Central pain syndromes

Central pain is a chronic neuropathic pain disorder that develops as a direct consequence of a lesion within the central nervous system. The most common causes for central pain are vascular lesions to the brain and the spinal cord, multiple sclerosis, and spinal cord injury. Clinically, central pain typically develops with a delay after the lesion. The pain typically is localized in an area of abnormal sensitivity corresponding to the preceding central lesion. Spontaneous pain and also evoked pains can be found. Pathophysiologically, ectopic neural activity and hyperexcitability are driven by pathological facilitatory and disinhibitory processes. In addition to medical history and clinical examination, diagnosis of central pain is based on imaging and electrophysiological techniques, including quantitative sensory testing, to confirm a central lesion and for identification of the underlying disease. Management of central pain mainly based on pharmacological treatment still is a great challenge, but evidence points to efficacy of antidepressants, anticonvulsants, and opioids.