• Shreya Mandloi, Mashaal Syed, Omid Shoraka, Isaiah Ailes, Ki Chang Kang, Anish Sathe, Joshua Heller, Sara Thalheimer, Feroze B Mohamed, Ashwini Sharan, James Harrop, Laura Krisa, Caio Matias, and Mahdi Alizadeh.
• Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
• J Neuroimaging. 2023 Sep 1; 33 (5): 781791781-791.

Background And PurposeSpinal cord injury (SCI) results in the loss of motor and sensory function from disconnections between efferent and afferent pathways. Most SCI patients are affected with chronic neuropathic pain, but there is a paucity of data concerning neuroplastic changes following SCI. Chronic pain disrupts default networks and is associated with abnormal insular connectivity. The posterior insula (PI) is associated with the degree of pain and intensity of pain. The anterior insula (AI) is related to signal changes. Comprehension of SCI pain mechanisms is essential to elucidate effective treatment options.MethodsThis study examines the insular gyri functional connectivity (FC) of seven (five male, two female) SCI participants with moderate-severe chronic pain compared to 10 (five male, five female) healthy controls (HC). All subjects had 3-Tesla MRI performed and resting-state functional MRI (fMRI) was acquired. FC metrics were obtained from the comparisons of resting-state fMRI among our various groups. A seed-to-voxel analysis was pursued, encompassing six gyri of the insula. For multiple comparisons, a correction was applied with a significance level of p < .05.ResultsThere were significant differences in FC of the insula between SCI participants with chronic pain compared with HC. In the SCI participants, there was hyperconnectivity of the AI and PI to the frontal pole. In addition, there was increased FC noted between the PI and the anterior cingulate cortex. Hyperconnectivity was also observed between the AI and the occipital cortex.ConclusionsThese findings illustrate that there is a complex hyperconnectivity and modulation of pain pathways after traumatic SCI.© 2023 The Authors. Journal of Neuroimaging published by Wiley Periodicals LLC on behalf of American Society of Neuroimaging.

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