Understanding the Causes and Symptoms of Central Pain Syndrome
Every person has experienced pain at one point or another. While certain types of pain are common and affect millions of people, others are rare but equally serious. One of the relatively less talked about forms of pain is central pain syndrome. Throughout this post, we will shed more light on this condition, so scroll down to learn more.
What is Central Pain Syndrome?
Central pain syndrome (CPS) is a neurological condition indicated by constant, moderate-to-severe pain induced by damage to the central nervous system (CNS). The CNS includes the brain, brainstem, and spinal cord.
According to estimates by the Central Pain Syndrome Foundation, about 3 million people in the United States have this condition. Yet, CPS is not a frequently discussed subject, and many people have never even heard of it.
Also known as centralized pain, central pain, central sensitization, and widespread or diffuse pain, CPS is a type of chronic neuropathic pain disorder involving damage to the sensory pathways of the CNS.
German neurologist L. Edinger was the first one to describe central pain back in 1891. For many years, it was believed CPS was due to damage in the thalamus often caused by a stroke. Thalamus is a small structure within the brain that relays motor and sensory signals to the cerebral cortex. Eventually, scientists discovered that damage to the pain-conducting pathways anywhere along the neural axis (from the spinal cord to the sensory cortex) could cause this condition.
Cause of Central Pain Syndrome
This condition develops as a direct consequence of a lesion within the central nervous system. Pain in this condition comes from the brain, not from peripheral nerves, which are outside of the brain and spinal cord. This is why CPS is not like other pain conditions.
You see, pain is generally a protective response to a harmful stimulus. That being said, harmful stimuli such as touching a hot stove do not cause pain in CPS. An injury to the brain creates the perception of the pain instead. In most cases, injury occurs in the thalamus, but it can happen in other places, too, as mentioned above.
The most common conditions that can lead to CPS include:
- Brain hemorrhage
- Brain tumor
- Multiple sclerosis
- Parkinson’s disease
- Spinal cord injury
- Surgical procedures involving the brain or spine
- Traumatic brain injury
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Symptoms of Central Pain Syndrome
The onset of CPS symptoms can vary from days to weeks, months, or even more than a year after the injury to a person’s central nervous system. In some people, the condition appears immediately after an injury or within a day. The primary symptom of CPS is pain. Different people may experience the pain of CPS differently. Pain can be:
- Widespread throughout the body
- Located to a specific body part
People describe the pain associated with CPS differently. It can be aching, burning, prickling, or tingling (pins and needles), stabbing, itchiness that becomes painful, shocking, freezing, and tearing.
In most cases, pain is moderate to severe.
Various factors can worsen the intensity of pain, such as:
- Anger and other strong or intense emotions
- Movement such as exercise
- Bright lights
- Loud noises
- Involuntary and/or reflexive movements, e.g., yawning
- Temperature changes (especially cold)
- Sun exposure, rain, wind
- Changes in barometric pressure and altitude
How is Central Pain Syndrome Diagnosed?
Diagnosis of CPS is based on the identification of characteristic symptoms, thorough clinical evaluation, detailed patient history, and certain specialized tests. The doctor may suspect CPS is present in patients who complain about pain or other abnormal sensations after an injury to CNS. They will order specific tests such as an MRI to exclude other conditions that may induce pain.
Treatment of Central Pain Syndrome
Keep in mind that CPS is usually a lifelong condition. Moreover, treatments that work for some patients may be ineffective for others. Traditional pain relievers such as NSAIDs provide little to no relief for persons with CPS. Therefore, drug therapy is the first-line therapy for most patients with this condition. The doctor may prescribe medications such as amitriptyline (an antidepressant) and lamotrigine (an anticonvulsant). Antiarrhythmics and local anesthetics may be effective as well.
In cases when medications do not work, the doctor may recommend surgery such as brain stimulation. The procedure involves implanting an electrode named neurostimulator to specific parts of the brain. This is done to send stimulation to the pain receptors.
Central pain syndrome is a lifelong but not life-threatening condition that affects the central nervous system. The condition does not develop on its own. Instead, it is a consequence of injury to CNS caused by a stroke or other problems. The diagnosis and treatment are complicated. Some medications may help alleviate pain.