Neuromodulation for central post-stroke pain: mechanism, safety and outcome.

Central post-stroke pain (CPSP) is an often pharmacorefractory type
of neuropathic pain that develops in 8% of stroke patients. CPSP has
been treated with three distinct types of neuromodulation (deep brain
stimulation of the sensory thalamus (Vc-DBS), motor cortex repetitive
transcranial magnetic stimulation (M1-rTMS), and motor cortex
stimulation (MCS)), but the level of evidence for these procedures is
very low . Moreover, data on the changes in pain brain circuitry in
CPSP, and the effect of neuromodulation on this circuitry is very
limited.
In this project, we propose a prospective, double-blind, randomised
cross-over on/off study in 24 CPSP patients. These patients will
undergo M1-rTMS and either MCS or Vc-DBS. Before and after
active and inactive stimulation, they will be assessed using clinical
scales for pain, functioning, quality of life and depression. Sensory
thresholds for perception and pain will be measured using a
standardised test. Adverse events will be monitored. This allows to
measure the outcome and safety of neuromodulation in CPSP.
In addition, we will use functional magnetic resonance imaging (fMRI)
and positron emission tomography (PET), as well as
electrophysiological recordings, with active vs. inactive stimulation
and in the absence and presence of noxious vs. innocuous stimuli.
This will deepen the insight in the pathological changes occurring in
the pain circuitry in CPSP and the influence of neuromodulation
hereon.