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Central pain in the face and head
1Department of Neurology, University Hospital, Uppsala, Sweden. jrgen.boivie@telia.com
Handbook of Clinical Neurology
|September 7, 2010
Summary
Central neuropathic pain arises from central nervous system lesions, often delayed after stroke or affecting legs in multiple sclerosis. Treatments like antidepressants and antiepileptics show limited efficacy.
Area of Science:
- Neurology
- Pain Medicine
- Neuroscience
Background:
- Central neuropathic pain (CNP) is a debilitating condition resulting from lesions in the central nervous system (CNS).
- Conditions like stroke, multiple sclerosis (MS), and spinal cord injury are common causes of CNP.
- The location and nature of CNS lesions significantly influence pain characteristics and prevalence.
Purpose of the Study:
- To summarize the etiology, clinical presentation, and treatment of central neuropathic pain.
- To highlight the variability in pain quality and location based on lesion type and site.
- To discuss the challenges in treating central neuropathic pain due to poor analgesic response.
Main Methods:
- Review of existing literature on central neuropathic pain.
- Analysis of clinical data regarding lesion location and pain manifestation in stroke and multiple sclerosis patients.
- Summary of current treatment strategies and their effectiveness.
Main Results:
- Central neuropathic pain can be induced by various CNS lesions, with location being a critical factor.
- Stroke-induced pain is often delayed, constant, and hemipain (75%), while MS-related pain predominantly affects the legs (87%).
- Central pain exhibits diverse qualities, is linked to sensory abnormalities, and responds poorly to conventional analgesics.
Conclusions:
- Lesions in spinothalamic pathways are hypothesized to cause central pain, but unknown factors contribute to its development.
- First-line treatments include tricyclic antidepressants and antiepileptic drugs, despite generally poor responses.
- Further research is needed to understand the underlying mechanisms and improve therapeutic outcomes for central neuropathic pain.
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