CENTRAL PAIN - NEW SYNDROMES AND THEIR EVALUATION

Central pain syndrome is defined as pain associated with a lesion of t he central nervous system. It has a low incidence but is frequently in tractable and does not have effective treatment. The cause of central pain is speculative, however the single common sensory abnormality in patients with central pain is interruption of spinothalamocortical noc iceptive pathways. It appears that severe central nervous system lesio ns, with total destruction of ascending sensory systems, do not lead t o a central pain syndrome; and that setting of mild, moderate, or seve re disruption of the anterolateral ascending system with partial or co mplete preservation of the dorsal column/medial lemniscus functions is most frequently associated with central pain syndrome. Furthermore, e ven during remission, dysesthesias and pain could be triggered by addi tional afferent input to the large fiber/dorsal column/medial lemniscu s system and, once established, they may not be abolished by additiona l deafferentation. (C) 1993 John Wiley & Sons, Inc.