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."
Last updated: 4/10/2017
How might central pain syndrome be treated?
Treatment of central pain syndrome (CPS) is known to be challenging. The method of treatment may vary depending on the cause of the neurological damage. Pain medications (analgesics) often provide only some relief of pain.
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.