CENTRAL PAIN

Central Pain is a controversial subject, because it is confused with the idea that pain can be "burned" into the CNS. This is extremely unlikely, but through processes such as wind-up, sympathetic coupling, thalamic strokes, demyelinization and descending pathway destruction painful stimuli from the PNS or CNS are augmented and at times raised to unbearable levels. These are difficult conditions to diagnose and treat.

Central Pain is most commonly caused by wind-up phenomena described elsewhere in this website. Sympathetic Coupling, also described elsewhere is another frequent contributor to Central Pain. Less common problems involve strokes in areas of the brain that involve ascending or descending pain pathways or of the thalamus itself. Multiple sclerosis can cause painful conditions, and other demyelinating illnesses can also do the same.

Treating central pain properly requires appropriate diagnosis, as each of the above conditions demands a different approach. Studies should start with a good neurological and general physical examination and follow with X-rays,CT, MRI, EMG, NCV and appropriate blocks.

Once diagnosis is established treatment should be aggressive and multimodal. Blocks, tricyclic analgesics, long acting opioids, calcium channel blockers, sodium channel blockers, membrane stabilizers, NMDA antagonists, alpha 2 agonists and alpha 1 antagonists all may be useful. Use of intrathecal delivery systems may be necessary. Ablative surgery has its greatest use in Central Pain problems, especially when they are combined with terminal cancer, but certainly not limited to malignancy. This group of patients and their families are in dire need of psychosocial interventions.