain 2008;140:509–518.
Hong JH, Bai DS, Jeong JY, Choi BY, Chang CH, Kim SH, Ahn SH, Jang SH: Injury of the spino-thalamo-cortical pathway is necessary for central post-stroke pain. Eur Neurol 2010;64:163–168.
Latremoliere A, Woolf CJ: Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain 2009;10:895–926.
Seghier ML, Lazeyras F, Vuilleumier P, Schnider A, Carota A: Functional magnetic resonance imaging and diffusion tensor imaging in a case of central poststroke pain. J Pain 2005;6:208–212.
Vestergaard K, Nielsen J, Andersen G, Ingeman-Nielsen M, Arendt-Nielsen L, Jensen TS: Sensory abnormalities in consecutive, unselected patients with central post-stroke pain. Pain 1995;61:177–186.
Bowsher D, Leijon G, Thuomas KA: Central poststroke pain: correlation of MRI with clinical pain characteristics and sensory abnormalities. Neurology 1998;51:1352–1358.
Misra UK, Kalita J, Kumar B: A study of clinical, magnetic resonance imaging, and somatosensory-evoked potential in central post-stroke pain. J Pain 2008;9:1116–1122.
Hong JH, Son SM, Jang SH: Identification of spinothalamic tract and its related thalamocortical fibers in human brain. Neurosci Lett 2010;468:102–105.
Kamali A, Kramer LA, Butler IJ, Hasan KM: Diffusion tensor tractography of the somatosensory system in the human brainstem: initial findings using high isotropic spatial resolution at 3.0 T. Eur Radiol 2009;19:1480–1488.
Lincoln NB, Jackson JM, Adams SA: Reliability and revision of the Nottingham Sensory Assessment for Stroke Patients. Physiotherapy 1998;84:358–365.
Flaherty SA: Pain measurement tools for clinical practice and research. AANA J 1996;64:133–140.
Miller MD, Ferris DG: Measurement of subjective phenomena in primary care research: the visual analogue scale. Fam Pract Res J 1993;13:15–24.
Smith SM, Jenkinson M, Woolrich MW, Beckmann CF, Behrens TE, Johansen-Berg H, Bannister PR, De Luca M, Drobnjak I, Flitney DE, Niazy RK, Saunders J, Vickers J, Zhang Y, De Stefano N, Brady JM, Matthews PM: Advances in functional and structural MR image analysis and implementation as FSL. Neuroimage 2004;23:208–219.
Behrens TE, Johansen-Berg H, Woolrich MW, Smith SM, Wheeler-Kingshott CA, Boulby PA, Barker GJ, Sillery EL, Sheehan K, Ciccarelli O, Thompson AJ, Brady JM, Matthews PM: Non-invasive mapping of connections between human thalamus and cortex using diffusion imaging. Nat Neurosci 2003;6:750–757.
Behrens TE, Berg HJ, Jbabdi S, Rushworth MF, Woolrich MW: Probabilistic diffusion tractography with multiple fibre orientations: what can we gain? Neuroimage 2007;34:144–155.
Habas C, Cabanis EA: Anatomical parcellation of the brainstem and cerebellar white matter: a preliminary probabilistic tractography study at 3 T. Neuroradiology 2007;49:849–863.
Naidich T, Duvernoy H, Delman B, Sorensen G, Kollias S, Haacke M: Duvernoy’s Atlas of the Human Brain Stem and Cerebellum, ed 1. New York, Springer, 2007.
Salamon N, Sicotte N, Alger J, Shattuck D, Perlman S, Sinha U, Schultze-Haakh H, Salamon G: Analysis of the brain-stem white-matter tracts with diffusion tensor imaging. Neuroradiology 2005;47:895–902.
Schmahmann JD, Pandya DN: Fiber Pathways of the Brain. Oxford, Oxford University Press, 2006.
Crain BJ, Mori S: MRI Atlas of Human White Matter, ed 1. Amsterdam, Elsevier, 2005.
Morel A, Magnin M, Jeanmonod D: Multiarchitectonic and stereotactic atlas of the human thalamus. J Comp Neurol 1997;387:588–630.
Alexander AL, Lee JE, Lazar M, Field AS: Diffusion tensor imaging of the brain. Neurotherapeutics 2007;4:316–329.
Assaf Y, Pasternak O: Diffusion tensor imaging (DTI)-based white matter mapping in brain research: a review. J Mol Neurosci 2008;34:51–61.
Basser PJ, Pierpaoli C: Microstructural and physiological features of tissues elucidated by quantitative-diffusion-tensor MRI. J Magn Reson B 1996;111:209–219.
Neil JJ: Diffusion imaging concepts for clinicians. J Magn Reson Imaging 2008;27:1–7.
Stadlbauer A, Salomonowitz E, Strunk G, Hammen T, Ganslandt O: Quantitative diffusion tensor fiber tracking of age-related changes in the limbic system. Eur Radiol 2008;18:130–137.
Pagani E, Agosta F, Rocca MA, Caputo D, Filippi M: Voxel-based analysis derived from fractional anisotropy images of white matter volume changes with aging. Neuroimage 2008;41:657–667.
Wasner G, Lee BB, Engel S, McLachlan E: Residual spinothalamic tract pathways predict development of central pain after spinal cord injury. Brain 2008;131:2387–2400.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.