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Chapter-038 Central Pain Syndrome

BOOK TITLE: Ramamurthy's Decision Making in Pain Management: An Algorithmic Approach

Author
1. SS Arora
2. Medical Director of Pain Management Ventura County Medical Center, Ventura, CA, USA
ISBN
9789386261458
DOI
10.5005/jp/books/14128_39
Edition
3/e
Publishing Year
2018
Pages
2
Author Affiliations
1. Cleveland Clinic, Cleveland, OH, USA
Chapter keywords
Central pain syndrome, traumatic brain injury, TBI, spinal cord injury, SCI, spinal cord stimulation, SCS, DREZ, tricyclic antidepressant, TCA

Abstract

Central pain syndromes, a form of neuropathic pain, encompass a wide range of neurological disorders affecting the central nervous system (CNS). It presents with signs and symptoms that may vary in parallel populations and its pathophysiological mechanisms remain complex and poorly understood. A detailed history and examination is the first step. Central pain can be categorized into spinal cord-related pain and brain-related pain. Pharmacotherapy is primarily targeted at treating neuropathic pain. Oral medications that potentially act on the thalamus via noradrenergic and serotoninergic pathways, i.e. antidepressants, are the mainstay of treatment, with amitriptyline having the most evidence and, therefore, utilized as first-line therapy. The most well-studied therapies are education, cognitive behavioral therapy, and exercise (e.g. physical and occupational therapy). Other options include biofeedback, hypnosis, and distraction techniques.

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