Central pain syndrome is a neurological condition that is caused by damage to the central nervous system (CNS), which leads to the sensitization of pain. It most often presents as a burning pain that may be generalized or localized to a region in the body, although the exact characteristics can vary greatly according to the cause of the syndrome.
Management of the central pain syndrome involves a combination of medications and non-pharmacological techniques to relieve pain and improve quality of life.
Central pain syndrome occurs as a result of damage to the CNS, which may occur as a result of various circumstances. This may include trauma from a car accident or other incident, limb amputation, tumor, stroke, epilepsy, multiple sclerosis, Parkinson’s disease, Graves or Addison’s disease or rheumatoid arthritis.
The symptoms often present shortly after the incident or initiation of causative disease, or may be delayed for several years prior to symptoms occurring, particularly for damage caused by stroke.
The pain associated with central pain syndrome may be general or localized to a certain region of the body. It can vary greatly between patients, as the characteristics of the pain is closely linked to the cause of the disease and the extent of nerve damage.
It is usually a moderate to severe pain that is constantly present, although may be aggravated by touch, movement, emotions and extreme temperature changes. Patients often describe the pain as burning, although it can vary and is sometimes referred a sensation of pins and needles or a pressing, aching, sharp or bursting pain. It is common for a loss of sensation to occur in the affected areas, particularly in the distal parts of the body, such as the feet and hands.
Other associated symptoms may include nausea, vomiting, hyperventilation and hypertension.
Central pain syndrome is not associated with a reduction in life expectancy, but the chronic pain can decrease the quality of life significantly for affected individuals. The aim of management for central pain syndrome is, therefore, to relieve the associated pain and improve the quality of life.
Simple analgesic medications, such as paracetamol, ibuprofen or aspirin, are often able to provide some degree of effective pain relief. However, they are not usually able to relieve the pain completely and other medications are also recommended. For example, stronger pain medications such as opioid medications can be used in some instances.
Tricyclic antidepressants (TCAs) such as amitriptyline or nortriptyline are commonly used to regulate pain in central pain syndrome that is associated with damage to the nerves. Additionally, some anticonvulsant medications such as gabapentin may also offer a benefit.
Non-pharmacological management techniques include the use of temperature packs to relieve pain and lifestyle alterations to lower stress levels, which have been linked to more severe pain symptoms. It is important that patients have access to a strong support system to deal with the life changes and difficulties that present with chronic pain. The involvement of a physical therapist and a psychologist can help the patient to find coping techniques to deal with the pain.
There is currently research being done to investigate the efficacy of different treatments for central pain syndrome and the possibility to reverse the causative damage to the nervous system. Breakthroughs in this area would be a significant step forward in the management of the syndrome.