Central pain syndrome: elucidation of genesis and treatment

Abstract

Central pain (CP), namely, pain or allied symptoms that follow damage to the CNS, has remained an obscure neurological syndrome with no explanation or effective treatment since Edinger’s description in 1891. Once believed to be rare, CP is now known to affect several millions of people worldwide, making it at least as frequent as, for example, Parkinson’s disease. It follows such common entities as stroke, spinal cord injury and multiple sclerosis, but also many other conditions, including neurosurgical procedures on the brain and spine. A disturbance of thalamocortical transmission is now acknowledged to be the main engine of CP. When drugs fail, neuromodulation, both electrical and chemical, provide relief to many drug nonresponders. A small stereotactic lesion deep in the subparietal white matter promises complete relief, without the ravages of neuroablation as performed widely in the past.

Keywords::

• central pain
• leukotomy
• motor cortex stimulation
• neuromodulation

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.