Net Guide: Central Pain Syndrome

Pain Management, November 2010, Volume 3, Issue 7

A collection of links and resources from across the web focused on one specific condition. These resource range from useful websites to clinical trials.

//The Educated Patient

Central Pain Syndrome

This site provides a complete overview of central pain syndrome that can be useful for patients newly diagnosed with the condition. Organized by the National Institute of Neurological Disorders and Stroke, the page begins by describing central pain syndrome as a “neurological condition caused by damage to or dysfunction of the central nervous system.” The syndrome - it goes on to explain - can be caused by “stroke, multiple sclerosis, tumors, epilepsy, brain or spinal cord trauma, or Parkinson’s disease.” Additionally, the site highlights treatment options, prognosis, and current research with links to clinical trials.

Who Gets Central Pain?

Here is a website that is dedicated to providing information solely on or related to Central Pain Syndrome. Patients can come to this site to understand the circumstances in which Central Pain develops. The site explains that often times, most individuals that suffer from neuropathic pain from the central nervous system, “have no idea that their most distressing symptom, intractable central pain, is shared by people with such a wide range of other health conditions.” The site provides information on how damage to sensory nerve cells in the central nervous system is the main criteria in diagnosing central pain. Likewise, the site mentions that the condition may appear to be peripheral neuropathy, which can cause difficulties in diagnosing the condition. Included on the site, are also patient descriptions of what it feels like to have central pain syndrome.

Central Pain Syndrome Alliance

This site is dedicated to providing resources for those with Central Pain Syndrome and is written specifically with the patient in mind and in simple to understand language. For example, it describes CPS as being “extremely difficult to diagnose, sometimes sending the patient to many doctors to find one that believes them, and/or has even heard of and dealt with and treated this savage pain.” The goal of the alliance is to “encourage the education of sufferers, doctors, therapists, and loved ones.” It was created by a group of CPS sufferers who had acquired the condition after a stroke who wanted to provide one another with support. Featured here is a key article on who gets CPS, news and journal articles, a collection of links to related resources, a message board, and an art gallery of paintings representing the condition.

//Medical Websites

Neuropathic Pain

Since Central Pain Syndrome is a form of neuropathic pain, this Webpage - based on information found in the Merck Manual - can offer physicians a quick review on the causes of neuropathic pain, the treatment, diagnosis, and more. The site goes into the etiology of neuropathic pain, symptoms, diagnosis, and treatment.


Operculo-insular Pain (parasylvian pain): a Distinct Central Pain Syndrome

Journal: Brain (August 18, 2010)

Authors: Garcia-Larrea L, Perchet C, Creac'h C, et al

Purpose: The researchers sought to investigate whether central pain with dissociated thermoalgesic sensory loss is common in cortical lesions.

Results: The researchers identified five cases out of 270 patients that were investigated “because of somatosensory abnormalities.” The five cases chosen presented “with central pain and pure thermaologic sensory loss contralateral to stroke.” The team found that “Central pain resulting from posterior parasylvian lesions appears to be a distinct entity.” They proposed that the terms “parasylvian or operculo-insular pain as appropriate labels” be used rather than “‘pseudo-thalamic.’”

Abnormal Activity of Primary Somatosensory Cortex in Central Pain Syndrome

Journal: Journal of Neurophysiology (September 2010)

Authors: Quiton R, Masri R, Thompson S, et al

Purpose: The researches sought to evaluate whether or not “CPS is associated with increased activity in the primary somatosensory cortex (SI),” which is a “major projection target of PO that plays an important role in processing sensory-discriminative aspects of pain.”

Results: Using rats with CPS, the team “recorded single units in SI” and found that the SI neurons “exhibited significantly higher spontaneous firing rates.” They concluded that “the excruciatingly painful symptoms of CPS may result…from abnormally increased activity in SI.”

Zona Incerta: A Role in Central Pain

Journal: Journal of Neurophysiology (July 2009)

Authors: Masri R, Quiton R, Lucas J, et al

Purpose: The researchers sought to “test the hypothesis that CPS is associated with abnormal inhibitory regulation” of posterior thalamus by zona incerta.

Results: They found that “the spontaneous firing rate and somatosensory evoked responses of ZI neurons were lower in lesioned animals compared with sham-operated controls.” Further findings led them to conclude, “CPS can result from suppressed inputs from the inhibitory nucleus zona incerta to the posterior thalamus.”

Development and Characterization of a Hemorrhagic Rat Model of Central Post-stroke Pain

Journal: Neuroscience (June 16, 2009)

Authors: Wasserman J, Koeberle P

Purpose: The researchers “describe the development and characterization of a rat model of thalamic CPSP.”

Results: They found that “thalamic hemorrhage produces a confined lesion that destroys the tissue within the initial bleed, with little or no neuron death beyond the hemorrhage core.” The surviving neurons, surrounded by activated glial cells, “likely contribute to neuropathic pain in this model,” the said. They conclude the findings may help researchers develop “therapeutics for central post-stroke pain.”

//Clinical Trials

Safety Study of Deep Brain Stimulation to Manage Thalamic Pain Syndrome (DBS)

Study Type: Interventional

Age/Gender Requirements: 21 years (male/female)

Sponsor: The Cleveland Clinic

Purpose: “To determine the safety and efficacy of Deep Brian Stimulation (DBS) of the ventral capsular/ventral striatal as a treatment for patients with Thalamic Pain Syndrome (TPS).”

Effects of Vaporized Marijuana on Neuropathic Pain

Study Type: Interventional

Age/Gender Requirements: 18-70 years (male/female)

Sponsor: University of California, Davis

Purpose: The study is designed to “measure the pain-relieving effects of vaporized marijuana in subjects with neuropathic pain.”

Pharma Focus

neurontin (gabapentin)

Clinical Trials

Study of Gabapentin to Reduce Duration of Postoperative Pain and Opioid Use

Study Type: Interventional

Age/Gender Requirements: 18-75 years (male/female)

Sponsor: Stanford University

Purpose: The goal of this study is to determine whether administering Gabapentin prior to surgery affects duration of pain and opioid use post-surgery. We aim to compare gabapentin to placebo in a prospective, randomized clinical trial in which patients will be followed post-surgery until pain resolves and opioid use ceases.

From the Network:


Robot-Assisted Post Stroke Therapy Beneficial Even for Late Starters

A late start to stroke therapy has been thought to be detrimental to getting much benefit out of it, so exercises must begin as soon as possible. A new study, published in the New England Journal of Medicine, has now shown that even late starters can see substantial improvement when using robotically assisted therapy.

American Journal of Managed Care

US Cost Burden of Ischemic Stroke: A Systematic Literature Review

This study was featured in our sister publication. It focused on conducting “a systematic literature review to determine current US costs of stroke and to assess if a gap in available information exists.”