What Is Thalamic Pain Syndrome/Central Post-Stroke Pain?
When it comes to identifying types of pain, there are two types: acute and chronic. Acute pain comes on quickly, can be severe but only lasts a relatively short time. It is typically experienced after an injury or trauma, and self-resolves.
Unlike acute pain, chronic pain is pain that lasts for a long time, and doesn’t seem to get better or go away. This time period can vary but is typically defined as a three- to six-month period after symptoms begin. Chronic pain is often a debilitating symptom of many diseases and is considered a disease itself when it persists beyond recovery from an injury or illness. Chronic pain is a frequent component of many neurological disorders.
Pain warns you that something is not quite right in your body and can cause you to take certain actions and avoid others. Pain can significantly affect your quality of life—by adversely affecting your physical and emotional well-being; upsetting relationships with family, coworkers and friends; and limiting your mobility and participation in daily activities.
Hundreds of pain syndromes or disorders make up the spectrum of pain. One cause of pain is Thalamic pain syndrome (TPS). TPS, or central post-stroke pain, can occur when there are disruptions of one of the pathways of the brain that affect the sensation of temperature. There can be burning or tingling pain or significant discomfort with temperature changes is a concern for thalamic pain syndrome following a stroke.
Types of Thalamic Pain Syndrome/Central Post-Stroke Pain
Thalamic pain syndrome, also known as central post-stroke pain (CPSP), is a type of centralized pain. In centralized pain, the origin of the area of pain is stemming from the central nervous system. Central sensitization of pain occurs when the patient’s nervous system is persistently in a state of high activity.
CPSP is a central neuropathic disorder characterized by constant or intermittent pain. It is associated with sensory abnormalities, particularly thermal sensation.
Causes of Thalamic Pain Syndrome/Central Post-Stroke Pain
Thalamic pain syndrome (also known as central post-stroke pain) occurs when there are disruptions of one of the pathways of the brain that affects the sensation of temperature. Thalamic pain syndrome can occur both following an ischemic (blockage cuts off the blood supply to part of your brain) or hemorrhagic (when a weakened blood vessel ruptures) stroke. The pain experienced in thalamic strokes is neuropathic, and any injury to the thalamus can cause contralateral pain. The pain associated with thalamic pain syndrome can occur acutely following a stroke but also can occur in either the subacute period (pain that is present for less than three months) or years after the initial injury.
Risk Factors for Thalamic Pain Syndrome/Central Post-Stroke Pain
Risk of developing thalamic pain syndrome (also known as central post-stroke pain) is determined by the location of the lesion and looking into the functionality of the spinothalamic system (the sensory tract that carries messages of temperature to the thalamus). It tends to occur most often in older individuals who are at risk of having a stroke (or who have already suffered a brain stroke).
Additional risk factors include:
- Blood clotting disorders
- Irregular heart rhythm
- High blood pressure
- High cholesterol
Screening for & Preventing Thalamic Pain Syndrome/Central Post-Stroke Pain
Physicians will eliminate other possible causes of the pain using imaging scans such as computed tomography (CT), magnetic resonance imaging (MRI) and angiogram scans of the brain, as well as a complete neurological evaluation. Individuals who are at high risk of stroke (those with high blood pressure and high cholesterol) can minimize risk of stroke and the possible subsequent thalamic syndrome diagnosis by managing their health conditions.
Signs & Symptoms of Thalamic Pain Syndrome/Central Post-Stroke Pain
Symptoms of thalamic syndrome may include one or more of the following indications:
- Continuous and extreme limb pain
- Exaggerated response to otherwise manageable pain (for instance a pin prick)
- Weakness in the limbs
- Paralysis
- Abnormal and involuntary limb movement
- Reduced ability to position a limb with eyes closed
Diagnosing Thalamic Pain Syndrome/Central Post-Stroke Pain
Your physician will first eliminate other potential causes of pain by using imaging tests such as computed tomography (CT), magnetic resonance imaging (MRI) and angiogram scans of the brain), as well as a thorough neurological evaluation.
Treating Thalamic Pain Syndrome/Central Post-Stroke Pain
Primary treatment of thalamic pain syndrome is focused on pain management. Medication (including opioids, antidepressants, selective serotonin reuptake inhibitors and anticonvulsants) is likely required for the remainder of the patient’s life. Other treatment may include:
- Topical anesthetic patches
- Stimulating the thalamus and spinal cord using stimulation treatment
- Physical therapy
Living with Thalamic Pain Syndrome/Central Post-Stroke Pain
Depending on the severity of the pain and the extent of the brain stroke, thalamic pain syndrome may last for the duration of the patient’s life. Due to high risk of addiction, prescriptions of opioids for pain management should be closely monitored and replaced with other management solutions as soon as possible.