Central Pain Syndrome (CPS)

What is central pain syndrome?

Damage to the central nervous system (CNS) can cause a neurological disorder called central pain syndrome (CPS). The CNS includes the brain, brainstem, and spinal cord. Several other conditions can cause it like:

• a stroke
• brain trauma
• tumors
• epilepsy

People with CPS typically feel different types of pain sensations, such as:

• aching
• burning
• sharp pains
• numbness

The symptoms vary widely among individuals. It can start immediately after a trauma or other condition, or it may take months or years to develop.

No cure for CPS is available. Pain medications, antidepressants, and other types of medications can usually help provide some relief. The condition can dramatically affect quality of life.

What are the symptoms of central pain syndrome?

The main symptom of CPS is pain. The pain varies greatly among individuals. It can be any of the following:

• constant
• intermittent
• limited to a specific body part
• widespread throughout the body

People usually describe the pain as any of the following:

• burning
• aching
• prickling or tingling, which is sometimes called “pins and needles”
• stabbing
• itching that turns painful
• freezing
• shocking
• tearing

The pain is typically moderate to severe. The pain may even be described as agonizing by some people. In severe cases, people with CPS may have pain even when touched lightly by clothing, blankets, or a strong wind.

A variety of factors may make the pain worse. These factors include the following:

• touch
• stress
• anger
• other strong emotions
• movement, such as exercise
• reflexive, involuntary movements, like sneezing or yawning
• loud noises
• bright lights
• temperature changes, especially cold temperatures
• sun exposure
rainwind
• barometric pressure changes
• altitude changes

In most cases, CPS remains a lifelong condition.

What causes central pain syndrome?

CPS refers to pain that comes from the brain and not from the peripheral nerves, which are outside of the brain and spinal cord. For this reason, it differs from most other pain conditions.

Pain is usually a protective response to a harmful stimulus, such as touching a hot stove. No harmful stimulus causes the pain that occurs in CPS. Instead, an injury to the brain creates the perception of pain. This injury usually occurs in the thalamus, a structure within the brain that processes sensory signals to other parts of the brain.

The most common conditions that can lead to CPS include:

• brain hemorrhage
• a stroke
• multiple sclerosis
• brain tumors
• an aneurysm
• a spinal cord injury
• a traumatic brain injury
• epilepsy
• Parkinson’s disease
• surgical procedures that involve the brain or spine

The Central Pain Syndrome Foundation estimates that nearly 3 million people in the United States have CPS.

How is central pain syndrome diagnosed?

CPS can be difficult to diagnose. The pain may be widespread and may seem unrelated to any injury or trauma. No single test is available to enable your doctor to diagnose CPS.

Your doctor will review your symptoms, perform a physical exam, and ask about your medical history. It’s very important to inform your doctor about any conditions or injuries you have now or may have had in the past, and any medications you’re taking. CPS doesn’t develop by itself. It only occurs following an injury to the CNS.

How is central pain syndrome treated?

CPS is difficult to treat. Pain medications, such as morphine, are sometimes used but aren’t always successful.

Some people can manage their pain with antiepileptic or antidepressant medications, such as:

• amitriptyline (Elavil)
• duloxetine (Cymbalta)
• gabapentin (Neurontin)
• pregabalin (Lyrica)
• carbamazepine (Tegretol)
• topiramate (Topamax)

Additional medications that may help include:

• transdermal creams and patches
• medical marijuana
• muscle relaxants
• sedatives and sleep aids

In general, these medications will reduce the pain, but they won’t make it go away completely. Through trial and error, a patient and their doctor will eventually find a medication or a combination of medications that work best.

Neurosurgery is considered a last resort. This type of surgery involves deep brain stimulation. During this procedure, your doctor will implant an electrode called a neurostimulator in specific parts of your brain to send stimulation to the pain receptors.

What types of doctors treat central pain syndrome?

A primary care doctor will typically be the first doctor to discuss your symptoms and check your medical history and current health. Once certain conditions are ruled out, your doctor may refer you to a specialist for more testing and treatment.

Specialists who treat or help manage CPS include the following:

Neurologist

A neurologist is a doctor who specializes in disorders of the nervous system, including the brain, spinal cord, and nerves. They’re usually skilled in treating chronic pain. You may have to see several neurologists before deciding which one can help you manage your pain.

Pain specialist

A pain specialist is usually a doctor who has been trained in neurology or anesthesiology. They specialize in pain management and use various modalities to treat pain including oral medications and injections of certain medications into painful sites to relieve the pain.

Physical therapist

A physical therapist is a professional who can help you reduce pain and improve mobility.

Psychologist

CPS often affects your relationships and emotional well-being. A psychologist or therapist will discuss the emotional issues with you.

What are the complications of central pain syndrome?

CPS can be painful. It can keep you from participating in social events and greatly impact your daily life. It can lead to emotional problems and other complications including:

• stress
• anxiety
• depression
• fatigue
• sleep disturbances
• relationship problems
• anger
• a decrease in quality of life
• isolation
• suicidal thoughts

What is the outlook for people with central pain syndrome?

CPS isn’t life-threatening, but the condition causes considerable difficulty for most people. CPS can potentially disrupt your daily routine.

In severe cases, the pain can be severe and greatly impact your quality of life. Some people can manage the pain with medications, but the condition typically lasts for the rest of a person’s life.

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