Central post-stroke pain
Other Names for this Disease
- Thalamic syndrome
- Dejerine Roussy syndrome
- Central pain syndrome
- Posterior thalamic syndrome
- Retrolenticular syndrome
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Your QuestionI had two thalamic strokes in 2009, which left me with chronic pain on my left side. What can I do for this condition?
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Central post-stroke pain (CPSP) is a rare neurological disorder in which the body becomes hypersensitive to pain as a result of damage to the thalamus, a part of the brain that affects sensation. Primary symptoms are pain and loss of sensation, usually in the face, arms, and/or legs. Pain or discomfort may be felt after being mildly touched or even in the absence of a stimulus; the pain may worsen by exposure to heat or cold and by emotional distress. It is caused by damage to, or dysfunction of, the central nervous system (CNS), which may be due to stroke, multiple sclerosis, tumors, epilepsy, brain or spinal cord trauma, or Parkinson's disease. Treatment typically includes pain medications to provide some reduction of pain, but complete relief of pain may not be possible. Tricyclic antidepressants or anticonvulsants can sometimes be useful. Lowering stress levels appears to reduce pain.
Last updated: 1/24/2011
Treatment of central post-stroke pain (CPSP) is known to be challenging. Pain medications (analgesics) often provide some reduction of pain, but not complete relief of pain. Tricyclic antidepressants such as nortriptyline, or anticonvulsants such as gabapentin can be useful. Lowering stress levels appears to reduce pain. Other treatment alternatives have included the administration of a sympathetic blockade (a type of nerve block) and a guanethidine block, as well as psychological evaluation and treatment. Rarely, surgery is necessary. Stereotactic radiosurgery of the pituitary has been used to treat CPSP with some success. Other forms of potential treatments for CPSP that have been discussed in the literature include transcutaneous electrical nerve stimulation (TENS); deep brain stimulation; and motor cortex stimulation.
Last updated: 1/24/2011
- Thalamic Syndrome (Dejerine Roussy). National Organization for Rare Disorders. December 31, 2010; http://www.rarediseases.org/search/rdbdetail_abstract.html?disname=Thalamic%20Syndrome%20%28Dejerine%20Roussy%29. Accessed 1/23/2011.
- NINDS Central Pain Syndrome Information Page. National Institute of Neurological Disorders and Stroke (NINDS). January 13, 2011; http://www.ninds.nih.gov/disorders/central_pain/central_pain.htm. Accessed 1/23/2011.
- YiLi Zhou. CHAPTER 48 – Principles of Pain Management. Bradley: Neurology in Clinical Practice, 5th ed.[Electronic version]. Deutschland: Butterworth-Heinemann; 2008 ; 905.
- Robert Gould, Susan S Barnes. Shoulder and Hemiplegia. eMedicine. February 5, 2009; http://emedicine.medscape.com/article/328793-overview. Accessed 1/23/2011.
- G D Schott. From thalamic syndrome to central poststroke pain. Journalof Neurology, Neurosurgery, and Psychiatry. December, 1996; 61(6):560-564. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC486645/pdf/jnnpsyc00012-0002.pdf. Accessed 1/23/2011.