Central Pain Syndrom

Central Pain Syndrome

What Is Central Pain Syndrome?

Central pain syndrome is a neurological disorder that is caused by damage to the central nervous system. The central nervous system includes the brain, brainstem, and spinal cord. The condition can be caused by several other conditions like a stroke, brain trauma, tumors, or epilepsy. People with central pain syndrome typically feel different types of pain sensations like:

  • aching
  • burning
  • sharp pains
  • numbness

The symptoms vary widely among individuals. It can start immediately after a trauma or other condition, or it may take months or years to develop.

There is currently no cure for central pain syndrome. Usually pain medications, antidepressants, and other types of medications can help provide some relief. The condition can dramatically reduce a person’s quality of life.

What Causes Central Pain Syndrome?

Central pain syndrome refers to pain that comes from the brain and not from the peripheral nerves, which are located outside of the brain and spinal cord. For this reason, it differs from most other pain conditions.

Pain is usually a protective response to a harmful stimulus, such as touching a hot stove. But in central pain syndrome, there is no harmful stimulus. Instead, an injury to the brain creates the perception of pain. This injury usually occurs in the thalamus, a structure within the brain that processes sensory signals to other parts of the brain.

The brain can be injured or damaged by many conditions. The most common conditions that can lead to central pain syndrome include:

  • brain hemorrhage
  • stroke
  • multiple sclerosis
  • brain tumors
  • aneurysm
  • spinal cord injury
  • traumatic brain injury
  • epilepsy
  • Parkinson’s disease
  • surgical procedures that involve the brain or spine

The Central Pain Syndrome Foundation estimates that nearly three million people in the United States suffer from central pain syndrome.

What Are the Symptoms of Central Pain Syndrome?

The main symptom of central pain syndrome is pain in the body. The pain varies greatly among individuals. It can be constant or it can come and go (intermittent) and it can be limited to a specific part of the body, or may be more widespread. The pain is usually described as any of the following:

  • burning
  • aching
  • prickling or tingling, sometimes called “pins and needles”
  • stabbing
  • itching that turns painful
  • freezing
  • shocking
  • tearing

The pain is typically described as moderate to severe in intensity. The pain may even be described as agonizing in some people. In more severe cases, people with central pain syndrome may have pain even when touched lightly by clothing, blankets, or a strong wind.

Several factors may make the pain worse. These factors include the following:

  • touch
  • stress, anger, or other strong emotions
  • movement or exercise
  • reflexive involuntary movements like sneezing or yawning
  • loud noises
  • bright lights
  • temperature change, especially cold temperatures
  • sun exposure
  • rain
  • wind
  • barometric pressure changes
  • altitude changes

In most cases, central pain syndrome remains a lifelong condition.

How Is Central Pain Syndrome Diagnosed?

Central pain syndrome can be difficult to diagnose. The pain may be widespread and may seem unrelated to any injury or trauma. There is no single test that can diagnose central pain syndrome.

A doctor will review your symptoms, perform a physical examination, and ask about your medical history. It’s very important to inform your doctor about any conditions or injuries you have now or may have had in the past and any medications you are taking. Central pain syndrome doesn’t develop by itself. It only occurs following an injury to the central nervous system.

How Is Central Pain Syndrome Treated?

Central pain syndrome is difficult to treat. Pain medications, like morphine, are sometimes used but aren’t always successful.

Some patients are able to manage their pain with antiepileptic or antidepressant medications like:

  • amitriptyline (Elavil)
  • duloxetine (Cymbalta)
  • gabapentin (Neurontin)
  • pregabalin (Lyrica)
  • carbamazepine (Tegretol)
  • topiramate (Topamax)

Additional medications that may help include:

  • transdermal cream and patches
  • medical marijuana
  • muscle relaxants
  • sedatives and sleep aids

In general, these medications will reduce the pain but won’t make it go away completely. Through trial and error, a patient and their doctor will eventually find a medication or a combination of medications that work best.

Neurosurgery is considered a last resort. This type of surgery involves deep brain stimulation. This procedure requires an electrode (neurostimulator) to be implanted in specific parts of the brain in order to  send stimulation to the pain receptors.

What Types of Doctors Treat Central Pain Syndrome?

A primary care doctor will typically be the first type of doctor to discuss your symptoms and check your medical history and current health. Once certain conditions are ruled out, your doctor may refer you to a specialist for more testing and treatment.

Specialists who treat or help manage central pain syndrome include the following.

  • Neurologist: a doctor who specializes in disorders of the nervous system, including the brain, spinal cord, and nerves. A neurologist is usually skilled in treating chronic pain. You may have to see several neurologists before deciding which one can help you manage your pain.
  • Physical therapist: a professional who helps patients reduce pain and improve mobility.
  • Psychologist: Central pain syndrome often affects a person’s relationships and emotional well-being. You may need to see a psychologist or therapist to discuss the emotional issues caused by having chronic pain.

What Are the Complications of Central Pain Syndrome?

Central pain syndrome can be painful and very frustrating. It can keep you from participating in social events and having a normal life.

Central pain syndrome can lead to emotional problems and other complications including:

  • stress and anxiety
  • depression
  • fatigue
  • sleep disturbances
  • relationship problems
  • anger
  • decreased quality of life
  • isolation
  • suicidal thoughts

What Is the Outlook for Central Pain Syndrome?

Central pain syndrome is not fatal, but for most patients the condition causes considerable suffering. Central pain syndrome can potentially disrupt an individual’s daily routine.

In severe cases, the pain can be agonizing and unrelenting and dramatically affect a person’s quality of life. Some are able to manage the pain with medications, but the condition typically lasts for the rest of a person’s life. 

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