Overview of Central Pain Syndrome

Central pain syndrome is a chronic neuropathic pain disorder caused by damage to the central nervous system. It can occur after a stroke, brain injury, or spinal cord injury. However, it can also be present along with conditions like multiple sclerosis or Parkinson’s disease.

Central pain syndrome may present differently depending on the area of the nervous system that was damaged. Pain may be localized in a small area of the body or may be widespread. The pain associated with central pain syndrome is often described as sharp, burning, or like pins and needles. For many, the pain is constant.

A man suffering from pain, holding head and back
Paul Bradbury / Getty Images

Central Pain Syndrome Overview

It should be noted that central pain is a blanket term that, according to George Riddoch in 1938, refers to "spontaneous pain and painful overreaction to objective stimulation resulting from lesions confined to the substance of the central nervous system including dysaesthesia of a disagreeable kind.” The word "dysaesthesia" means that touch is misinterpreted by your body as pain. The word "lesion" means tissue damage.

In other words, central pain can result from any insult to any part of the central nervous system.

History of Central Poststroke Pain: A Type of Central Pain

Central poststroke pain (CPSP) is a type of central pain that was first described by Déjerine and Roussy almost 100 years ago. CPSP was previously called thalamic pain. Thalamic pain is the most widely known of all the central pain syndromes.

What Is Central Poststroke Pain?

Central poststroke pain results from a lesion or injury to the thalamus. The thalamus is a part of your brain that regulates motor and sensory signals on their way to the frontal cortex. The frontal cortex interprets sensory input and makes decisions. Of note, pain and discomfort similar to CPSP can also be produced certain lesions in the parietal lobe, spinal cord, and brainstem.

The thalamus is commonly damaged after a stroke. A stroke is defined as an interruption or leakage of blood flow that results in brain damage.

CPSP occurs in about 8-percent of people who have had a stroke and is a scary, painful, and distressing condition. People with CPSP feel intermittent pain accompanied by strange thermal sensations, such as burning, freezing, or scalding.

Treatment for Central Poststroke Pain

Central pain syndrome may be treated with adjuvant analgesics, such as antidepressants or anticonvulsants, but there is no specific treatment for central poststroke pain. However, the following medications have proven useful in some people with this condition:

  • Analgesics for pain relief
  • Anticonvulsants (for example, phenytoin, carbamazepine, and gabapentin)
  • SSRIs (antidepressants like Prozac or Paxil)
  • Tricyclic antidepressants
  • Phenothiazines
  • Opioids (Vicodin, Oxycodone, and so forth)

Unfortunately, one of the risks of prolonged opioid use for conditions like CPSP can lead to abuse and dependence.

Associated Terms: thalamic pain syndrome, Dejerine-Roussy syndrome, post-stroke pain, central poststroke pain, central poststroke pain (CPSP)

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By Erica Jacques
Erica Jacques, OT, is a board-certified occupational therapist at a level one trauma center.