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.
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.
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.
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.