When pain becomes self: limbic-default mode network hyperconnectivity predicts microvascular decompression failure in trigeminal neuralgia.
Brain Communications January 1, 2026 Ying Wang, Chenglong Cao, Hao Chen et al.
Poor surgical outcomes after microvascular decompression for trigeminal neuralgia are linked to maladaptive central neural reorganization rather than ineffective surgery. Among 60 patients, those with poor outcomes showed enhanced functional connectivity between default mode, somatomotor, and control networks and subcortical limbic structures (amygdala, nucleus accumbens, hippocampus) compared to those with good outcomes. A classifier using these connections achieved 86% accuracy in distinguishing outcome groups. Longer disease duration correlated with decreased fractional anisotropy in sensorimotor white matter tracts. The findings suggest that pain becomes cognitively and affectively 'self-embedded', transitioning from a sensory event to a persistent self-referential narrative that sustains pain even after peripheral trigger removal, reframing some trigeminal neuralgia as a central network disorder.