Central neuropathic pain

Nat Rev Dis Primers, 2023 · DOI: 10.1038/s41572-023-00484-9 · Published: August 17, 2023

Simple Explanation

Central neuropathic pain (CNP) is caused by damage to the central somatosensory nervous system, affecting the way the brain and spinal cord process sensory information. This can result from conditions like brain injury, spinal cord injury, stroke, or multiple sclerosis. People with CNP may experience ongoing pain, pain that comes and goes, or pain triggered by things that shouldn't normally cause pain, like a light touch. This pain is often felt in areas where sensation is already altered. Treatments for CNP include medications like antidepressants and gabapentinoids, as well as non-drug options such as exercise and strategies for managing the condition. Researchers are working to better understand CNP and find more effective ways to diagnose and treat it.

Study Duration

Not specified

Participants

Individuals with brain injury, spinal cord injury, stroke, multiple sclerosis or related neuroinflammatory conditions

Evidence Level

Not specified

Key Findings

1
Central post-stroke pain (CPSP) is the most prevalent form of central neuropathic pain worldwide, given the high number of new stroke cases each year.
2
In individuals with spinal cord injury (SCI), neuropathic pain, which is often CNP, has a high prevalence.
3
Initial hypersensitivity to mechanical and thermal stimulation is a well-established predictor of future CNP.

Research Summary

Central neuropathic pain (CNP) arises from lesions or diseases affecting the central somatosensory nervous system, with conditions like spinal cord injury and stroke being common causes. The underlying mechanisms are complex and involve maladaptive changes in spinal and brain circuits. Current treatments include pharmacological options like antidepressants and gabapentinoids, as well as non-pharmacological approaches such as exercise and neuromodulation. Diagnosis relies on clinical examination and advanced techniques like neuroimaging. Future research aims to improve understanding of CNP mechanisms and identify predictive biomarkers to enhance treatment outcomes. This includes exploring genetic risk factors and refining diagnostic and treatment strategies.

Practical Implications

Improved Diagnostic Approaches

Better identification and classification of CNP through comprehensive pain histories, clinical examinations, and advanced neurophysiological and neuroimaging techniques.

Development of Targeted Therapies

Modulation of neuronal activity, neuron–glia interactions, and neuro-immune interactions, as well as targeting pain-related alterations in brain connectivity, offer potential therapeutic approaches.

Personalized Treatment Strategies

Tailoring interventions based on individual clinical pain phenotypes and putative pain mechanisms, including genetic variations, to improve treatment outcomes and minimize adverse effects.

Study Limitations

1
The global prevalence of CNP is unknown due to the lack of specific data in the Global Burden of Disease study.
2
Risk factors associated with CNP are poorly understood, with no studies investigating genetic risk factors.
3
The exact sequences involved in the development and maintenance of CNP are incompletely understood.

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