Comprehensive Summary
This study explored the prevalence, clinical predictors, and neural underpinnings of post-stroke pain (PSP) using data from the large INSPiRE-TMS cohort. One year after a minor ischemic stroke, nearly half of survivors reported experiencing pain, with 5–6% describing it as severe. Of all baseline clinical factors assessed, anxiety stood out as the only significant predictor of developing severe PSP. Traditional lesion-symptom mapping failed to identify consistent brain regions linked to PSP, but lesion network mapping revealed a distributed pain-related network involving the anterior cingulate cortex, thalamus, and insular cortex, key brain regions in pain processing. When analyses accounted for anxiety, the network became even more refined, underscoring the dynamic interaction between psychological states and neural circuits. Meta-analytic comparisons with Neurosynth further validated these findings, showing strong overlap between the identified networks and those previously associated with pain and nociception.
Outcomes and Implications
The findings of this study highlight the need for a more holistic approach to managing post-stroke pain. The strong predictive role of anxiety suggests that routine psychological screening and early intervention may help reduce the risk of severe PSP. At the same time, the identification of a distributed pain-related network rather than isolated lesion sites points to the importance of targeting brain circuits rather than single regions. This has direct implications for therapy, supporting the integration of psychological care, multidisciplinary rehabilitation, and the exploration of neuromodulation techniques targeting key brain regions, such as the anterior cingulate cortex, thalamus, and insula. Ultimately, incorporating pain monitoring and mental health assessment into standard stroke care could improve long-term outcomes and quality of life for survivors of post-stroke pain.