Post-stroke Pain Research Articles

Decoding neuronal genes in stroke-induced pain: insights from single-nucleus sequencing in mice

BackgroundThe role of neurons in central post-stroke pain (CPSP) following thalamic hemorrhage remains unclear. This study aimed to identify key genes associated with post-thalamic hemorrhage pain and to explore their functions in neurons. Single-nucleus RNA sequencing (snRNA-seq) data from a mouse model was used for this analysis.MethodsFirst, snRNA-seq data were analyzed to identify cell types associated with CPSP induced by thalamic hemorrhage. Differentially expressed genes (DEGs) in neurons were then screened between control and model groups, followed by the construction of a protein-protein interaction (PPI) network for the DEGs. CytoNCA was used to assess node connectivity in the PPI network, and the top 5 key genes were identified. Subsequently, transcription factor (TF)-mRNA and miRNA-mRNA networks were constructed, and small-molecule drugs potentially targeting these key genes were predicted. Finally, the expression differences of key genes in neurons were compared between the model and control groups.ResultsA total of 13 cell clusters were identified, categorized into 8 cell types: T cells, endothelial cells, monocytes, neural progenitor cells (NPCs), microglia, astrocytes, neurons, and oligodendrocytes. A total of 228 DEGs were detected in neurons when comparing the model group with the control group. The PPI network of the DEGs consisted of 126 nodes and 209 edges, identifying the top 5 key genes: Dlgap1, Cacna1c, Gria2, Hsp90ab1, and Gapdh. The miRNA-mRNA network included 68 miRNA-mRNA pairs, 62 miRNAs, and 5 mRNAs, while the TF-mRNA network consisted of 66 TF-mRNA pairs, 56 TFs, and 5 mRNAs. Drug prediction identified 110 small-molecule drugs (e.g., purpurogallin, nifedipine, and novobiocin) potentially targeting these key genes. Additionally, Cacna1c were significantly upregulated in model mice.ConclusionThis study identified the role of key genes in thalamic hemorrhage-induced CPSP through snRNA-seq, providing a scientific basis for further exploration of the molecular mechanisms underlying CPSP.

Bee Venom Acupuncture for Shoulder Pain: A Literature Review of Clinical Studies.

Managing shoulder pain typically involves the use of acetaminophen or oral nonsteroidal anti-inflammatory drugs, but prolonged use of these medications can lead to dependence and various side effects. To overcome the dose dependency and side effects of these conventional drugs, animal venoms have begun to be utilized. Among them, bee venom stands out for its powerful anti-inflammatory properties, which help relieve pain and treat chronic inflammatory conditions. This review evaluates the efficacy and safety of bee venom acupuncture (BVA) for shoulder pain. In March 2024, we searched 11 databases: 5 international and 6 Korean databases. We identified 23 clinical studies on BVA for shoulder pain. The causes of shoulder pain were post-stroke pain (43.5%), rotator cuff syndrome (17.4%), and brachial plexus palsy (13.0%). The BVA concentration and dosage per session were 0.005-1.0 mg/mL and 0.01-2.0 mL, respectively. All included clinical studies reported positive effects on pain outcomes. This review suggests that BVA, which involves injecting bee venom into acupuncture points, may serve as a viable alternative for pain management. However, the level of evidence in the included studies was low and adverse effects were reported infrequently, indicating that further research is needed.

Beneficial effects of non-pharmacological interventions for post-stroke pain: A meta-analysis.

Pain is a frequent post-stroke health concern, and several non-pharmacological interventions are commonly employed to manage it. However, few reviews have examined the effectiveness of such interventions, making it difficult to draw conclusions about their usefulness. Furthermore, subgroup analysis based on post-stroke pain level or intervention characteristics is rarely performed. This study aimed to investigate the effectiveness of non-pharmacological interventions and evaluate the significant factors associated with post-stroke pain through subgroup analysis. Systematic review and meta-analysis. Relevant studies were obtained from seven databases, from their commencement up to March 2024, as well as from the gray literature. The PICOS approach was used to evaluate the eligibility criteria of the studies. The RoB-2 tool was used to determine the risk of bias in each randomized trial. Pooled estimations of standardized mean difference and heterogeneity (quantified with I2) were obtained using a random-effects model. The stability of the pooled result was then assessed using the leave-one-out approach. STATA 17.0 was used to run the meta-analysis. Non-pharmacological interventions were effective in reducing pain immediately after intervention (pooled SMDs: -0.79; 95% confidence interval [CI]: -1.06 to -0.53; p < 0.001). The approach involving acupuncture, aquatic therapy, or laser therapy and rehabilitation training was effective for post-stroke hemiplegic shoulder pain. A pooled analysis of non-pharmacological interventions showed that both less than 4 weeks and more than 4 weeks of interventions were effective in alleviating pain in stroke patients. Non-pharmacological approaches appear to be beneficial for reducing post-stroke pain. The outcomes based on the modalities merit further research. Further studies are needed to determine the effects of different modalities on pain intensity following a stroke. Furthermore, to avoid overestimation of intervention efficacy, future randomized trials should consider blinding approaches to the interventions delivered.

Therapy to ‘Scramble’ Pain Signals May Help Reduce Poststroke Pain

Therapy to ‘Scramble’ Pain Signals May Help Reduce Poststroke Pain

Photobiomodulation on shoulder and neck pain and disability: A comprehensive review.

The purpose of this review was to evaluate the effect of Photobiomodulation (PBM) in managing shoulder and neck pain and disability. A literature search was conducted using the PubMed and ScienceDirect/EMBASE databases. The keywords used were "Low-level laser therapy", "photobiomodulation", "LASER", combined with "shoulder" or "neck". Only clinical studies written in English, Portuguese, Spanish, Italian, French, and German, were included. The review included 36 studies applying PBM therapy to alleviate pain or disability in patients with shoulder and neck conditions. Of these, 12 studies focused on neck conditions, and 24 studies addressed shoulder conditions, with one study concurrently examining both areas. This review on PBM therapy for shoulder and neck conditions shows promising results, particularly in pain relief and functional improvements, with infrared wavelengths being the most commonly used. Subacromial Impingement Syndrome (SAIS) and Myofascial Pain Syndrome (MPS) were the most frequently studied conditions. However, chronic and complex conditions like cervical osteoarthritis and post-stroke shoulder pain were less frequently represented, indicating a research gap. PBM was found to be a safe and non-invasive therapeutic option. Despite positive outcomes, variability in PBM protocols remains a challenge. Further standardized trials are needed to confirm its effectiveness across diverse conditions. This review updates current knowledge, highlights key findings, and provides direction for future research and clinical applications.

Efficacy of manual lymphatic drainage combined with repetitive transcranial magnetic stimulation in post-stroke complex regional pain syndrome: a pilot study

Purpose The aim of this study was to investigate the efficacy of manual lymphatic drainage (MLD) combined with repetitive transcranial magnetic stimulation (rTMS) on the recovery of upper limb in patients with post-stroke complex regional pain syndrome (CRPS). Methods This pilot study was conducted with 54 patients with post-stroke CRPS. Patients were randomized into three groups: the MLD combined with rTMS group (MLD + rTMS group), the rTMS group and the sham-rTMS group. The results of numeric rating scale (NRS), volumetric measurement, Fugl-Meyer assessment of upper extremity (FMA-UE), CRPS severity score (CSS), generalized anxiety disorder-7 (GAD-7) and patient health questionnaire-9 (PHQ-9) before and after the intervention were analyzed. Results Fifty-four participants (37 males, 17 females; mean age 66.11 ± 8.43 years; range, 18 to 85) were included in the study. Among groups, improvements were statistically significant with superiority of rTMS + MLD group after treatment (p < 0.05). NRS, GAD-7, and PHQ-9 in the rTMS + MLD group improved more significantly than those in the rTMS group (p < 0.05). Conclusion MLD combined with rTMS has an add-on efficacy on the basis of rTMS therapy in post-stroke patients, especially in pain. MLD could also have an effect on anxiety and depression.

Bedside Neuromodulation of Persistent Pain and Allodynia with Caloric Vestibular Stimulation.

Caloric vestibular stimulation (CVS) is a well-established neurological diagnostic technique that also induces many phenomenological modulations, including reductions in phantom limb pain (PLP), spinal cord injury pain (SCIP), and central post-stroke pain. We aimed to assess in a variety of persistent pain (PP) conditions (i) short-term pain modulation by CVS relative to a forehead ice pack cold-arousal control procedure and (ii) the duration and repeatability of CVS modulations. The tolerability of CVS was also assessed and has been reported separately. We conducted a convenience-based non-randomised single-blinded placebo-controlled study. Thirty-eight PP patients were assessed (PLP, n = 8; SCIP, n = 12; complex regional pain syndrome, CRPS, n = 14; non-specific PP, n = 4). Patients underwent 1-3 separate-day sessions of iced-water right-ear CVS. All but four also underwent the ice pack procedure. Analyses used patient-reported numerical rating scale pain intensity (NRS-PI) scores for pain and allodynia. Across all groups, NRS-PI for pain was significantly lower within 30 min post-CVS than post-ice pack (p < 0.01). Average reductions were 24.8% (CVS) and 6.4% (ice pack). CRPS appeared most responsive to CVS, while PLP and SCIP responses were less than expected from previous reports. The strongest CVS pain reductions lasted hours to over three weeks. CVS also induced substantial reductions in allodynia in three of nine allodynic CRPS patients, lasting 24 h to 1 month. As reported elsewhere, only one patient experienced emesis and CVS was widely rated by patients as a tolerable PP management intervention. Although these results require interpretative caution, CVS was found to modulate pain relative to an ice pack control. CVS also modulated allodynia in some cases. CVS should be examined for pain management efficacy using randomised controlled trials.

ID: 330096 Successful Relief of Poststroke Pain with BurstDR Spinal Cord Stimulation: A Case Series

ID: 330096 Successful Relief of Poststroke Pain with BurstDR Spinal Cord Stimulation: A Case Series

Usefulness of Mirogabalin in Central Neuropathic Pain After Stroke: Post Hoc Analysis of a Phase3 Study by Stroke Type and Location.

Central post-stroke pain (CPSP) is a common type of central neuropathic pain (CNeP) that can occur following the onset of stroke. The oral gabapentinoid mirogabalin besylate (mirogabalin) is a selective α2δ ligand that is effective for the treatment of CNeP, including CPSP. However, it is unknown whether the analgesic effect of mirogabalin on CPSP varies in patients with different background factors. This was a post hoc subgroup analysis of a multinational, open-label, long-term phase3 study of mirogabalin for the treatment of CNeP conducted between March 2019 and December 2020. Data from patients with CPSP were stratified by type of stroke (ischemic or hemorrhagic), stroke location (thalamus, putamen, brainstem, or other), presence/absence of motor weakness, median time since stroke (≥ 59 or < 59months), and median duration of CPSP (≥ 55.5 or < 55.5months). Efficacy was assessed with the short-form McGill Pain Questionnaire (SF-MPQ), and treatment-emergent adverse events (TEAEs) and adverse drug reactions (ADRs) were recorded. This subanalysis included all 94 patients with CPSP from the phase3 study; all were Japanese, and the mean age was 65.3years. The least squares mean change [95% confidence interval] in SF-MPQ visual analog scale (VAS) score from baseline at week52 (last observation carried forward) was - 17.0 [- 22.1, - 11.9] mm. Among the subgroups, least squares mean changes in SF-MPQ VAS scores were not different. Most TEAEs were mild or moderate; severe TEAEs occurred in six patients (6.4%). Somnolence (25.5%), peripheral edema (13.8%), dizziness (11.7%), and weight gain (6.4%) were the most common ADRs, and the types and frequencies of ADRs were similar among subgroups. Mirogabalin was generally effective and well tolerated in patients with CPSP, regardless of background factors such as stroke type or location, presence/absence of motor weakness, time since stroke, and duration of CPSP. Trial registration number NCT03901352.

Use of Two Pain Assessment Tools to Improve Pain Recognition in Post Stroke Patients: A Quality Improvement Project

Abstract Background Post stroke patients can suffer from a variety of complex pain syndromes. These are often associated with decline in function, cognitive impairment, impaired quality of life and mood disturbances. Pain identification can be challenging in this population, due to stroke deficits that impair communication, and associated medical conditions that can affect the patient’s ability to self-report pain. This Quality Improvement (QI) project aims at implementing two pain assessment tools to support clinicians assess pain in a structured manner, and thereby improve pain management. Methods An initial audit was performed to identify whether post stroke pain (PSP) was being recorded in a reliable manner in St Mary's hospital. A pain assessment proforma was then designed, incorporated in the admission proforma and rolled-out for use. This included two pain assessment tools: the Numerical Pain Scale for patients who could self-report pain, and the Abbey Pain Scale for patients with communication difficulties. A second audit was performed to analyse the compliance to documentation and a qualitative evaluation of its use was also conducted in semi-structured staff interviews. Results The first audit showed pain being under reported with only 25% of patients having formal pain assessment documented on admission. The second audit showed improvement in pain assessment with 72.7% pain documentation. Qualitative evaluation revealed staff expressing challenges with pain identification in post stroke patients and viewed the proforma as a useful prompt. Limitations to the use of observational tools included time constraints, lack of familiarity with tools and potential inaccuracy of scores. Conclusion Identification of PSP is key to optimising treatment, and hence improving function and quality of life of stroke patients. This QI project shows that the use of pain assessment tools, in combination with detailed clinical assessment can help pain assessment. Clinician awareness and continuous training are required to support this challenging task.

CENTRAL POST-STROKE PAIN: A SCOPING REVIEW

Introduction: Central post-stroke pain (CPSP) is a neuropathic pain syndrome that can affect individuals who have suffered a stroke and which is still under-recognized by doctors. CPSP has an estimated prevalence of 11% and is more common in lesions involving the thalamus. Diagnosis is challenging due to the variable clinical manifestations and the lack of specific diagnostic criteria. The study aims to gather up-to-date information on this condition and highlight the importance of its early recognition. Methodology: This is a descriptive review of the literature in Medline databases, including articles from 2014 to 2024. A total of 468 articles were initially found, of which 43 were selected after applying inclusion and exclusion criteria. Results and discussion: Risk factors were identified as involvement of the spinothalamic pathway, presence of sensory deficits, female gender, young age, and initial stroke severity. The clinical characteristics of CPSP include pain and sensory abnormalities in the regions corresponding to the injured brain territory. The differential diagnosis includes other etiologies, such as post-stroke spasticity, complex regional pain syndrome, headache and shoulder pain. CPSP has a significant impact on quality of life and is associated with psychological disorders and functional limitations. Conclusion: It is understood that early recognition and appropriate management of CPSP are essential for improving patients' quality of life, highlighting the need for clear diagnostic criteria and effective treatments.

Scrambler therapy for treatment of poststroke pain.

Strokes involving sensory pathways can result in contralesional pain syndromes often refractory to pharmacologic interventions. Scrambler therapy (ST) is a noninvasive electroanalgesia device used to treat pain caused by peripheral neuropathy; however, data are scarce regarding its use in conditions secondary to central nervous system pathology. We evaluate the efficacy of ST to treat poststroke pain. Twenty patients with a history of prior stroke resulting in contralesional pain were randomized to receive ST or Sham as an adjunct to their stable medication regimen. Participants underwent 5 consecutive daily 40-min sessions. The study was blinded to patient and assessor. Pain scores (0-10) were recorded at baseline, pre- and postsession, and 4 weeks after final treatment. Student's t-tests compared differences in the mean change in pain score between groups immediately post-treatment #5, and at 4-weeks. The chi-squared analysis compared the proportion of patients in each group with >50% pain reduction. Participants randomized to ST had a mean change in pain score of -3.73 (SD 2.85) postintervention and -2.57 (SD 2.07) at 4 weeks, while the Sham group had a mean change in score of -0.94 (SD 1.36) and -0.25 (SD 0.84) (p between groups = 0.012, 0.004, respectively). Significantly more participants treated with ST reported a >50% reduction in pain immediately postintervention compared to Sham (70% vs. 10%, p = 0.006), but not at follow-up (30% vs. 10%, p = ns). ST may effectively decrease poststroke pain compared to Sham. Larger studies are needed to evaluate confounders such as stroke location, time from stroke, and concomitant treatment with medications.

The Cytidine N-Acetyltransferase NAT10 Promotes Thalamus Hemorrhage-Induced Central Poststroke Pain by Stabilizing Fn14 Expression in Thalamic Neurons.

The recognition of RNA N4-acetylcytidine (ac4C) modification as a significant type of gene regulation is growing; nevertheless, whether ac4C modification or the N-acetyltransferase 10 protein (NAT10, the only ac4C "writer" that is presently known) participates in thalamus hemorrhage (TH)-induced central poststroke pain (CPSP) is unknown. Here, we observed NAT10 was primarily located in the neuronal nuclei of the thalamus of mice, with Fn14 and p65. An increase of NAT10 mRNA and protein expression levels in the ipsilateral thalamus was observed from days 1 to 14 after TH. Inhibition of NAT10 by several different approaches attenuated Fn14 and p65 upregulation of TH mice, as well as tissue injury in the thalamus on the ipsilateral side, and the development and maintenance of contralateral nociceptive hypersensitivities. NAT10 overexpression increased Fn14 and p65 expression and elicited nociceptive hypersensitivities in naïve mice. Our findings suggest that ac4C modification and NAT10 participate in TH-induced CPSP by activating the NF-κB pathway through upregulating Fn14 in thalamic neurons. NAT10 could serve as a promising new target for CPSP treatment.

Advancements in Modern Treatment Approaches for Central Post-Stroke Pain: A Narrative Review.

Central post-stroke pain (CPSP) poses a multifaceted challenge in medical practice, necessitating a thorough and multidisciplinary approach for its diagnosis and treatment. This review examines current methods for addressing CPSP, highlighting both pharmacological and non-pharmacological therapies. It covers the mechanisms and clinical effectiveness of these treatments in managing CPSP and emphasizes the importance of personalized treatment plans, given the varied causes of CPSP. Recent advancements have illuminated diverse treatment modalities for CPSP. Pharmacotherapy spans from conventional analgesics to anticonvulsants and antidepressants, tailored to mitigate the neuropathic characteristics of CPSP. Non-pharmacological interventions, including physical therapy and psychological strategies, are pivotal in managing CPSP's chronic nature. For cases resistant to standard treatments, advanced interventions such as nerve blocks and surgical procedures like deep brain stimulation (DBS) or motor cortex stimulation (MCS) are considered. Additionally, innovative technologies such as neuromodulation techniques and personalized medicine are emerging as promising avenues to enhance therapeutic outcomes and improve quality of life for individuals grappling with CPSP. Modern approaches in managing CPSP require an interdisciplinary and patient-centric approach. Customizing treatment plans to address the specific etiology and symptoms of CPSP is crucial. Pharmacotherapy remains fundamental, encompassing medications such as anticonvulsants and antidepressants tailored to manage neuropathic pain. Integrating non-pharmacological interventions is crucial for providing comprehensive care. Additionally, investigating innovative technologies and personalized medicine presents promising opportunities to enhance treatment results and elevate the quality of life for those suffering from CPSP. Ultimately, an integrated approach that acknowledges the multifaceted nature of CPSP is essential for effective management and patient well-being.

Investigating combined acupuncture and transcranial direct current stimulation in patients with poststroke shoulder pain from China: protocol for a randomised controlled trial

IntroductionPoststroke shoulder pain is a common complication that severely affects the recovery of upper limb motor function. Acupuncture has positive analgesic effects in treating poststroke shoulder pain, and studies have...

Comparative Study between Effectiveness of Ultrasound-guided ONA-botulinum Toxin Type A Injection with Exercise Therapy on Shoulder Pain Due to Post-stroke Subscapularis Spasticity

Abstract Background: Several invasive and non-invasive procedures are effective in post-stroke shoulder pain (PSP). In this study, we wanted to assess the role of early intervention by ultrasound-guided botulinum toxin type A injection in shoulder pain due to post-stroke subscapularis spasticity. Methods: This study was a prospective randomised open-label control trial. Patients suffering from PSP due to subscapularis spasticity were selected (n = 80). After computer-generated randomisation, they were allocated into two groups (Group 1: patients on exercise therapy only and Group 2: botulinum toxin injection in subscapularis along with exercise therapy) consisting of 40 patients in each group. The primary outcome measure was Visual Analogue Scale (VAS) score of shoulder pain. The secondary outcome measures were Shoulder Pain and Disability Index (SPADI) and Modified Ashworth Scale (MAS) for spasticity of subscapularis. Results: Statistically significant differences in improvement were found with superior result in Group 2 at 2 weeks for shoulder pain VAS (P = 0.025), SPADI (P = 0.047) and MAS (P = 0.038); at 6 weeks for shoulder pain VAS (P = 0.019), SPADI (P = 0.037) and MAS (P = 0.041); and at 12 weeks for shoulder pain VAS (P = 0.011), SPADI (P = 0.027) and MAS (P = 0.035). No adverse effect was observed in either of the group. Conclusion: In clinical practice, botulinum toxin injection is regarded as the first-choice treatment of focal spasticity in the upper limb, as it gives us the opportunity to target specifically selected muscles. Botulinum toxin injection along with exercise therapy is more effective in early intervention of PSP due to subscapularis spasticity to improve shoulder pain and function.

Contributions of neuroimaging in central poststroke pain: a review.

Central neuropathic poststroke pain (CNPSP) affects up to 12% of patients with stroke in general and up to 18% of patients with sensory deficits. This pain syndrome is often incapacitating and refractory to treatment. Brain computed tomography and magnetic resonance imaging (MRI) are widely used methods in the evaluation of CNPSP. The present study aims to review the role of neuroimaging methods in CNPSP. We performed a literature review of the main clinical aspects of CNPSP and the contribution of neuroimaging methods to study its pathophysiology, commonly damaged brain sites, and possible differential diagnoses. Lastly, we briefly mention how neuroimaging can contribute to the non-pharmacological CNPSP treatment. Additionally, we used a series of MRI from our institution to illustrate this review. Imaging has been used to explain CNPSP pathogenesis based on spinothalamic pathway damage and connectome dysfunction. Imaging locations associated with CNPSP include the brainstem (mainly the dorsolateral medulla), thalamus (especially the ventral posterolateral/ventral posteromedial nuclei), cortical areas such as the posterior insula and the parietal operculum, and, more recently, the thalamocortical white matter in the posterior limb of the internal capsule. Imaging also brings the prospect of helping search for new targets for non-pharmacological treatments for CNPSP. Other neuropathic pain causes identified by imaging include syringomyelia, multiple sclerosis, and herniated intervertebral disc. Imaging is a valuable tool in the complimentary evaluation of CNPSP patients in clinical and research scenarios.

The prevalence and factors associated with neck and low back pain in patients with stroke: insights from the CHARLS

BackgroundAlthough stroke is prevalent among Chinese, individuals with stroke may become more disabling if they have concomitant neck pain (NP) and low back pain (LBP). However, the prevalence and factors associated with post-stroke spinal pain among Chinese remain unknown. The current study used the 2018 cohort data from the China Health and Aged Care Tracking Survey (CHARLS) to determine the prevalence and factors associated with increased post-stroke NP and LBP in China.MethodsThe CHARLS study was conducted on four cohorts of nationally representative samples of individuals aged 45 years and above from 30 provincial-level administrative units in China. We used data from the 2018 cohort of the CHARLS survey to determine the prevalence and factors associated with NP and LBP in the non-stroke and post-stroke populations. Participants aged 45 years or older who reported to have NP, and/or LBP were identified. The study was statistically analyzed using t-test, and ANOVA analysis of variance. A multiple logistic regression model was used to identify factors significantly associated with NP and/or LBP in the non-stroke and post-stroke populations.ResultsA total of 19,816 individuals participated in the 2018 survey. The final inclusion of 17,802 subjects who met the criteria included 16,197 non-stroke and 885 stroke participants. The prevalence of NP and LBP in non-stroke population was 17.80% (95% CI: 17.21–18.39) and 37.22% (95% CI: 36.47–37.96), respectively. The prevalence of NP and LBP in the target stroke population was 26.44% (95% CI: 23.53–29.35) and 45.42% (95% CI: 42.14–48.71), respectively, and the difference was statistically significant (p < 0.05). Factors associated with increased post-stroke NP included female, short sleep duration, long lunch break, physical dysfunction, and depression. Factors associated with increased post-stroke LBP included female, comorbidities of two or more chronic diseases, physical dysfunction, and depression.ConclusionThe current study highlighted the high prevalence of post-stroke neck pain (26.44%) and LBP (45.42%) in China. While slightly different associated factors were found to be associated with a higher prevalence of post-stroke NP and LBP, female and individuals with more physical dysfunction or depression were more likely to experience post-stroke spinal pain. Clinicians should pay more attention to vulnerable individuals and provide pain management measures.

A neural network for religious fundamentalism derived from patients with brain lesions

Religious fundamentalism, characterized by rigid adherence to a set of beliefs putatively revealing inerrant truths, is ubiquitous across cultures and has a global impact on society. Understanding the psychological and neurobiological processes producing religious fundamentalism may inform a variety of scientific, sociological, and cultural questions. Research indicates that brain damage can alter religious fundamentalism. However, the precise brain regions involved with these changes remain unknown. Here, we analyzed brain lesions associated with varying levels of religious fundamentalism in two large datasets from independent laboratories. Lesions associated with greater fundamentalism were connected to a specific brain network with nodes in the right orbitofrontal, dorsolateral prefrontal, and inferior parietal lobe. This fundamentalism network was strongly right hemisphere lateralized and highly reproducible across the independent datasets (r = 0.82) with cross-validations between datasets. To explore the relationship of this network to lesions previously studied by our group, we tested for similarities to twenty-one lesion-associated conditions. Lesions associated with confabulation and criminal behavior showed a similar connectivity pattern as lesions associated with greater fundamentalism. Moreover, lesions associated with poststroke pain showed a similar connectivity pattern as lesions associated with lower fundamentalism. These findings are consistent with the current understanding of hemispheric specializations for reasoning and lend insight into previously observed epidemiological associations with fundamentalism, such as cognitive rigidity and outgroup hostility.

Post-stroke pain syndrome: clinical, pathophysiological characteristics and modern rehabilitation management

Background. Pain is a common complication after stroke and is associated with the presence of depression, cognitive dysfunction, and impaired quality of life. It remains underdiagnosed and undertreated, despite evidence that effective treatment of pain may improve function and quality of life. The article highlights the issues of epidemiology, pathogenesis, methods of clinical assessment and risk factors for the development of post-stroke pain. A review of the literature on the most common post-stroke pain syndromes including central post-stroke pain, complex regional pain syndrome, musculoskeletal pain, shoulder pain, pain associated with spasticity and headache is presented. Modern management of the pain is analyzed.Conclusion. In the best interests of optimizing the rehabilitation of a stroke patient, improving his quality of life and function after stroke, clinicians should be aware of pain as a common complication after stroke, identify those patients at highest risk, detail the presence and characteristics of pain, and also be aware of options for correcting post-stroke pain syndromes.