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Central poststroke pain

Ajit Kumar, Sanjeev K Bhoi, Jayantee Kalita, Usha K Misra
OBJECTIVE: In view of the paucity of studies on central poststroke pain (CPSP), in this hospital-based prospective study, we evaluated the frequency, the spectrum, imaging, and quantitative sensory testing in a cohort of stroke patients with CPSP. METHODS: Stroke patients who developed CPSP at onset or during follow-up were included. Patients were subjected to clinical evaluation and sensory testing. The severity of stroke was defined by the Modified Rankin Scale and disability by the Barthel Index...
November 2016: Clinical Journal of Pain
Gulseren Akyuz, Pinar Kuru
Central poststroke pain (CPSP) is one of the most common central neuropathic pain syndromes seen after stroke. It is mainly related with vascular damage at certain brain territory and pain related to corresponding body areas. In the past, it was described as one of the definitive symptoms of thalamic lesion. However, recent findings suggest that it is not only seen after thalamic lesions but also seen after vascular lesions in any part of the central nervous system. Although there are certain hypotheses to explain physiopathologic mechanisms of CPSP, further evidence is needed...
August 2016: American Journal of Physical Medicine & Rehabilitation
Wataru Matsuura, Erika Kageyama, Shinichi Harada, Shogo Tokuyama
Central poststroke pain is associated with specific somatosensory abnormalities, such as neuropathic pain syndrome. Although central poststroke pain is a serious condition, details pertaining to underlying mechanisms are not well established, making current standard treatments only partially effective. Here, we assessed the effects of tramadol, an analgesic drug mediated by opioid receptors, using a mouse model of global cerebral ischemia. Ischemia was induced by bilateral carotid artery occlusion (30 min) in male ddY mice...
June 15, 2016: Neuroreport
Takamitsu Yamamoto, Mitsuru Watanabe, Toshiki Obuchi, Toshikazu Kano, Kazutaka Kobayashi, Hideki Oshima, Chikashi Fukaya, Atsuo Yoshino
OBJECTIVES: Spinal cord stimulation (SCS) is not typically recommended for the treatment of central poststroke pain (CPSP). We examined whether the pharmacological evaluation of CPSP is useful for selecting the candidates for SCS. MATERIALS AND METHODS: Changes in visual analog scale (VAS) scores for pain following pharmacological evaluation using morphine, thiopental, and ketamine were compared with those following SCS in 22 CPSP patients. RESULTS: Twelve of the 22 (54...
March 15, 2016: Neuromodulation: Journal of the International Neuromodulation Society
Şule Şahin-Onat, Sibel Ünsal-Delialioğlu, Fazıl Kulaklı, Sumru Özel
[Purpose] The aim of this study was to assess the effects of central poststroke pain on quality of life, functionality, and depression in stroke. [Subjects and Methods] Twenty-four patients with stroke having central poststroke pain (a mean age of 60.6±8.5 years; 14 males, 10 females; Group I) and 24 similar age-and gender-matched patients with stroke without central poststroke pain (Group II) were enrolled. Characteristics of pain were recorded in patients with stroke having central poststroke pain. The Visual Analogue Scale and Leeds Assessment of Neuropathic Symptoms and Signs pain scale were used to evaluate pain...
January 2016: Journal of Physical Therapy Science
James C Watson, Paola Sandroni
Chronic pain is common in patients with neurologic complications of a central nervous system insult such as stroke. The pain is most commonly musculoskeletal or related to obligatory overuse of neurologically unaffected limbs. However, neuropathic pain can result directly from the central nervous system injury. Impaired sensory discrimination can make it challenging to differentiate central neuropathic pain from other pain types or spasticity. Central neuropathic pain may also begin months to years after the injury, further obscuring recognition of its association with a past neurologic injury...
March 2016: Mayo Clinic Proceedings
D Feierabend, S Frank, R Kalff, R Reichart
BACKGROUND: Spinal cord stimulation (SCS) is an established procedure for treatment of chronic neuropathic pain of peripheral origin. The efficacy of SCS in case of central poststroke pain (CPSP), especially thalamic pain, has not been adequately proven. OBJECTIVES: The efficacy of SCS as an extracranial neurostimulation method for the management of central pain syndrome was investigated. MATERIALS AND METHODS: In this study, relevant pharmacological and nonpharmacological measures for central pain management were reviewed...
April 2016: Der Schmerz
Sohail M Mulla, Li Wang, Rabia Khokhar, Zain Izhar, Arnav Agarwal, Rachel Couban, D Norman Buckley, Dwight E Moulin, Akbar Panju, Sun Makosso-Kallyth, Alparslan Turan, Victor M Montori, Daniel I Sessler, Lehana Thabane, Gordon H Guyatt, Jason W Busse
BACKGROUND AND PURPOSE: Central poststroke pain is a chronic neuropathic disorder that follows a stroke. Current research on its management is limited, and no review has evaluated all therapies for central poststroke pain. METHODS: We conducted a systematic review of randomized controlled trials to evaluate therapies for central poststroke pain. We identified eligible trials, in any language, by systematic searches of AMED, CENTRAL, CINAHL, DARE, EMBASE, HealthSTAR, MEDLINE, and PsychINFO...
October 2015: Stroke; a Journal of Cerebral Circulation
Masahito Kobayashi, Takamitsu Fujimaki, Ban Mihara, Takayuki Ohira
OBJECTIVE: Central poststroke pain is a serious problem for some patients after stroke. Repetitive transcranial magnetic stimulation (rTMS) has been reported to relieve poststroke pain but its efficacy is still controversial. We tested the possibility that rTMS, when applied once a week, would induce sustainable relief of poststroke pain. MATERIALS AND METHODS: Eighteen patients with central poststroke pain were included in this study. rTMS (10 trains of 10-sec 5 Hz-rTMS) was delivered over the primary motor cortex on the affected side...
June 2015: Neuromodulation: Journal of the International Neuromodulation Society
Koichi Hosomi, Ben Seymour, Youichi Saitoh
Central poststroke pain (CPSP) is one of the most under-recognized consequences of stroke, occurring in up to 10% of patients, and is also one of the most difficult to treat. The condition characteristically develops after selective lesions to the spinothalamic system, most often to the ventral posterior thalamus. Here, we suggest that CPSP is best characterized as a disorder of brain network reorganization, and that this characterization offers insight into the inadequacy of most current pharmacological treatments...
May 2015: Nature Reviews. Neurology
Sang-Hyuk Im, Sang-Woo Ha, Deok-Ryeong Kim, Byung-Chul Son
BACKGROUND/OBJECTIVES: Although motor cortex stimulation (MCS) has been used for more than 20 years in the treatment of chronic neuropathic pain, there is still a debate about the efficacy of MCS. METHODS: To investigate the long-term results and the factors associated with the long-term success of chronic MCS, 21 patients who underwent MCS trial were classified as having central poststroke pain, central pain after spinal cord injury (SCI) and peripheral neuropathic pain, and we investigated the clinical factors associated with long-term success and degree of pain relief...
2015: Stereotactic and Functional Neurosurgery
Takashi Morishita, Kelly D Foote, Derek B Archer, Stephen A Coombes, David E Vaillancourt, Anhar Hassan, Ihtsham U Haq, Janine Wolf, Michael S Okun
Poststroke central pain (PSCP) can be a debilitating medication-refractory disorder. We report a single case where right unilateral ventral capsule/ventral striatum (VC/VS) deep brain stimulation was used to treat PSCP and inadvertently induced a smile without euphoria. The patient was a 69 year-old woman who had a stroke with resultant dysesthesia and allodynia in her left hemibody and also a painful left hemibody dystonia. In her case, VC/VS stimulation induced a smile phenomenon, but without a euphoric sensation...
2015: Neurocase
Henriette Klit, Anne P Hansen, Ninna S Marcussen, Nanna B Finnerup, Troels S Jensen
Central poststroke pain (CPSP) is a central neuropathic pain condition caused by a cerebrovascular lesion affecting the central somatosensory nervous system. Once developed, CPSP is difficult to treat, so there is an interest in identifying stroke patients at risk for the development of CPSP. This study examined if sensory abnormalities, including evoked dysesthesia, allodynia, or hyperalgesia to static and dynamic touch, cold, and pinprick, at stroke onset are a predictor for the development of CPSP. Consecutive stroke patients were recruited from a large prospective study of poststroke pain in Aarhus, Denmark, between 2007 and 2008...
December 2014: Pain
Rogério Adas Ayres de Oliveira, Daniel Ciampi de Andrade, Melina Mendonça, Rafael Barros, Tatiana Luvisoto, Martin Luiz Myczkowski, Marco Antonio Marcolin, Manoel Jacobsen Teixeira
UNLABELLED: Central poststroke pain (CPSP) is caused by an encephalic vascular lesion of the somatosensory pathways and is commonly refractory to current pharmacologic treatments. Repetitive transcranial magnetic stimulation (rTMS) of the premotor cortex/dorsolateral prefrontal cortex (PMC/DLPFC) can change thermal pain threshold toward analgesia in healthy subjects and has analgesic effects in acute postoperative pain as well as in fibromyalgia patients. However, its effect on neuropathic pain and in CPSP, in particular, has not been assessed...
December 2014: Journal of Pain: Official Journal of the American Pain Society
T Krause, S Asseyer, B Taskin, A Flöel, A V Witte, K Mueller, J B Fiebach, K Villringer, A Villringer, G J Jungehulsing
It has been proposed that cortical structural plasticity plays a crucial role in the emergence and maintenance of chronic pain. Various distinct pain syndromes have accordingly been linked to specific patterns of decreases in regional gray matter volume (GMV). However, it is not known whether central poststroke pain (CPSP) is also associated with cortical structural plasticity. To determine this, we employed T1-weighted magnetic resonance imaging at 3 T and voxel-based morphometry in 45 patients suffering from chronic subcortical sensory stroke with (n = 23) and without CPSP (n = 22), and healthy matched controls (n = 31)...
January 2016: Cerebral Cortex
Hanna Harno, Elena Haapaniemi, Jukka Putaala, Maija Haanpää, Jyrki P Mäkelä, Eija Kalso, Turgut Tatlisumak
OBJECTIVE: We describe the frequency, duration, clinical characteristics, and radiologic correlates of central poststroke pain (CPSP) in young ischemic stroke survivors in a prospective study setting. METHODS: A questionnaire of pain and sensory abnormalities and EQ-5D quality-of-life questionnaire were sent to all 824 surviving and eligible patients of the Helsinki Young Stroke Registry. Patients (n = 58) with suspected CPSP were invited to a clinical visit and filled in the PainDETECT, Brief Pain Inventory, and Beck Depression Inventory questionnaires...
September 23, 2014: Neurology
Mohammad Hasan, Jennifer Whiteley, Rebecca Bresnahan, Kate MacIver, Paul Sacco, Kumar Das, Turo Nurmikko
OBJECTIVE: To quantify changes in pain and somatosensory function in patients with central poststroke pain (CPSP) syndrome following five sessions of repetitive transcranial magnetic stimulation (rTMS). METHODS: Fourteen CPSP patients underwent MRI-guided TMS mapping to identify the motor hotspot for evoked responses from a muscle corresponding to a painful region (hand, N = 11, or distal leg, N = 3). Targeted rTMS consisting of 2000 stimuli/10 Hz each session was delivered over five sessions...
December 2014: Neuromodulation: Journal of the International Neuromodulation Society
S J Snedecor, L Sudharshan, J C Cappelleri, A Sadosky, P Desai, Y Jalundhwala, M Botteman
OBJECTIVE: To estimate the relative efficacy of pharmacological therapies for the treatment of postherpetic neuralgia (PHN), multiple sclerosis (MS)-related pain, posttraumatic pain, central poststroke pain (CPSP) and human immunodeficiency virus (HIV)-related neuropathic pain (NeP). METHODS: This systematic review (through June 2011) identified randomised, controlled trials of treatments for these conditions. Bayesian mixed treatment comparison (MTC) methods were used to determine the relative efficacy and safety among the treatments within each pain condition...
July 2014: International Journal of Clinical Practice
Paras Karmacharya, Kalpana Shah, Ranjan Pathak, Sushil Ghimire, Richard Alweis
Central Poststroke Pain syndrome (CPSP) can occur due to disruption of the somatosensory pathways of the brain at any level such as the thalamus, medulla, or cerebral cortex. It is characterized by sensory abnormalities and hyperesthesia in the part of the body correlating to the central lesion. The treatment of this pain syndrome is often difficult, and it does not usually respond to traditional analgesics. The first line of treatment is drugs aimed at lowering neuronal hyperexcitability, for example, amitriptyline or lamotrigine, with gabapentin considered a second line...
2014: Journal of Community Hospital Internal Medicine Perspectives
Roy Freeman, Ralf Baron, Didier Bouhassira, Javier Cabrera, Birol Emir
This manuscript aimed to characterize the clinical profile of various neuropathic pain (NeP) disorders and to identify whether patterns of sensory symptoms/signs exist, based on baseline responses on the Neuropathic Pain Symptom Inventory (NPSI) questionnaire and the quantitative sensory testing (QST). These post hoc analyses were based on data from 4 randomized, double-blind, placebo-controlled clinical studies of pregabalin (150-600mg/day) in patients with NeP syndromes: central poststroke pain, posttraumatic peripheral pain, painful HIV neuropathy, and painful diabetic peripheral neuropathy...
February 2014: Pain
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