Researchers pooled 21 neuroimaging studies (31 datasets) and report convergent structural and resting-state functional changes in brains of people with postherpetic neuralgia (PHN). The multimodal voxel-wise meta-analysis, registered on PROSPERO (CRD420251030103) and published in Journal of Pain Research, synthesised data collected through December 31, 2025.
The team used Seed-based d Mapping with Permutation of Subject Images (SDM-PSI), a coordinate-based meta-analytic method that combines reported peak coordinates and available statistical maps. Included studies comprised 12 resting-state fMRI datasets and 6 voxel‑based morphometry (VBM) datasets comparing PHN patients with healthy controls, plus additional comparisons with herpes zoster patients and pre/post treatment scans.
Main finding: structural and spontaneous functional alterations converged on three large-scale systems. These were (1) cross-modal sensory processing regions (including occipital and parietal association cortices), (2) affective–cognitive regulatory areas (notably medial cingulate/paracingulate cortex and cerebellar Crus II), and (3) cortico–basal ganglia circuits (including the putamen/lentiform nucleus). The authors interpret these patterns as network-level reorganization rather than isolated regional damage.
The analysis flagged these network signatures as candidate neuroimaging biomarkers and potential targets for mechanism-guided therapies. The paper specifically notes implications for neuromodulation approaches such as repetitive transcranial magnetic stimulation and transcranial direct-current stimulation, and for multisensory or cognitive interventions aimed at emotional burden and maladaptive behavioral control.
The authors also report study limitations. The PHN literature remains small and heterogeneous, many included datasets were cross‑sectional, and coordinate‑based synthesis can miss spatially distributed or subthreshold effects. Meta-regressions did not identify demographic or clinical moderators that overlapped with the main clusters. The team calls for larger, harmonised longitudinal and interventional imaging studies to test whether the identified networks predict disease course or treatment response.
Funding came from the Beijing Traditional Chinese Medicine Science and Technology Development Fund and the National Natural Science Foundation of China. The authors declared no conflicts of interest.
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Tags: postherpetic neuralgia, neuroimaging meta-analysis, resting-state fMRI, voxel-based morphometry, brain networks
Topics: Neuroscience & neuroplasticity, Neuromodulation, Non-invasive brain stimulation