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Central pain states: Etiology and management in rehabilitation

Lookup NU author(s): Dr Stephen Tyrer


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Central pain occurs when the central nervous system is damaged and results from either brain or spinal cord injury. Damage to the spinothalamic tracts and associated pathways is necessary to lead to central pain but is not sufficient to cause this condition. The symptoms and quality of pain perceived in conditions giving rise to central pain differ considerably from pain arising from non-neural tissue damage. The hyperalgesia that occurs in central pain states results from alterations in NMDA receptor activity associated with the influx of calcium into neurons. Differentiation needs to be made between pain arising from musculoskeletal strains and from spasticity before treating central painful conditions. The treatment ladder includes tricyclic antidepressants and anticonvulsants as first-line treatments; NMDA antagonists, such as ketamine; followed by motor cortex stimulation or stereotactic neurosurgical techniques, if drugs are unsuccessful. The opioid drugs are much less effective in central pain conditions in which there is reduced opioid-receptor availability. © 2005 by Begell House, Inc.

Publication metadata

Author(s): Tyrer S, Davis E

Publication type: Article

Publication status: Published

Journal: Critical Reviews in Physical and Rehabilitation Medicine

Year: 2005

Volume: 17

Issue: 2

Pages: 131-162

Print publication date: 01/01/2005

ISSN (print): 0896-2960

ISSN (electronic):

Publisher: Begell House


DOI: 10.1615/CritRevPhysRehabilMed.v17.i2.30


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