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Thread: Is there a difference between Central pain and Neuropathic pain?

  1. #1

    Wink Is there a difference between Central pain and Neuropathic pain?

    Ok so I know I should know the answer to this question but the truth is I don't. Are Central pain and Neuropathic pain one in the same or are they different or just related?? If so how is one treated vs the other? I always thought that the burning...I want to rip my skin off pain was considered neuro. pain but I have heard others call it central pain. Also is it usual to have numbness along with the burning pain? I assume that it is but even though it's been almost a year I am still learning.


    thanks!!
    ACDF C5/C6, C6/C7 9/2011& Central Cord Syndrome

  2. #2
    Central pain is often term used to describe pain which is caused by a lesion in the CNS (central nervous system) which is the brain and spinal cord. Neuropathic pain includes central pain but also can include pain which can occur due to lesions of the peripheral nervous system (PNS). Examples include diabetic peripheral neuropathy, alcoholic peripheral neuropathy, or Guillian-Barre syndrome.

    (KLD)

  3. #3
    Pain can be a big issue and can prevent you from getting back out and participating in life. I am not familiar with it too much, as I did't and still don't experience much pain, due to my injury. I know that I have a feeling in my legs and feet that reminds me of any of your extremities falling asleep. There is a very distinct sensation of 'pins and needles'. Sometimes I forget about it, because I have become accustomed to the feeling, but it can become bothersome if I dwell on it. I have met guys that cannot even put a shirt on due the pain, or when the wind blows the hair on their arms the freak out because of the pain. We have sensory nerve pathways that give us the hot, cold, sharp, dull, then there is the autonomic nerve pathways that regulate breathing, heart rate, blood pressure etc. I am not sure how or if we can regulate the sensory, due in part to how the CNS works... be sure to explore all possibilities for the source. Sitting position, bladder and bowel, are your shoes too tight...? This will take time and patience, but you will begin to learn your body and the source of the discomfort. Good luck faceplant. Great screen name, by the way.
    SCI Boot Camp

  4. #4
    waiting for dej on this one.

  5. #5
    face plant - 'you say tomato and I say tomaaato'. 'you say CP and I say NP'. It is a nomenclature issue that isn't fully resolved. These are terms trying to describe poorly understood pathophysiologic mechanisms.

    SCI nurse (KLD) spells it out well. The nervous system is divided into the Central Nervous System(CNS) and the Peripheral Nervous System(PNS). The spinal cord is considered part of the central nervous system but there are cell bodies in there and cells in ganglion nearby that are part of the peripheral nervous system. Neuropathic pain is a broader term that includes all pain that originates from both the peripheral nervous system and the central nervous system. CENTRAL PAIN is pain that is generated from the central nervous system which is a subset of NEUROPATHIC PAIN. Some people are 'lumpers' of all these pains and some people are 'splitters' who like to differentiate and use more specific terms.

    The mechanisms of these pains are poorly understood scientifically. Now the people here know a lot about these pains if you are living this nightmare like you and I. I know what you are experiencing but the mechanisms which get named in the scientific world are not fully (to say the least) understood. You could call it Gobbletimash and I know what you are talking about. Terms like neuropathic pain or central pain don't demonstrate an understanding of the pathophysiologic mechanism.
    So science must progress our understanding of the mechanisms and maybe a bunch of neuroscientists will come up with new names that are better associated with known mechanisms of how it works. In the meantime, if the pain generator is coming from an area of the Thalamus (part of the brain- central nervous system) well, that is clearly CENTRAL PAIN and it has a name called "Dejerine, Roussy Syndrome". Clearly central pain. BTW that isn't named after our Dejerine, but rather another famous French neurologist in the early 20th century who identified this syndrome in people with thalamic strokes.
    One problem is that there are shades of gray with traumatic peripheral neuropathic pain. Say I tear my sciatic nerve off my leg and/or smash my Cauda Equina which is part of the peripheral nervous system. Well that will cause peripheral neuropathic pain BUT if it goes on for a number of years, there are changes in the central nervous system that perpetuate the pain and now it has a bit of PERIPHERAL NEUROPATHIC PAIN generators to it and a bit of Central Pain generators - so it is not clear cut.

    Back to 'you say tomato and I say tomaaato'. We, as sufferers, know what it feels like and I plan on letting the really smart neurology doctors,arguably the sharpest docs of all, like our Dejerine and HLH, figure it all out.

    Till then I tell you what I call all of it ..... a real *&^%$ bummer.

  6. #6
    KLD nailed it, central pain is one form of neuropathic pain. The other is peripheral neuropathy. When the sensory nerves in the CNS are injured from the thalamus on down through the cord, central pain can result. SCI, stroke, and MS are all possible causes, or anything that can cause damage to those neurons. Bowsher's criteria details how central pain can be diagnosed.
    The diagnosis of Central Pain is one of the easiest in medicine. Bowsher's criteria easily identify the presence of Central Pain. (Bowsher 1990) Central Pain is characterized by the following symptoms in a patient with an injury to the Central Nervous System, which injury may be determined either clinically or electrophysiologically through Somatosensory Evoked Potentials:

    • Unfamiliar burning pain from light touch, but not from deep pressure.
    • Paradoxically, there is a component of cold.
    • The pain is made worse by rubbing or the touch of clothing.

    Beyond Bowsher's three criteria is a constellation of neuropathic symptoms, not necessarily painful, which some authors unfortunately place under the rubric of Central Pain. It is misleading to lump paresthesias together with pain since it confuses unspeakable agony with mere strangeness.

    Non-painful sensations generated by an injured nervous system should be termed central paresthesias, not Central Pain. As one physician said in regard to mixing paresthesias with agonizing burning, "It is like listing Auschwitz in the same category as bad room service".

    more...>
    http://painonline.org/bowsh.htm

    Central pain can manifest in a number of different ways, from the burning sensations, to "lightening pains", etc. I have a couple more pages on the website that give more info on that.

    The mnemonic of central pain (different types of central pain)
    http://painonline.org/mnem.htm

    Descriptions of central pain
    http://painonline.org/description.htm
    Last edited by David Berg; 05-05-2012 at 12:01 AM.

  7. #7
    Thanks for the replies! Even though I am a nurse (an oncology nurse clearly not in neuro) I was still confused with why the difference so thanks for the clarification. And Arndog you are correct no matter what the heck we call it....it just completely just sucks. Tomorrow will mark my one year since my accident. Someone fairly close to me asked me what I was going to do to mark the anniversary......nothing why the heck would I want to celebrate that day. Heck I am just happy to still be able to do what I can do, I know that my accident could have been so much worse.....yes the pain is horrific and I keep hoping that I find something to make it better but as I continue to read and get more familiar with this site I learn that it is going to be a life long challenge to get some form of pain relief if it's even possible.

    So here's to us all that pain relief comes one day!!
    ACDF C5/C6, C6/C7 9/2011& Central Cord Syndrome

  8. #8
    Thanks David for the websites I finally get it "light bulb moment". I finally get what Dejerine was trying to explain in another post about why MD's don't understand our pain and why we as central pain patients are not the best at describing it. So I am going to take that knowledge to my MD appointment today in hopes that he will have a "light bulb moment" too and see if he can offer something more than before at least!!
    ACDF C5/C6, C6/C7 9/2011& Central Cord Syndrome

  9. #9
    CNS is much more difficult to treat in comparison to peripheral. Just a side note...

  10. #10
    FWIW, my docs described mine as an SCI induced radiculopathy til the symptoms evolved after which neuropathic pain was bantered abot then finally Central Pain. I asked my GP who also said he thought as there is no positive prognosis for CP and it is a damnable curse, the docs were reluctant to actaully use the term while they tried with ZERO success to manage it. The only thing they've managed to partially help is the 24x7 spasms and spasticity.

    I'm expecting to start Prialt this month if the insurance will authorize it. a bit scary but 12 years in with no relif trying everything I have to try it or i'll go down the darker rout

    Good lucj,

    ket
    Kindly,

    The Ketamine Kitty

    All the tears, all the pain, all the rage through the night (apolgies to the rewrite) RR

    Next time I die make sure I'm gone,
    don't leave 'em nothing to work on JT

    And I ain't nothin but a dream JM

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