Skip to main content
NCBI home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1995 Oct;71(840):598–604. doi: 10.1136/pgmj.71.840.598

The management of central post-stroke pain.

D Bowsher 1
PMCID: PMC2398253  PMID: 8545288

Abstract

Central post-stroke pain (CPSP) used to be known as 'thalamic syndrome'. Early post-mortem studies showed that many cases had extrathalamic lesions, and modern imaging methods have confirmed and extended these findings. CPSP affects between 2 and 6% of stroke patients, ie, there is an annual incidence in the UK of between 2000 and 6000. Most patients with CPSP appear to be younger than the general stroke population, and usually to have relatively mild motor affliction; thus they may live for many years, giving a prevalence perhaps as high as 20,000. True CPSP, characterised by a partial or total deficit for thermal and/or sharpness sensations, is best treated initially with adrenergically active antidepressants. If these do not work, mexiletine may be added in suitable cases. Recent studies suggest that stimulation of the motor cortex or spinal cord by implanted electrodes may help patients resistant to medical treatment. Positive relaxation, as an adjuvant therapy, should be used in nearly all cases. Considerable or even total relief can be achieved in almost two thirds of patients. There is evidence that the sooner antidepressant treatment is begun, the more likely the patient is to respond; time should not be wasted trying conventional analgesics, which rarely have any significant effect.

Full text

PDF
598

Images in this article

598Figure 1
on p.598
598Figure 2
on p.598
601Figure 3
on p.601
604p604-a
on p.604

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ardid D., Guilbaud G. Antinociceptive effects of acute and 'chronic' injections of tricyclic antidepressant drugs in a new model of mononeuropathy in rats. Pain. 1992 May;49(2):279–287. doi: 10.1016/0304-3959(92)90152-2. [DOI] [PubMed] [Google Scholar]
  2. Awerbuch G. I., Sandyk R. Mexiletine for thalamic pain syndrome. Int J Neurosci. 1990 Dec;55(2-4):129–133. doi: 10.3109/00207459008985960. [DOI] [PubMed] [Google Scholar]
  3. BOWSHER D. Termination of the central pain pathway in man: the conscious appreciation of pain. Brain. 1957 Dec;80(4):606–622. doi: 10.1093/brain/80.4.606. [DOI] [PubMed] [Google Scholar]
  4. Bainton T., Fox M., Bowsher D., Wells C. A double-blind trial of naloxone in central post-stroke pain. Pain. 1992 Feb;48(2):159–162. doi: 10.1016/0304-3959(92)90052-D. [DOI] [PubMed] [Google Scholar]
  5. Bond M. R., Pilowsky I. Subjective assessment of pain and its relationship to the administration of analgesics in patients with advanced cancer. J Psychosom Res. 1966 Sep;10(2):203–208. doi: 10.1016/0022-3999(66)90064-x. [DOI] [PubMed] [Google Scholar]
  6. Bowsher D. R., Foy P. M., Shaw M. D. Central pain complicating infarction following subarachnoid haemorrhage. Br J Neurosurg. 1989;3(4):435–441. doi: 10.3109/02688698909002829. [DOI] [PubMed] [Google Scholar]
  7. Bowsher D. Neurogenic pain syndromes and their management. Br Med Bull. 1991 Jul;47(3):644–666. doi: 10.1093/oxfordjournals.bmb.a072498. [DOI] [PubMed] [Google Scholar]
  8. Bowsher D. Sensory consequences of stroke. Lancet. 1993 Jan 16;341(8838):156–156. doi: 10.1016/0140-6736(93)90015-9. [DOI] [PubMed] [Google Scholar]
  9. Chapman C. E., Bushnell M. C., Miron D., Duncan G. H., Lund J. P. Sensory perception during movement in man. Exp Brain Res. 1987;68(3):516–524. doi: 10.1007/BF00249795. [DOI] [PubMed] [Google Scholar]
  10. Jones A. K., Brown W. D., Friston K. J., Qi L. Y., Frackowiak R. S. Cortical and subcortical localization of response to pain in man using positron emission tomography. Proc Biol Sci. 1991 Apr 22;244(1309):39–44. doi: 10.1098/rspb.1991.0048. [DOI] [PubMed] [Google Scholar]
  11. Koppel B. S. Amitriptyline in the treatment of thalamic pain. South Med J. 1986 Jun;79(6):759–761. doi: 10.1097/00007611-198606000-00028. [DOI] [PubMed] [Google Scholar]
  12. Lahuerta J., Bowsher D., Lipton S., Buxton P. H. Percutaneous cervical cordotomy: a review of 181 operations on 146 patients with a study on the location of "pain fibers" in the C-2 spinal cord segment of 29 cases. J Neurosurg. 1994 Jun;80(6):975–985. doi: 10.3171/jns.1994.80.6.0975. [DOI] [PubMed] [Google Scholar]
  13. Leijon G., Boivie J. Central post-stroke pain--a controlled trial of amitriptyline and carbamazepine. Pain. 1989 Jan;36(1):27–36. doi: 10.1016/0304-3959(89)90108-5. [DOI] [PubMed] [Google Scholar]
  14. Loh L., Nathan P. W., Schott G. D. Pain due to lesions of central nervous system removed by sympathetic block. Br Med J (Clin Res Ed) 1981 Mar 28;282(6269):1026–1028. doi: 10.1136/bmj.282.6269.1026. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Max M. B., Schafer S. C., Culnane M., Smoller B., Dubner R., Gracely R. H. Amitriptyline, but not lorazepam, relieves postherpetic neuralgia. Neurology. 1988 Sep;38(9):1427–1432. doi: 10.1212/wnl.38.9.1427. [DOI] [PubMed] [Google Scholar]
  16. Milne R. J., Aniss A. M., Kay N. E., Gandevia S. C. Reduction in perceived intensity of cutaneous stimuli during movement: a quantitative study. Exp Brain Res. 1988;70(3):569–576. doi: 10.1007/BF00247604. [DOI] [PubMed] [Google Scholar]
  17. Nurmikko T., Wells C., Bowsher D. Pain and allodynia in postherpetic neuralgia: role of somatic and sympathetic nervous systems. Acta Neurol Scand. 1991 Aug;84(2):146–152. doi: 10.1111/j.1600-0404.1991.tb04923.x. [DOI] [PubMed] [Google Scholar]
  18. Todd A. J., McKenzie J. GABA-immunoreactive neurons in the dorsal horn of the rat spinal cord. Neuroscience. 1989;31(3):799–806. doi: 10.1016/0306-4522(89)90442-9. [DOI] [PubMed] [Google Scholar]
  19. Tsubokawa T., Katayama Y., Yamamoto T., Hirayama T., Koyama S. Chronic motor cortex stimulation in patients with thalamic pain. J Neurosurg. 1993 Mar;78(3):393–401. doi: 10.3171/jns.1993.78.3.0393. [DOI] [PubMed] [Google Scholar]
  20. Watson C. P., Evans R. J., Reed K., Merskey H., Goldsmith L., Warsh J. Amitriptyline versus placebo in postherpetic neuralgia. Neurology. 1982 Jun;32(6):671–673. doi: 10.1212/wnl.32.6.671. [DOI] [PubMed] [Google Scholar]
  21. Wiesenfeld-Hallin Z., Lindblom U. The effect of systemic tocainide, lidocaine and bupivacaine on nociception in the rat. Pain. 1985 Dec;23(4):357–360. doi: 10.1016/0304-3959(85)90005-3. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES