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Central Pain Syndrome

Table of Contents

Central Pain Syndrome

CPS; Thalamic syndrome (former); Dejerine Roussy syndrome (former); Posterior thalamic syndrome (former); Retrolenticular syndrome; Thalamic hyperesthetic anesthesia; Thalamic pain

Central pain syndrome is a neurological condition caused by damage to or dysfunction of the central nervous system (CNS), which includes the brain, brainstem, and spinal cord.

Spinal cord and Spinal Nerves

Image by TheVisualMD

Summary

Kabir Spinal Cord Lesions and Syndromes

Image by Rian Kabir/Wikimedia

Kabir Spinal Cord Lesions and Syndromes

Types of spinal cord syndrome

Image by Rian Kabir/Wikimedia

What Is Central Pain Syndrome?

Central pain syndrome (CPS) is a rare neurological disorder caused by damage to or dysfunction of the pain-conducting pathways of the central nervous system (in the brain, brainstem, and spinal cord). Symptoms of CPS can vary greatly from one person to another, partly because the cause may differ. Primary symptoms are pain and loss of sensation, usually in the face, arms, and/or legs. Pain or discomfort may be felt after being touched, or even in the absence of a trigger. The pain may worsen by exposure to heat or cold and by emotional distress. CPS is usually associated with stroke, multiple sclerosis, tumors, epilepsy, brain or spinal cord trauma, or Parkinson's disease. Treatment typically includes pain medications, but complete relief of pain may not be possible. Tricyclic antidepressants or anticonvulsants can sometimes be useful. Lowering stress levels appears to reduce pain.

Many different names have been used for this disorder, including Dejerine-Roussy syndrome, thalamic pain syndrome, central post-stroke syndrome and others. The current name acknowledges that damage to various areas of the central nervous system can cause central pain, and that a stroke is not necessarily the cause. When CPS is due to a stroke, it may be referred to as the more specific term "central post-stroke pain."

Source: Genetic and Rare Diseases (GARD) Information Center

Additional Materials (5)

Central Pain Syndrome: I am one of 100,000

Video by rarediseaseday/YouTube

Centralized Pain: Chronic Pain and Fatigue Research Center

Video by Michigan Medicine/YouTube

What Is Central Pain Syndrome Resulting from a Stroke?

Video by Los Robles Regional Medical Center/YouTube

Central Neuropathic Pain Syndromes

Video by Mayo Proceedings/YouTube

What is Chronic Pain

Video by Blazin Guns/YouTube

3:36

Central Pain Syndrome: I am one of 100,000

rarediseaseday/YouTube

4:12

Centralized Pain: Chronic Pain and Fatigue Research Center

Michigan Medicine/YouTube

0:31

What Is Central Pain Syndrome Resulting from a Stroke?

Los Robles Regional Medical Center/YouTube

6:34

Central Neuropathic Pain Syndromes

Mayo Proceedings/YouTube

5:00

What is Chronic Pain

Blazin Guns/YouTube

Symptoms

Depression and Pain

Image by TheVisualMD

Depression and Pain

Pain and depression walk hand in hand. People with depression tend to experience more severe and longer-lasting pain than people without depression. In fact, having untreated clinical depression increases by 50% the likelihood that you’ll develop a chronic pain condition. Pain disorders suffered by people with depression can include nerve pain, irritable bowel syndrome, low back pain, fibromyalgia, and headaches (particularly migraines).

Image by TheVisualMD

What Are the Signs and Symptoms of Central Pain Syndrome?

The severity of pain is usually related to the cause of the central nervous system (CNS) injury or damage. Pain is typically constant, may be moderate to severe in intensity, and is often made worse by touch, movement, emotions, and temperature changes (usually cold temperatures).

People with CPS experience one or more types of pain sensations, the most prominent being burning. Mingled with the burning may be sensations of pins and needles, pressing, lacerating, aching, or brief, intolerable bursts of sharp pain. Some people also experience numbness. The burning and loss-of-touch sensations are usually most severe on the distal parts of the body, such as the feet or hands.

Source: Genetic and Rare Diseases (GARD) Information Center

Additional Materials (1)

How does pain turn into chronic pain? - Harkirat Chahal, MD | UCLA Pain Center

Video by UCLA Health/YouTube

0:39

How does pain turn into chronic pain? - Harkirat Chahal, MD | UCLA Pain Center

UCLA Health/YouTube

Diagnosis

Suffering Lower Back pain

Image by TheVisualMD

Suffering Lower Back pain

Back Pain

Image by TheVisualMD

How Is Central Pain Syndrome Diagnosed?

A diagnosis of central pain syndrome (CPS) is based on the characteristic symptoms, a detailed patient history, a thorough clinical exam and a variety of specialized tests. CPS is suspected in people who complain of pain or other abnormal sensations following injury to the central nervous system. Other conditions that cause pain may need to be ruled out before a diagnosis of CPS is made. The clinical exam may include sensory testing to confirm and pinpoint the presence of sensory abnormalities, but also to rule out other causes of pain.Imaging tests such as a CT scan and MRI may be used to see tumors, infarcts, cerebral bleeding, and other lesions that may cause pain. MRI is the preferred technique when CPS is suspected.

Source: Genetic and Rare Diseases (GARD) Information Center

Additional Materials (9)

How is Back Pain Treated?

Common Back Pain Treatments : Most back pain can be treated successfully with conservative, nonsurgical therapy. Surgery is a last resort and, in most cases, unnecessary.

Image by TheVisualMD

To the Bone: Spinal Causes of Back Pain

Image by TheVisualMD

Sensitive content

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To the Bone: Spinal Causes of Back Pain

Image by TheVisualMD

What Is Back Pain?

Set out on a voyage of discovery into one of the miracles of nature: your back. Dynamic, multilayered views of the spine and the hundreds of muscles that support it reveal the hidden architecture of your vertebrae and discs. Go deep inside the spine to see exactly what happens when a disc herniates or spinal stenosis, spinal osteoarthritis, and other disorders develop. Noted back experts Dr. Mark Liponis of Canyon Ranch, Dr. Norman Marcus of NYU, and many others talk about what causes most back pain and the difference between chronic and acute pain. See therapists in action using both standard and alternative treatments, from physical and thermal therapy to acupuncture and massage.

Image by TheVisualMD

What Are the Causes of Back Pain? NIAMS/NIH

Spinal Causes of Back Pain

Image by TheVisualMD

Female with Visible Nervous System Experiencing Back Pain

Individuals with chronic back pain are at least four times more likely to experience major depression than people in the general population. Many are reluctant to accept a separate diagnosis of depression, feeling that the \"depressive\" symptoms diagnosed by a doctor would disappear if only the pain would go away. In another case of mind-body give-and-take, individuals with depression are also more prone to developing back pain. The reasons remain unclear. Often, depressed individuals experience pain without an observable physical stimulus,although it is never-the-less real. This is called neuropathic pain.

Image by TheVisualMD

The Function of Pain

This video explains the physiological function and purpose of pain. Pain is part of the body's defense system, triggering a reflex reaction to retract from a painful stimulus, and helps adjust behavior to increase avoidance of that particular harmful situation in the future.

Image by TheVisualMD

Acute and Chronic Pain are Different

This video explains the difference between acute and chronic pain. Acute pain results from a series of transmission among the major components of the nervous system. An injury to the body tissue structure sets off a cascade of reactions which are translated into electrical signals, carried by nociceptors (peripheral pain nerves). The nerve fibers that transmit pain messages enter the spinal cord in an area called the dorsal horn. There they release neurotransmitters that activate other nerve cells in the spinal cord, which process the information and then transmit it up to the brain. Chronic pain is pain that persists or progresses over a long period of time. It is persistent and in which the cause of the pain cannot always be removed or is difficult to treat. If chronic pain remains untreated, the pain signals are embedded in the central nervous system like a painful memory.

Image by TheVisualMD

How Many Different Types Of Pain Are There?

Video by Seeker+/YouTube

How is Back Pain Treated?

TheVisualMD

To the Bone: Spinal Causes of Back Pain

TheVisualMD

Sensitive content

This media may include sensitive content

To the Bone: Spinal Causes of Back Pain

TheVisualMD

What Is Back Pain?

TheVisualMD

What Are the Causes of Back Pain? NIAMS/NIH

TheVisualMD

Female with Visible Nervous System Experiencing Back Pain

TheVisualMD

The Function of Pain

TheVisualMD

Acute and Chronic Pain are Different

TheVisualMD

10:33

How Many Different Types Of Pain Are There?

Seeker+/YouTube

Treatment

Antidepressants and depression

Image by TheVisualMD

Antidepressants and depression

Antidepressants and depression: Antidepressant medications are commonly used to treat clinical depression. With the introduction of the selective serotonin reuptake inhibitors (SSRIs), and later the serotonin norepinephrine reuptake inhibitors (SNRIs), the estimated proportion of people in the United States with depressive disorders who received an antidepressant medication as part of their treatment program increased dramatically from 37% in 1987 to 75% in 1997. Antidepressants are prescribed by health care professionals. This can be your primary care physician or a psychiatrist, a physician who specializes in mental, emotional, or behavioral disorders. It is important to communicate with your doctor and monitor the effects of your medication. You should never \"go it alone\" when taking antidepressants. In the right setting, antidepressants can treat depression and may even help reverse some of the biological changes that occur with this illness. Recent studies have found that some antidepressants increase BDNF in the brain.2,3 BDNF is responsible for protecting neurons and stimulating the growth of new neurons - processes that are impaired when clinical depression strikes. For some patients, effective treatment can literally be life-saving. There are several different general \"classes\" of antidepressant medications. We will briefly describe each.

Image by TheVisualMD

How Might Central Pain Syndrome Be Treated?

In general, first-line management includes the use of tricyclic antidepressants such as nortriptyline, anticonvulsants such as gabapentin, or topical lidocaine. Second-line management involves the use of opioid analgesics such as tramadol, along with first-line medication. Third-line management may include other antidepressant or anticonvulsant medications.

Lowering stress levels appears to reduce pain. Other treatment alternatives have included the administration of a sympathetic blockade (a type of nerve block) and a guanethidine block, as well as psychological evaluation and treatment. Rarely, surgery is necessary.Stereotactic radiosurgery of the pituitary has been used with some success. Other forms of potential treatments that have been discussed in the literature include transcutaneous electrical nerve stimulation (TENS); deep brain stimulation; and motor cortex stimulation.

Source: Genetic and Rare Diseases (GARD) Information Center

Additional Materials (2)

Antidepressant Medication

Antidepressant medications are commonly used to treat clinical depression. With the introduction of the selective serotonin reuptake inhibitors (SSRIs), and later the serotonin norepinephrine reuptake inhibitors (SNRIs), the estimated proportion of people in the United States with depressive disorders who received an antidepressant medication as part of their treatment program increased dramatically from 37% in 1987 to 75% in 1997. Antidepressants are prescribed by health care professionals. This can be your primary care physician or a psychiatrist, a physician who specializes in mental, emotional, or behavioral disorders. It is important to communicate with your doctor and monitor the effects of your medication. You should never \"go it alone\" when taking antidepressants. In the right setting, antidepressants can treat depression and may even help reverse some of the biological changes that occur with this illness. Recent studies have found that some antidepressants increase BDNF in the brain.2,3 BDNF is responsible for protecting neurons and stimulating the growth of new neurons - processes that are impaired when clinical depression strikes. For some patients, effective treatment can literally be life-saving. There are several different general \"classes\" of antidepressant medications. We will briefly describe each.

Image by TheVisualMD

Antidepressants

Antidepressants

Image by Carsten Schertzer

Antidepressant Medication

TheVisualMD

Antidepressants

Carsten Schertzer

Fact Sheet

Chronic Pain (Fact Sheet)

Image by Borsook D, Moulton EA, Schmidt KF, Becerra LR.

Chronic Pain (Fact Sheet)

Image Cption : Schematic Examples of CNS Structural Changes. Red circles signify decreased gray matter density relative to controls. A. Subjects with chronic back pain show decreases in gray matter density in bilateral dorsolateral prefrontal cortex (DLPFC) and right anterior thalamus (adapted from [25]). B. Patients with fibromyalgia show decreases in cingulate cortex (CC), medial prefrontal cortex (Med. PFC), parahippocampal gyrus (PHG) and insula (adapted from [27]). 3-D surface renderings were created using Freesurfer. Borsook et al. Molecular Pain 2007 3:25 doi:10.1186/1744-8069-3-25

Image by Borsook D, Moulton EA, Schmidt KF, Becerra LR.

Central Pain Syndrome Information

What is central pain syndrome?

Central pain syndrome is a neurological condition caused by damage to or dysfunction of the central nervous system (CNS), which includes the brain, brainstem, and spinal cord. This syndrome can be caused by stroke, multiple sclerosis, tumors, epilepsy, brain or spinal cord trauma, or Parkinson's disease. The character of the pain associated with this syndrome differs widely among individuals partly because of the variety of potential causes. Central pain syndrome may affect a large portion of the body or may be more restricted to specific areas, such as hands or feet. The extent of pain is usually related to the cause of the CNS injury or damage. Pain is typically constant, may be moderate to severe in intensity, and is often made worse by touch, movement, emotions, and temperature changes, usually cold temperatures. Individuals experience one or more types of pain sensations, the most prominent being burning. Mingled with the burning may be sensations of "pins and needles;" pressing, lacerating, or aching pain; and brief, intolerable bursts of sharp pain similar to the pain caused by a dental probe on an exposed nerve. Individuals may have numbness in the areas affected by the pain. The burning and loss of touch sensations are usually most severe on the distant parts of the body, such as the feet or hands. Central pain syndrome often begins shortly after the causative injury or damage, but may be delayed by months or even years, especially if it is related to post-stroke pain.

Is there any treatment?

Pain medications often provide some reduction of pain, but not complete relief of pain, for those affected by central pain syndrome. Tricyclic antidepressants such as nortriptyline or anticonvulsants such as neurontin (gabapentin) can be useful. Lowering stress levels appears to reduce pain.

What is the prognosis?

Central pain syndrome is not a fatal disorder, but the syndrome causes disabling chronic pain and suffering among the majority of individuals who have it.

Source: National Institute of Neurological Disorders and Stroke (NINDS)

Related HealthJournals

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Central Nervous System

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Nervous System

The human nervous system can be divided into two interacting subsystems: the peripheral nervous system (PNS) and the central nervous system (CNS). The CNS consists of the brain and spinal cord. The peripheral nervous system is an extensive network of nerves connecting the CNS to the muscles and sensory structures.

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Central Pain Syndrome

Central pain syndrome is a neurological condition caused by damage to or dysfunction of the central nervous system (CNS), which includes the brain, brainstem, and spinal cord.

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