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Central Pain Syndrome
Central pain syndrome is a neurological disorder caused by damage to the sensory pathways in the brain and spinal cord (CNS). Pain and a loss of feeling in the face, arms, and legs are typical symptoms. The pain might be minor, moderate, or severe and may be continual or intermittent. Those who are affected may have a heightened pain sensitivity. Different people may feel different kinds of pain depending on factors, including the fundamental cause of the condition and the particular region of something like the central nervous system that is dysfunctional. The onset of central pain syndrome may throw off one's regular schedule. A person's standard of living might be drastically reduced when the pain is severe and constant. The central nervous system may be damaged in many ways, resulting in the central pain syndrome.
What is Central pain syndrome?
Central pain syndrome is classified as spinal pain or pain in the brain or brainstem, depending on where the pain is coming from. Central post−stroke pain is the medical name for the subset of central pain syndrome that results from central nervous system (CNS) injury. However, the pain experienced by those with central−pain allied illnesses, such as Parkinson's disease, is not the same as true central pain and requires a separate etiology and treatment strategy.
What are the Symptoms of Central Pain Syndrome?
It includes −
Pain: Central pain syndrome is characterized by spontaneous pain or pain that occurs without any obvious cause or trigger. It is possible that people with this illness have hyperalgesia, a heightened sensitivity to acute painful stimuli, and hyperpathy, an exaggerated emotional response to pain. Further, people may experience pain despite stimuli that typically do not cause discomfort (allodynia). Individuals afflicted may feel agony with the slightest touch. Some people are so sensitive that even the slightest wind, the weight of the blanket, or their clothing may cause excruciating discomfort.
Disorder: Initial symptoms of central pain syndrome might include a reduction in or a distorted perception of touch for some patients (dysesthesia). Indistinct, distressing feelings characterize dysesthesia. For others, the numbness might be particularly excruciating in the feet. Central pain syndrome patients have also been known to experience itching (pruritus).
Stroke: Some people who have had a major stroke may only feel pain on one side of their body; other significant, associated symptoms include a lack of feeling, partial or full muscular paralysis, and, on rare occasions, aberrant, involuntary, unpredictable jerky motions and sluggish, writhing movements.
What are the Causes of Central Pain Syndrome?
One of the causes of persistent central pain is a breakdown in the normal flow of information between the sensitive thalamus and the sensory cortex.
When it comes to sensory processing, the thalamus works in tandem with the cerebral cortex, a more prominent brain area. When the brain's regulatory tone is altered due to a neurological injury, the cortex and specific thalamic nuclei get "locked" together for an aberrant activity state. Therefore, CPS results from a dysfunction in the archicortical loop of the sensory pain pathways.
What is the Diagnosis of Central Pain Syndrome?
A diagnosis of central pain syndrome requires the observation of telltale signs, a comprehensive patient history, a careful clinical assessment, and sometimes even a battery of specialist diagnostic tests. Central nervous system trauma may cause pain and other odd feelings, leading doctors to suspect central pain syndrome. Before diagnosing central pain syndrome, it may be necessary to rule out other possible causes of pain.
Magnetic resonance imaging is the gold standard for diagnosing tumors, infarcts, cerebral hemorrhages, degenerative neurological diseases, and other causal lesions (MRI). An MRI may provide cross−sectional images of certain body tissues using a magnetic field and radio waves. Recent modifications to this technique, such as magnetic resonance and default−state MRI, have failed to garner much interest outside academic circles. Laser evoked is seldom required to validate damage to sensation conducting pathways and is not routinely accessible. Questionnaire−based screening techniques have been created. However, they are not advised to make a definitive diagnosis since they miss 12−45% of cases.
What are the Treatments for Central Pain Syndrome?
While most people treated for central pain syndrome do see some improvement, total elimination of their symptoms is still quite rare. Moreover, treatments that work for some people may not affect others. People with central pain syndrome often find that traditional pain drugs do not help. Many people with this condition initially turn to pharmaceutical treatment. In randomized controlled studies, amitriptyline and lamotrigine showed positive effects, particularly in those with central pain originating in the brain. An antidepressant, amitriptyline, is used to treat emotional distress. Medications containing lamotrigine are used to treat seizures. Local anesthetics like lidocaine and antiarrhythmics may be useful. However, FDA−approved for central pain, gabapentinoids (another kind of anti−seizure medicine) are not recommended as the first treatment since they are ineffective for the overwhelming majority of patients and very rarely provide any noticeable relief. While the FDA has authorized ziconotide for chronic pain, a comprehensive review of the data demonstrates that the drug has a weak therapeutic index and fails to help most patients reliably. Opioids like morphine and levorphanol are not only ineffective in the great majority of situations but also inappropriate for most people.
While CPS does not pose any immediate danger to a person's life, it does create significant distress. One's regular activities may be interrupted by CPS, and the discomfort may be debilitating and limit daily activities in extreme situations. Although medication may help some individuals cope with discomfort, chronic pain is usually permanent.
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