Central Pain Syndromes

Abstract

Central pain syndrome (CPS) is caused by damage or dysfunction of the central nervous system (CNS) in such cases as stroke, multiple sclerosis, tumors, trauma, or Parkinson’s disease. The character of CPS differs widely among individuals and between various causes that may affect a large portion or specific parts of the body. A constant burning pain sensation, although non-pathognomonic of CPS, is the predominant symptom. Alterations of sensory pathway and impaired inhibitory mechanism may be involved in CPS, which often begins shortly after the causative injury or damage, but may be delayed by months or even years, especially after stroke. Diagnosis of CPS may be straightforward with the recognition of the inciting disorder, but differential diagnosis cannot be overlooked. Functional restoration and rehabilitation by managing the inciting illness is the main goal for treatment. Because of the lack of specific and effective treatment, having a multidisciplinary approach to managing CPS increases success rate and satisfaction. Pharmacotherapy options include membrane stabilizers, antidepressants, NMDA antagonists, and low doses of opioids. Drug therapy is directed to find the most effective drug or combination of drugs with minimal side effects. Amitriptyline, gabapentin, and pregabalin are recommended as first-line treatment, and lamotrigine and opioids are considered second- and third-line treatment. Neuromodulation, neuroablation, and intrathecal therapy may be considered in cases where traditional and conservative therapies have failed.