• Central Pain Syndrome


    What is it?

    Central Pain Syndrome (CPS) refers to pain that originates in the brain and not in the nerves, which lie outside of the brain.  Pain is ordinarily a protective sensation that causes a person to move away from its cause, such as withdrawing one's hand from a fire. 


    In the case of CPS, a source of the pain does not exist.  Instead, the sensory pathways within the brain have been damaged by the stroke.  This stimulates central nerve fibers, which creates a perception of pain.


    CPS is a burning, aching, or cutting sensation with a mixture of pain sensations, the most prominent being intense sunburn.  Intermixed with this pain are sensations of cold, "pins and needles" tingling, and nerve proximity.


    CPS includes several painful conditions such as pain to one side of the face, shoulder, lower back, arm, hand, leg and foot.  Pain may be moderate to severe in intensity and is often exacerbated by movement and temperature changes, usually cold temperatures.


    Spasticity and joint stiffness can contribute to the pain, as limbs contract and expand during movement. 

    Also, pain sensations are increased significantly by any light touch.


    Clinical Names

    Central Pain Syndrome has existed for many years.  This is a list of other names Central Pain Syndrome is known by:

    • Central Post-Stroke Pain
    • Central Post-Stroke Syndrome
    • Dejerine-Roussy Syndrome
    • Thalamic Pain Syndrome
    • Thalamic Syndrome



    Central pain syndrome is a neurological condition caused by a dysfunction that specifically affects the central nervous system (CNS), which includes the brain, brainstem, and spinal cord. 

    The disorder can occur in people who have experienced:

    • Stroke
    • Multiple Sclerosis
    • Parkinson's Disease
    • Brain Tumors
    • Limb Amputations
    • Brain Injuries
    • Spinal Cord Injuries


    It may develop months or years after injury or damage to the CNS.



    Most doctors do not know what Central Pain Syndrome (CPS) is let alone know how to manage your pain.  At the same time, you may not know yourself that your pain is actually CPS.

    It may take years, and lots of luck, for you to finally know that you have CPS.  Then, the hunt to find a knowledgeable doctor who understands CPS begins. 

    Begin the hunt by searching for a qualified pain management doctor to treat you. Most large hospitals have a Pain Management Clinic.  Explain your pain and make sure their doctors are familiar with treating CPS. 


    Central pain syndrome is not a fatal disorder, but the syndrome causes disabling chronic pain and suffering among the majority of individuals who have it. Unfortunately, there is no cure for CPS.  However, there are a variety of ways that your pain can be managed.  Treatment of central pain syndrome is difficult and often only partially successful.



    Some oral antidepressants and anticonvulsants can be useful in treating mild central pain syndrome.  Older antidepressant drugs such as amitriptyline (Elavil) appear to reduce the pain, but they have side effects of sleepiness, dry mouth, and dizziness.  A newer antidepressant drug called duloxetine (Cymbalta) is also used for central pain syndrome; this drug has less of these undesirable side effects than amitriptyline.

    Antiepileptic drugs (AEDs) appear to affect the transmission of the sensory nerves that result in central pain. The most commonly used AEDs for central pain syndrome are gabapentin (Neurontin) and pregabalin (Lyrica).  Other AEDs sometimes used in treatment of pain include carbamazepine (Tegretol) and topiramate (Topamax).


    With time, pain may increase in intensity.  As pain eventually becomes worse, treatment may progress through increasingly strong analgesics and possibly up to narcotics.  Narcotics are the best drugs for pain because they bind specifically to pain receptors.  Narcotic analgesics like morphine, methadone and heroin are very effective. In cases where spasticity and stiffness are a contributor to pain, oral Baclofen may be prescribed.  High dosages of oral Baclofen may cause serious side-effects.  An implanted Interthecal Baclofen (ITB) Pump, which has virtually no side-effects, may become necessary. 

    With an implanted pump, small amounts of the drug are delivered from the pump flowing to the fluid around the spinal cord.  Thus, only tiny amounts of drugs are affecting the central nervous system.