Definition

Central neuropathic pain refers to pain originating from damage, malfunction, or changes in one or more nerves. Pain occurs when the nervous system is damaged or not functioning properly due to disease in the brain, brainstem, or spinal nerves. Damage to the nerves can cause the incorrect signal transmission to the pain center. The function of these nerves can also change in the injured area, including in the central nervous system.

Neuropathic pain affects about 7-10 per cent of the general population. The pain experienced can arise from various conditions depending on the affected nerve. Patients typically report sharp, burning, or needle-like pain sensations. In some cases, this pain persists constantly. Patients may also feel pain months or even years after the injury, which can complicate disease diagnosis.

 Read More: Neuropathy - Definition, Causes and Risk Factors.

Causes

The nervous system is divided into the central nervous system (the brain and spinal cord) and the peripheral nerves. As the name suggests, central neuropathic pain results from any injury and damage to the central nervous system, namely the brain and spinal nerves.

Some conditions that can cause central neuropathic pain include:

• Infection of the brain (encephalitis) or spinal cord (myelitis)
• Trauma or injury to the brain or spinal cord
• Tumors and cancers in the central nervous system
• Increased blood pressure in the brain
• Stroke resulting from reduced blood flow to the brain or brain blood vessel leakage
• Syringomyelia, the formation of fluid-filled sacs in the spinal cord

This damage can also occur after a stroke or injury to the brain or spinal nerves. Central neuropathic pain may also accompany conditions such as Parkinson's disease or multiple sclerosis (an autoimmune disease where the body's immune cells attack healthy nerve sheaths).

Read more: Stroke - Definition, Causes and Risk Factors.

Risk factor

Patients experiencing prolonged pain are at risk of developing central pain syndrome. Chronic neuropathic pain is more commonly felt by women than men. Below are some factors that can increase the risk of central neuropathic pain:

• Injury, such as a blow or wound to the brain
• Central nervous system infections
• Chronic stress
• Overweight or obesity
• Depression
• Autoimmune diseases attacking nerve cells
• Family history of central neuropathic pain

Symptoms

Diagnosis

The doctor will start by asking about the complaints that brought you to the consultation. Describe your complaints in detail and how they affect your quality of life. The doctor may also ask about your previous medical history, family medical history, treatment history, and daily activities.

The doctor will then perform a physical and neurological examination to check for abnormalities in nerve function. Reflexes and muscle strength, sensory abilities, and body posture and coordination will be assessed.

Since central neuropathic pain results from disorders in the brain or spinal cord, additional tests will be conducted to confirm the diagnosis. Some of these tests include:

• Blood tests to check for body disorders, such as possible infections, anemia, inflammation, or other immune function abnormalities
• Radiological examinations like CT scans or MRIs to assess the condition of the central nervous system if there is damage
• Electromyography (EMG) to evaluate nerve and muscle function
• Nerve conduction velocity tests to measure the speed of signal transmission in the nerves
• Cerebrospinal fluid analysis for microscopic examination

Management

Since neuropathic pain is thought to stem from central nervous system abnormalities, treatment will focus on addressing the underlying disease causing the pain and relieving the pain. The goal is to maintain nerve function and improve the patient's quality of life. The doctor may recommend a combination of therapies such as medication, physical therapy, counselling, and surgery if necessary.

Various drug classes are recommended for treating neuropathic pain. Antidepressants or medications that work on several central nervous system receptors may be prescribed. Common painkillers are generally ineffective for central neuropathic pain, so stronger pain medications are typically given. Some drugs are still in the development and research stages.

Surgical procedures to deliver medication directly to specific body areas or alter specific nerve structures can be an alternative treatment for recurrent neuropathic pain. However, these procedures carry risks of complications.

Complications

Neuropathic pain can be long-lasting and cause psychological stress for patients. Additionally, as mentioned in the treatment section, surgical procedures can also risk complications such as infection or numbness in other body parts.

Prevention

Preventing central neuropathic pain involves maintaining a healthy lifestyle and being informed about neuropathic pain. Maintain an ideal weight, as obesity is a risk factor for neuropathic pain. If you have central nervous system disorders, you should regularly follow up with your doctor to prevent more severe complications.

If you work in a high-risk job, always wear protective gear to prevent injuries. Exercise regularly, at least 30 minutes five times a week, to strengthen your muscles.

When to see a doctor?

Consult a doctor if you experience persistent pain that appears suddenly or occurs with light touch or cold temperatures.

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