Prediction of Central Post-Stroke Pain by Quantitative Sensory Testing

Abstract

AbstractObjectiveAmong patients with acute stroke, we aimed to identify those who will later develop central post-stroke pain (CPSP) versus those who will not (non-pain sensory stroke: NPSS) by assessing potential differences in somatosensory profile patterns and evaluating their potential as predictors of CPSP.MethodsWe performed a prospective longitudinal quantitative sensory testing (QST) study in 75 stroke patients with somatosensory symptoms, recruited in the acute phase and followed up for 12 months. Based on previous QST studies in chronic stroke, we hypothesised that QST values of cold detection threshold (CDT) and dynamic mechanical allodynia (DMA) would differ between CPSP and NPSS patients before the onset of pain. Mann-Whitney U-tests and mixed ANOVAs with Bonferroni corrections were performed to compare z-normalised QST scores between both groups.ResultsIn total 26 patients (34.7%) developed CPSP. In the acute phase, CPSP patients showed significant contralesional cold hypoesthesia compared to NPSS patients (P= 0.04), but no significant DMA differences. Additional exploratory analysis showed NPSS patients exhibit cold hyperalgesia on the contralesional side compared to the ipsilesional side, not seen in CPSP patients (P= 0.011). A gradient-boosting approach to predicting CPSP from QST patterns prior to pain onset, had an overall accuracy of 84.6, with a recall and precision of 0.75. Notably, both in the acute and the chronic phase, about 80% of CPSP and NPSS patients showed bilateral QST abnormalities.InterpretationCold perception differences between CPSP and NPSS patients appear early post stroke before pain. Prediction of CPSP through QST patterns seems feasible.