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Central poststroke pain: A systematic review.

Jonathan Singer1, Alyssa Conigliaro2, Elizabeth Spina3

  • 11 Department of Neurology, SUNY Downstate Medical Center & Stroke Center, Brooklyn, NY, USA.

International Journal of Stroke : Official Journal of the International Stroke Society
|May 13, 2017
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Summary
This summary is machine-generated.

Central poststroke pain, often debilitating, is linked to spinothalamic pathway damage. This systematic review suggests reevaluating the historical focus on thalamic strokes for central poststroke pain understanding and treatment.

Keywords:
Central poststroke painbrain imagingclinical studiesrandomized control trialssomatosensoryspinothalamic pathwaythalamic stroke

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Area of Science:

  • Neurology
  • Neuroscience
  • Pain Medicine

Background:

  • Post-stroke impairments, including physical, psychological, and social, can be worsened by pain.
  • Central poststroke pain (CPSP) is a neurological condition attributed to central nervous system mechanisms.
  • The prevalence of CPSP varies widely (8%-55%), indicating challenges in its consistent identification and definition.

Purpose of the Study:

  • To clarify the association between thalamic strokes and the spinothalamic pathway in CPSP.
  • To update the understanding of anatomical substrates, neuroimaging, and therapeutic strategies for CPSP.
  • To investigate the role of the spinothalamic pathway in the pathophysiology of CPSP.

Main Methods:

  • A systematic review of 10,144 identified publications was conducted.
  • Data extraction from 23 selected papers followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
  • Articles were categorized based on their focus: somatosensory deficits, pathway stimulation, clinical trials, and brain imaging.

Main Results:

  • Damage to the spinothalamic pathway is significantly associated with CPSP.
  • The review identified a need to reevaluate the established link between thalamic strokes and CPSP.
  • Strokes in brain regions beyond the thalamus were also frequently associated with CPSP.

Conclusions:

  • The spinothalamic pathway's involvement in CPSP offers potential insights into its mechanisms and treatment development.
  • Current understanding of CPSP etiology necessitates a broader consideration of stroke locations beyond the thalamus.
  • Further research is warranted to refine diagnostic criteria and therapeutic interventions for CPSP.