Cortico-Limbic Disconnection Phenotype in Chronic Central Neuropathic Pain: A Case Report

Chronic neuropathic pain that arises after severe burns often involves central sensitization. While self-report is key for the condition to be diagnosed, tools like quantitative electroencephalograms (qEEGs), event-related potentials (ERPs), and neuropsychological tests may offer objective support.

A 59-year-old man developed chronic multifocal pain after severe burns. Subsequently, he experienced tingling, numbness, and burning for 3 years, with mood and cognitive issues. The neurological exam revealed allodynia and hyperalgesia over the burned regions. qEEGs and ERPs revealed dysfunction in the patient's orbitofrontal, anterior cingulate, and insular regions, with high-frequency frontal hyperactivity. Neuropsychological testing confirmed deficits in the man's attention, executive function, and reaction time. Gabapentin and duloxetine gave partial relief to the patient.

This case highlights complex brain changes linked to central neuropathic pain. qEEGs, ERPs, and neuropsychological assessments of the patient revealed a constellation best conceptualized as a cortico-limbic disconnection with frontal hyperarousal syndrome. This construct offers an alternative framework to thalamocortical dysrhythmia. These findings support the use of clinical and medicolegal evaluation to investigate neuropathic pain and emphasize the need for further validation of this emerging phenotype.