What are the most common central pain syndromes? What are the evidence based treatments of central pain syndromes?
The most common central pain syndromes are poststroke pain, spinal cord injury pain, and myelopathic pain due to MS. Central pain syndromes typically develop in a delayed fashion—that is, several months after the inciting clinical event. Poststroke pain, unsurprisingly, usually occurs after a stroke affecting somatosensory pathways (thalamus or, less commonly, parietal cortex). Spinal cord injury pain can have two components: an “at-level” radicular pain and a “below-level” central pain state referable to interruption or dysfunction of ascending somatosensory pathways.
Central pain syndromes are often refractory to typical treatments for peripheral neuropathic pain. Amitriptyline, pregabalin, and lamotrigine have been demonstrated to be beneficial in poststroke pain, and pregabalin has been demonstrated to be beneficial in spinal cord injury pain.