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Central poststroke pain

Na Young Kim, Sang Chul Lee, Young-Sil An, Ji-Cheol Shin, Yong Wook Kim
PURPOSE: Central poststroke pain (CPSP) is one of the most refractory neuropathic pains following stroke. Injury in the spinothalamic pathway appears crucial for the development of CPSP, but changes in activity in multiple brain regions may also be related. We investigated brain metabolic changes in patients with CPSP following thalamic intracerebral hemorrhage (ICH). METHODS: Forty-three patients with thalamic ICH were examined. Overall brain metabolism was measured with F-FDG PET...
March 2018: Clinical Nuclear Medicine
Abdulbaki Halliru Bashir, Auwal Abdullahi, Muhammad Aliyu Abba, Naziru Bashir Mukhtar
BACKGROUND: Central poststroke pain (CPSP) caused by sensory dysfunction of central origin is a disabling condition that significantly affects the quality of life of stroke patients. AIM: The aim of this study is to determine the clinical profiles and pattern of CPSP among stroke patients in Kano, Nigeria. METHODS: The study was a cross-sectional design involving stroke survivors who were ≥18 years old and with no significant cognitive impairment approved by the Research Ethics Committee of Aminu Kano Teaching Hospital...
2017: Behavioural Neurology
Catriona McDaid, Debra Fayter, Alison Booth, Joanne O'Connor, Rocio Rodriguez-Lopez, Dorothy McCaughan, Roy Bowers, Cynthia P Iglesias, Simon Lalor, Rory J O'Connor, Margaret Phillips, Gita Ramdharry
OBJECTIVES: To assess the effectiveness of orthotic devices for the management of instability of the knee in adults with a neuromuscular disorder or central nervous system disorder. DESIGN: A systematic review of primary studies. SETTING: Community. PARTICIPANTS: Adults with a neuromuscular disorder or central nervous system disorder and impaired walking ability due to instability of the knee. INTERVENTIONS: Orthoses with the clinical aim of controlling knee instability, for example, knee-ankle-foot orthoses, ankle-foot orthoses and knee orthoses or mixed design with no restrictions in design or material...
September 5, 2017: BMJ Open
Jonathan Singer, Alyssa Conigliaro, Elizabeth Spina, Susan W Law, Steven R Levine
Background Physical, psychological, and/or social impairment can result after a stroke and can be exacerbated by pain. One type of pain after stroke, central poststroke pain, is believed to be due to primary central nervous system mechanisms. Estimated prevalence of central poststroke pain ranges widely from 8% to 55% of stroke patients, suggesting a difficulty in reliably, accurately, and consistently identifying central poststroke pain. This may be due to the absence of a generally accepted definition. Aim We aimed to clarify the role of thalamic strokes and damage to the spinothalamic pathway in central poststroke pain patients...
June 2017: International Journal of Stroke: Official Journal of the International Stroke Society
Jayantee Kalita, Satish Chandra, Usha Kant Misra
BACKGROUND: Comparative study of Class I drugs in central poststroke pain (CPSP) is lacking. OBJECTIVE: To evaluate the safety and efficacy of pregabalin and lamotrigine in patients with CPSP. SETTING: Tertiary care teaching referral hospital. METHODS: We included consecutive patients with CPSP having ≥50 mm score on Visual Analog Scale (VAS) and randomized them to receive either oral pregabalin or oral lamotrigine...
May 2017: Neurology India
Hsi-Chien Shih, Yung-Hui Kuan, Bai-Chung Shyu
Approximately 7% to 10% of patients develop a chronic pain syndrome after stroke. This chronic pain condition is called central poststroke pain (CPSP). Recent studies have observed an abnormal increase in the secretion of brain-derived neurotrophic factor (BDNF) in spinal cord tissue after spinal cord injury. An animal model of CPSP was established by an intrathalamus injection of collagenase. Mechanical and thermal allodynia was induced after lesions of the thalamic ventral basal complex in rats. Four weeks after the injection, the number of neurons decreased, the number of astrocytes, microglia, and P2X4 receptors increased, and BDNF mRNA expression increased in the brain lesion area...
July 2017: Pain
Xiaolei Zhang, Yongsheng Hu, Wei Tao, Hongwei Zhu, Dongsheng Xiao, Yongjie Li
OBJECTIVE: To investigate the effect of motor cortex stimulation (MCS) on central poststroke pain (CPSP) and the outcome predictors associated with medium- to long-term results. MATERIALS AND METHODS: This is a retrospective review of 16 CPSP patients treated with MCS with a mean follow-up of 28.2 months. The pain intensity was assessed based on the visual analogue scale (VAS) before surgery and at various follow-up visits. An effective outcome was determined to be at least 40% pain relief...
January 19, 2017: Neuromodulation: Journal of the International Neuromodulation Society
Philippe De Vloo, Bart Morlion, Johannes van Loon, Bart Nuttin
Central poststroke pain (CPSP) is a severe type of neuropathic pain that can develop after stroke and is difficult to treat. Research into its underlying mechanisms and treatment options could benefit from a valid CPSP animal model. Nine different CPSP animal models have been published, but there are relatively few reports on successful reproductions of these models and so far only little advances in the understanding or the management of CPSP have been made relying on these models. In general, the construct validity (similarity in underlying mechanisms) of these CPSP animal models is relatively high, although this cannot be evaluated into depth because of lack of understanding the mechanisms through which thalamic stroke can lead to CPSP...
January 2017: Pain
Gui-Hua Tian, Shan-Shan Tao, Man-Tang Chen, Yu-Sang Li, You-Ping Li, Hong-Cai Shang, Xiao-Yi Tang, Jian-Xin Chen, He-Bin Tang
Electroacupuncture (EA) is reported to effectively relieve the central poststroke pain (CPSP). However, the underlying mechanism remains unclear. The present study investigated the detailed mechanisms of action of EA treatment at different frequencies for CPSP. A CPSP model was established with a single collagenase injection to the left ventral posterolateral nucleus of the thalamus. The EA-treated groups then received EA treatment at frequency of 2, 2/15, or 15 Hz for 30 min daily for five days. The pain-related behavioral responses, neuronal apoptosis, glial activation, and the expression of pain signal transmission-related factors ( β -catenin, COX-2, and NK-1R) were assessed using behavioral tests, Nissl staining, TUNEL staining, and immunohistochemical staining, respectively...
2016: Neural Plasticity
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...
October 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
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