The predictive value of cortical activity during motor imagery for subacute spinal cord injury-induced neuropathic pain

•Both subacute spinal cord injury (SCI) and central neuropathic pain (CNP) affect motor imagery (MI) activity and lateralization.•MI activity is greater in SCI with upcoming CNP compared to SCI with no CNP.•MI activity is more bilateral in SCI with upcoming CNP and more contralateral in SCI with existing CNP. The aim of this study is to explore whether cortical activation and its lateralization during motor imagery (MI) in subacute spinal cord injury (SCI) are indicative of existing or upcoming central neuropathic pain (CNP). Multichannel electroencephalogram was recorded during MI of both hands in four groups of participants: able-bodied (N = 10), SCI and CNP (N = 11), SCI who developed CNP within 6 months of EEG recording (N = 10), and SCI who remained CNP-free (N = 10). Source activations and its lateralization were derived in four frequency bands in 20 regions spanning sensorimotor cortex and pain matrix. Statistically significant differences in lateralization were found in the theta band in premotor cortex (upcoming vs existing CNP, p = 0.036), in the alpha band at the insula (healthy vs upcoming CNP, p = 0.012), and in the higher beta band at the somatosensory association cortex (no CNP vs upcoming CNP, p = 0.042). People with upcoming CNP had stronger activation compared to those with no CNP in the higher beta band for MI of both hands. Activation intensity and lateralization during MI in pain-related areas might hold a predictive value for CNP. The study increases understanding of the mechanisms underlying transition from asymptomatic to symptomatic early CNP in SCI.