Central pain syndrome

Central pain syndrome

Central pain syndrome is a condition that comes as a result of some kind of damage within the central nervous system. Most often this damage is to the sensory pathways. Sensitization of the pain system is what always comes with central pain syndrome, so it is very important to understand what sensitization is.

It is a process during which continual application of a certain stimulus gradually amplifies the response to that same stimulus. Moreover, the increase in response often spreads to more stimuli, which can make patients sensitive to a far wider variety of stimuli.

The kind of pain, its severity and location greatly depend on the cause of the damage and/or malfunction, so it is difficult to pinpoint central pain syndrome as the cause for pain just by paying attention to its kind.

What is central pain syndrome?

Central pain syndrome is classified as 338.0 under ICD-9 and G89.0 under ICD-10.

It is a neurological condition which stems from some kind of malfunction within the central nervous system and results in one or more different kinds of pain.

The malfunction can be caused by a number of different traumas, amputations of limbs, accidents, stroke, several different tumors, spinal cord injury, disorders within the immune system, epilepsy, Rheumatoid arthritis, Grave’s disease, Parkinson’s disease, Addison’s disease, Multiple Sclerosis and more. What makes central pain syndrome even more elusive is the fact that the damage to the central nervous system rarely causes the symptoms to appear immediately. It is far more common that they develop months or even years after the initial damage.

The feeling of pain can be localized or spread throughout the body. The level of pain is usually constant or gradually increasing between moderate and severe. However, different stimuli can greatly affect the pain. For example, a simple touch can greatly increase pain. The same goes for noticeable temperature changes, even the slightest movement and even different emotional states.

The kind of pain can also greatly differ and range from burning pain (which is the most common sensation) to cutting pain, bursts of excruciating pain to pins and needles. Some patients also experience a reduction in sensitivity to touch and this symptom is most common in areas which are further from the central nervous system, e.g. hands and feet. In most severe cases, pain is accompanied by vomiting, hyperventilation and increase in blood pressure.

Causes of Central Pain Syndrome
Causes of Central Pain Syndrom – Image powered by Epainassist.com

The pain can be limited to certain part of the body (most often the limbs), but it can also be widely spread with varying pain intensity over different areas of the body. The intensity is often constant, but some patients reported regular changes based on the time of day. As already mentioned, touch, movement, emotional state and temperature can all affect pain intensity. On the other hand, resting can reduce the severity of symptoms.

The increased sensitivity to pain stimuli is one of the most common symptoms. In addition to the chronic pain, increased sensitivity leads to acute pain episodes  stemming from hyperalgesia or hyperpathia. It can go as far as allodynia, which is a pain sensation felt due to a stimulus which is not usually painful. The patients with extreme cases of allodynia can experience pain when they have a blanket on them, or even clothes.

Having in mind that some patients experience increased sensitivity, while others experience reduced sensitivity shows that central pain syndrome is a disorder within the sensory system, rather than being one coming from an outside source. It is a case of distorted interpretation of the stimuli.

Central pain syndrome is by no means fatal in itself, but its severe symptoms and chronic pain often lead to patients’ not being able to perform even the simplest daily tasks and reducing the quality of life. Sadly, in vast majority of cases, central pain syndrome remains present for as long as the patient lives. However, managing its symptoms can result in a bearable state.

Foundation

CPS fpundation
CPS foundation

Central Pain Syndrome Foundation was founded by a group of central pain syndrome patients and their family members and friends. Its value lies in their members’ direct contact with the syndrome and their dedication to helping the central pain syndrome community.

They aim to provide support to the patients and also spread the word shedding the light on central pain syndrome and eliminating the ignorance that overshadows it.

Moreover, they support research which is dedicated to improving the quality of life of the patients, but also finding the cure for central pain syndrome.

Central Pain Syndrome Diagnosis

Diagnosis comes from detecting the most common symptoms, having insight into the patient’s history (especially having in mind all the diseases that are connected to central pain syndrome, such as Multiple Sclerosis or stroke) and performing a large number of specialized tests.

The first sign which hints is that the patient experiences abnormal pain after sustaining an injury to the central nervous system. However, many other conditions need to be ruled out before central pain syndrome diagnosis.

CT scan and MRI can also be used during the diagnosis process.

Central Pain Syndrome Treatment

Treating central pain syndrome is a problem. Due to the wide array of symptoms and causes, many treatments that provide relief for one patient have absolutely no value for another.

Painkillers seem like the first option, but they provide little improvement, while inevitably bringing side effects they are infamous for. Some anticonvulsants such as lamotrigine and gabapentin have been reported to provide some relief. Moreover, options such as morphine come with contraindications, rather than improvement.

The problem with these pain relieving options is that their side effects, negative interactions and habituation issues limit their scope even for the patients who do experience some relief from them.

Extradural cortical stimulation of the sensory motor area is also an option which is said to reduce pain for more than 50% of patients.

Very small number of patients reported improvements from procedures such as transcranial magnetic stimulation, transcranial direct current stimulation and spinal cord stimulation.

In recent years, many patients have turned to novel treatments, especially regarding pain management with varying levels of success. The most effective one seems to be palmitoylethanolamide (PEA), an endogenous fatty acid which is produced by the body naturally in order to reduce pain and inflammation. The way PEA helps with managing pain is by addressing cellular receptors inside the body which deal with the pain sensation and also by inhibiting iNOX and COX-2 expression and neutrophils influx. All of these things make PEA incredibly valuable for pain management, but there is another reason why PEA is a far better option than all painkillers.

It is completely safe. Unlike opioids and NSAIDs, PEA has not a single side effect in more than 400 studies. Similarly, there is no way anyone can overdose regardless of the amount taken in and there are no negative interactions reported when PEA is taken with any drugs.

This is so because PEA is naturally present in the body and it is a fatty acid which gets broken down very quickly. It is literally nature’s way of dealing with pain without any downsides and the lack of habituation makes it a long-term solution for all central pain syndrome patients who experience any benefit from it.