Prediction of Central Post-Stroke Pain by Quantitative Sensory Testing

Objective: Among 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. Methods: We 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. Results: In 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. Interpretation: Cold perception differences between CPSP and NPSS patients appear early post stroke before pain. Prediction of CPSP through QST patterns seems feasible. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Eleni Panagoulas was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) - 337619223 / RTG2386. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB of Charite-Universitaets Medizin Berlin gave ethical approval for this work I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors