Central pain syndrome: elucidation of genesis and treatment

Central pain (CP), namely, pain or allied symptoms that follow damage to the CNS, has remained an obscure neurological syndrome with no explanation or effective treatment since Edinger's description in 1891. Once believed to be rare, CP is now known to affect several millions of people worldwide, making it at least as frequent as, for example, Parkinson's disease. It follows such common entities as stroke, spinal cord injury and multiple sclerosis, but also many other conditions, including neurosurgical procedures on the brain and spine. A disturbance of thalamocortical transmission is now acknowledged to be the main engine of CP. When drugs fail, neuromodulation, both electrical and chemical, provide relief to many drug nonresponders. A small stereotactic lesion deep in the subparietal white matter promises complete relief, without the ravages of neuroablation as performed widely in the past.