Central Pain Syndrome

Qeios · Definition, November 11, 2019 Ope n Pe e r Re vie w on Qe ios Central Pain Syndrome National Institute of Neurological Disorders and Stroke (NINDS) Source National Institute of Neurological Disorders and Stroke (NINDS). Central Pain Syndrome Information Page. 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. T his syndrome can be caused by stroke, multiple sclerosis, tumors, epilepsy, brain or spinal cord trauma, or Parkinson's disease. T he 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. T he 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. T he 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. Qeios ID: 149323 · https://doi.org/10.32388/149323 1/1.

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Thalamic Pain Syndrome (Central Post-Stroke Pain) in a Patient Presenting with Right Upper Limb Pain: a Case Report
0008-3194/99/243–248/$2.00/©JCCA 1999 JR Tuling, E Tunks Thalamic Pain Syndrome (Central Post-Stroke Pain) in a patient presenting with right upper limb pain: a case report Jeffrey R Tuling, BSc, DC* Eldon Tunks, MD, FRCP(C)** In the elderly, pain of a widespread nature can often be Les douleurs irradiantes, chez les personnes âgées, debilitating. It is not uncommon to attribute this peuvent souvent devenir incapacitantes. Il est fréquent widespread pain to osteoarthritis within the spinal d’attribuer ce type de douleur à l’arthrose, qui touche les column structures and peripheral joints or to other structures de la colonne vertébrale et les articulations musculoskeletal etiology. However, chiropractors should périphériques, ou encore à une autre étiologie musculo- remain wary regarding pain experienced by the elderly, squelettique. Cependant, les chiropraticiens devraient se especially if pain is widespread and exhibits neuropathic montrer circonspects devant les cas de douleur chez les features. Common features of neuropathic pain involve personnes âgées, surtout si celle-ci couvre une grande the presence of allodynia, hyperpathia and hyperalgesia. région et présente des caractéristiques neurologiques. This characteristic widespread pain can sometimes be Les cas de douleur neurologique sont habituellement the sequelae of a central nervous system lesion such as a associés à la présence d’allodynie, d’hyperpathie et “Thalamic Pain Syndrome”, or “Central Post-Stroke d’hyperalgésie. Ce type de douleur irradiante peut Pain”, which are terms commonly used to describe pain parfois être une séquelle d’une lésion du système that originates in the central nervous system. nerveux central, comme le syndrome de douleur Following is the case of a 90-year-old patient thalamique ou la douleur post-accident vasculaire presenting with widespread pain attributed to Thalamic central.
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A Comprehensive, Multispecialty Approach to an Acute Exacerbation of Chronic Central Pain in a Tetraplegic
Spinal Cord (2014) 52, S17–S18 & 2014 International Spinal Cord Society All rights reserved 1362-4393/14 www.nature.com/sc CASE REPORT A comprehensive, multispecialty approach to an acute exacerbation of chronic central pain in a tetraplegic EY Chang1,2,3, X Zhao2, DM Perret1,2,3,ZDLuo3 and SS Liao4 Study design: We present a case report describing the multidisciplinary treatment of a tetraplegic spinal cord injury (SCI) patient who developed an acute exacerbation of chronic central pain. Objective: To bring further awareness to the importance of using a comprehensive, multidisciplinary approach in treating acute exacerbation of chronic central pain in SCI patients. Setting: University of California Irvine Medical Center, Orange, CA, USA. Case report: We present a 34-year-old man with a past medical history of C5 American Spinal Injury Association B tetraplegia secondary to a surfing accident 8 years prior, central pain syndrome, spasticity, autonomic dysreflexia and anxiety who arrived at the emergency room with a 1-month history of worsening acute on chronic pain refractory to opioid escalation. The multispecialty treatment plan included treatment of the patient’s urinary tract infection by the primary medicine service, management of the patient’s depression by the psychiatric service, treatment of bowel obstruction by general surgery and adjustment of pain medications by pain management. The patient was found to have stable neurological findings, neuroimaging unchanged from prior imaging and a urinary tract infection. Hospitalization was complicated by severe colonic dilation that required disimpaction by general surgery. Conclusion: The treatment of this patient’s acutely worsened central pain highlights the importance of applying a multidisciplinary approach to SCI patients with an acute exacerbation of chronic central pain.
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Pain After Stroke
Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Pain after stroke After a stroke you might experience various physical effects, such as weakness, paralysis or changes in sensation. Unfortunately you may also experience pain. This factsheet will help you to understand some of the causes of pain after stroke and the treatments that may be available. It also gives details of useful organisations that can provide you with further information and support. There are many different types of pain you Spasticity happens when there is damage may experience after having a stroke. to the area of your brain that controls your Weakness on one side of your body is one muscles. If you have spasticity you will have of the most common effects of stroke. This increased muscle tone. Muscle tone is the can lead to painful conditions such as muscle amount of resistance or tension in your stiffness (spasticity) and shoulder problems. muscles, and it is what enables us to hold our Some people also experience central post- bodies in a particular position. This increased stroke pain, headaches and sore swollen muscle tone can make it difficult to move hands after stroke. your limbs. Spasticity may also cause your muscles to tense and contract abnormally, As with many effects of stroke, pain may causing spasms, which can be very painful. persist for some time, but treatments Spasticity can also damage your tissues and such as medication and physiotherapy joints and can sometimes cause painful night are often successful in relieving pain. cramps. Many people also benefit from attending pain management clinics and learn coping It is important to treat spasticity as soon as techniques to help them to manage any possible because your joints and muscles long-term pain (see page 7 for details).
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Pain in Parkinson's Disease
Global Journal of Medical Research: A Neurology and Nervous System Volume 20 Issue 1 Version 1.0 Year 2020 Type: Double Blind Peer Reviewed International Research Journal Publisher: Global Journals Online ISSN: 2249-4618 & Print ISSN: 0975-5888 Pain in Parkinson's Disease: From the Pathogenetic Basics to Treatment Principles By Alenikova Olga Abstract- Pain syndromes are quite common in Parkinson's disease, in addition to the motor defect, can significantly worsen the quality of life. Various types of pain related to PD have been described. Different clinical characteristics of the pain, variable relationship with motor symptoms, and variable response to dopaminergic drugs, as well as, in some cases, the dependence its appearance in a specific time of the day, suggest that pain in PD has a complex mechanism with the widespread impairment of the sensory information transmission at different levels of the CNS. In addition to the dopaminergic systems of the brain and spinal cord, non- dopaminergic systems (nor epinephrine, serotonin, gamma-amino butyric acid, glutamate, endorphin, melatonin) are also involved in the development pain syndromes in PD. A neurodegenerative process associated with PD establishes a new dynamic balance between the nociceptive and antinociceptive systems, which ultimately determines the level of pain susceptibility and the pain experience characteristics. Basal ganglia along with amygdala, intralaminar nuclei of the thalamus, insula, prefrontal cortex, anterior and posterior cingulate cortex determine the motor, emotional, autonomic and cognitive responses to pain. Keywords: pain, parkinson's disease, nociceptive pathway, basal ganglia, non motor symptoms, noradrenergic system. GJMR-A Classification: NLMC Code: WL 359 PaininParkinsonsDiseaseFromthePathogeneticBasicstoTreatmentPrinciples Strictly as per the compliance and regulations of: © 2020.
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Hope Through Research: National Institute of Neurological Disorders and Stroke (N...Page 1 of 17
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Eur opean Rev iew for Med ical and Pharmacol ogical Sci ences 2013; 17: 3257-3261 Neuropathic pain following spinal cord injury: what we know about mechanisms, assessment and management R. D’ANGELO, A. MORREALE 1, V. DONADIO, S. BORIANI 2, N. MARALDI 2, G. PLAZZI, R. LIGUORI IRCCS Istituto delle Scienze Neurologiche, Dipartimento di Scienze Biomediche e NeuroMotorie, Alma Mater Studiorun, University of Bologna, Bologna, Italy 1Montecatone Rehabilitation Institute, Imola-Bologna, Italy 2IRCCS Istituto Ortopedico Rizzoli, Dipartimento di Scienze Biomediche e NeuroMotorie, Alma Mater Studiorun, University of Bologna, Bologna, Italy Abstract. – BACKGROUND: In biology, it is its physiological response is pain. When pain is easy to understand how a damaged functional caused by non-neural tissues it is called “noci - system may generate wrong signals, but why ceptive pain”, whereas if pain “arises as a direct this should happen when the system is discon - consequence of a lesion or disease affecting the nected is less clear. For this reason, among oth - 1 er pain syndromes, neuropathic pain (NP) follow - somatosensory system” with or without ade - ing spinal cord injury (SCI) leaves most ques - quate stimulation, the term “neuropathic pain” tions unanswered. (NP) has been introduced. AIMS AND METHODS: Our purpose is to re - Spinal cord injury (SCI) directly affects the view current knowledge on NP after SCI, focus - somatosensory system and SCI patients experi - ing on the mechanisms, assessment and man - ence both nociceptive pain and NP, immediately agement of the syndrome. RESULTS: The mechanisms responsible for NP (> 1 month) after the acute injury or developing following SCI are poorly understood: NP is clas - later.
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Reduction of Central Neuropathic Pain with Ketamine Infusion in a Patient with Ehlers–Danlos Syndrome: a Case Report
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Diagnosis, Prevalence, Characteristics, and Treatment Of
® VOLVO XXIIIL XXI • NNOO 13 •• J APRILUNE 2013 2015 Diagnosis, Prevalence, Characteristics, Vol.ÊXXI,ÊIssueÊ1Ê JuneÊ2013 andEditorial Treatment Board of Central Poststroke Pain Editor-in-Chief PsychosocialÊAspectsÊofÊChronicÊPelvicÊPain ain is a common complaint mortality.49,62,63 Since the incidence severe pain attributed to a vascular JaneÊC.ÊBallantyne,ÊMD,ÊFRCA Anesthesiology,ÊPainÊMedicinefollowing stroke, reported of stroke increases with age and life lesion in the thalamus. This pain syn- USA in 11–55% of stroke sur- expectancy is rising, the prevalence drome became known as the “Dejerine- Pain is unwanted, is unfortunately common, and remains essential for survival (i.e., 5,24,31,47 PAdvisoryÊBoardvivors. Poststroke of poststrokeevading dang pain,er) a includingnd facilitati centralng med ical dRoussyiagnos esyndrome”s. This com orple “thalamicx amalgamati painon of painMichaelÊJ.ÊCousins,ÊMD,ÊDSC can arise from muscles, joints, poststrokesensation, pain em o(CPSP),tions, a isnd also though likelyts ma nifesyndrome.”sts itself as pExpertsain beh alatervior .demonstrated Pain is a moti - PainÊMedicine,ÊPalliativeÊMedicine 1 - or viscera,Australia or from the peripheral to increasevating fact inor the for future. physicia Itn isconsu imporltati- ons that and extrathalamicfor emergency vasculardepartme lesionsnt visit scan and is or central nervous system.39,63 The tant to assess the presence most common types of poststroke of pain in stroke survivors pain include hemiplegic shoulder because of its negative pain, pain due to painful spasms or impact on quality of life and spasticity, poststroke headache, and rehabilitation. central poststroke pain. Patients may have several types of poststroke pain Central Poststroke Pain concomitantly.24,39,63 CPSP is a central neuropathic Risk factors for poststroke pain pain condition in which pain include young age, female sex, stroke arises as a direct result of severity, spasticity, diabetes, sensory a cerebrovascular lesion in disturbance, depression, and pain the central somatosensory before stroke onset.
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A Publication of the British Pain Society
painMARCH 2020 VOLUnewsME 18 ISSUE 1 a publication of the british pain society A view from the Accademia Bridge towards the Basilica di Santa Maria della Salute. Venice 2019. Credit by kind permission of Keith Truman. Different professional views of pain in ICD -11 A view of pain and suffering in Oxton Attending a viewing: sculpture and mental pain Viewing the elephant in the room about chronic post surgical pain ISSN 2050–4497 Reviewing post stroke pain Reviewing a childhood and development of pain PAN_cover_18_1.indd 1 07/02/2020 6:40:38 PM PAN_cover_17_1.indd 2 04/02/2019 8:06:10 PM Third Floor Churchill House 35 Red Lion Square London WC1R 4SG United Kingdom Tel: +44 (0)20 7269 7840 Email [email protected] www.britishpainsociety.org A company registered in England and Wales and limited by guarantee. Registered No. 5021381. Registered Charity No. 1103260. A charity registered in Scotland No. SC039583. contents The opinions expressed in PAIN NEWS do not necessarily reflect those of the British Pain Society Council. PAIN NEWS MARCH 2020 Officers Co-opted Members Editorials Dr Arun Bhaskar Dr Chris Barker Representative, Royal College of GPs President 3 Adverse childhood events and adult chronic pain: Dealing with the ACEs that life has Mr Neil Betteridge Prof. Andrew Baranowski Representative Chronic Pain Policy Coalition dealt you - Rajesh Munglani Immediate Past President Ms Felicia Cox 10 In this issue – Jenny Nicholas Prof. Roger Knaggs Editor, British Journal of Pain and Representative, RCN Vice President Dr Andrew Davies Regulars Dr Ashish Gulve Representative; Palliative Medicine Interim Honorary Treasurer Ms Victoria Abbott-Fleming 11 From the President – Arun Bhaskar Patient Lead, National Awareness Campaign 13 From the Honorary Secretary – Ayman Eissa Dr Ayman Eissa Dr Stephen Ward 14 From the Interim Honorary Treasurer – Ashish Gulve Honorary Secretary Chair, Scientific Programme Committee Dr Andreas Goebel Elected Chair, Science & Research Committee Articles Prof.
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Central Pain
Central Post-Stroke Pain 柳營奇美醫院神經內科吳明修醫師 Central Pain • “pain associated with lesions of the central nervous system” • Central post-stroke pain (CPSP) • Spinal cord injury (SCI) Nicholson. Neurology 2004; 62(Suppl 2): S30-36. Central Neuropathic Pain Klit. Lancet Neurol 2009; 8: 857–68 Central post-stroke pain (CPSP) • Thalamic pain syndrome by Dejerine and Roussey (1906) • (1) a thalamic lesion, • (2) slight hemiplegia, • (3) disturbance of superficial and deep sensibility, • (4) hemiataxia and hemiastereognosia, • (5) intolerable pain, and • (6) choreoathetoid movements Andersen. Pain, 61 (1995) 187-193 Central post-stroke pain (CPSP) • pain resulting from a primary lesion or dysfunction of the central nervous system after a stroke • thalamic & extra-thalamic lesions Kumar. Anesth Analg 2009;108:1645–57 Common types of chronic pain that can occur after stroke Klit. Lancet Neurol 2009; 8: 857–68 Locations of stroke producing central poststroke pain 1 sensory cortex; 2 thalamocortical projection of spinothalamic sensations; 3 ventral posterolateral nucleus of thalamus; 4 mid-brain; 5 pons 6 and 7 medulla Kumar. Anesth Analg 2009;108:1645–57 Stroke lesion and Central Poststroke pain localization Kumar. Anesth Analg 2009;108:1645–57 Prevalence of CPSP (1) • between 8% and 35% • timing of the study • variations in inclusion criteria, • the definition of CPSP Kumar. Anesth Analg 2009;108:1645–57 Prevalence of CPSP (2) Klit. Lancet Neurol 2009; 8: 857–68 Pathophysiology • Unclear • Spinothalamiocortical sensory pathways • The ventrocaudal (Vc) nuclei of the thalamus, particularly within the ventroposterior inferior (VPI) nucleus • Subthreshold activation of nociceptive neurons, in which nociceptive neurons fire in response to a normally nonpainful stimulus Nicholson.
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Deep Brain Stimulation of the Posterior Insula in Chronic Pain: a Theoretical Framework
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