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Is there a difference between Central pain and Neuropathic pain?

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  • 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
    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)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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    • #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.
      sigpicSCI Boot Camp

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      • #4
        waiting for dej on this one.

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        • #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.

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          • #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, 12:01 AM.

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            • #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

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              • #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

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

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                  • #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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                    • #11
                      It took me awhile to get to the light bulb moment. I was happy to finally know what it is, but, unhappy to find out what it is!

                      Faceplant, there is much to learn, so many drugs to try and most of the time, it takes a cocktail of drugs to even help. And, there are so many things that can make it worse......more intense. Stress, the weather, just to name a couple of things that make mine worse. I hate it when we have storms, and they don't even have to be in my area if the storm front is large enough. This has been a hard winter for me, we have had so many storms this winter! I'm dealing with one now, in fact. I wish you good luck in dealing with yours....

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                      • #12
                        The taxonomy committee of the IASP decided to lump both central and peripheral pain under the same term, "NEUROPATHIC PAIN". In my opinion this is ill advised and reflects the lack of a vocabulary by which the clinician can tell what he is dealing with.

                        Having a DSM number unique to CP permitted some Central Pain patients to get more care. Now, they appear to deserve nothing more than someone with diabetic neuropathy.

                        If clinicians would use the Mitchell test (exacerbation of pain from light touch [eg. a newspaper laid on the skin], is immediate in peripheral nerve injury, but delayed by seconds to perhaps 20 seconds in central pain) they would be able to better tell the difference.

                        They also could simply look at the lives of those with the condition. If the patient is completely taken apart and looks like they really almost need to be terminated out of mercy, so to speak, that is central pain. (Posting frequently on Grange's" I can't stand this &%$&%&@ pain" thread is also a clue) On the other hand, if they hurt, that is peripheral pain. Worlds away from each other in magnitude. The doctor must ask the right questions to get the answers they need, and few do.

                        However, even this distinction won't work since most who get central pain get a moderate pain. I know quite a number with post SCI pain who can still wear clothing etc. It is when you get into the agonies of someone like Alan, Cass, Bollefen or Hipcrip (pardon for those omitted) that you really start to become aware what a monster Central Pain is. One sees different statistics.

                        CP gets missed a lot. Betty Jo Hamilton, who was a patient of "Dr. Death" was widely reported in the newspapers over euthanasia, but not one newspaper article reported that she had CP and had had TEN surgeries to try to get rid of it. She was also a bona fide patient at Duke pain center. However, the osteopathic ER doctor who received her dead body from Dr. Kevorkian said he doubted she really had any pain. So if even suicide doesn't raise eyebrows, the public and the medical profession can be perceived as being possibly lacking or even totally ignorant as to the condition. That does not help accurate reporting of statistics.

                        Remembering that most SCI patients have had surgery and have musculoskeletal pain from the injury and/or the surgery, the burning pain of injured nerve occurs to a slight degree in about fifteen percent of all SCI patients. Only a minority of these will really be gutted by the pain.

                        The name central pain originally was reserved for the truly ugly cases, but those who are enduring okay also fall under the category and can have a great deal of pain, just not the personality destroying pain of all out CP. Riddoch (1940) was the first to use "central pain" and he defined it as a "pain beyond pain". S. Weir Mitchell called it "pain of central origin" (1876), as did Dejerine, Egger, and Roussy (1903), who focused on those with CP from stroke in or near the thalamus (now thought possibly to actually be in the subthalamus).

                        You can see why the IASP just lumped everything together. However, there is no reason to mistrust CP patients, since most don't respond to opiates, unless it is sedation you are after. Many docs disagree and say high dose opiates work, but I do not personally think this is commonly the case and when it is, I have to wonder if it is the musculoskeletal pain which is being reached, with any help to the burning being simple sedation and NOT pain relief. I could be wrong on this point.

                        There is nothing to say CP patients cannot have peripheral neuropathy and tons of regular nociceptive musculoskeletal pain also.

                        At present, it is futile for the physician to grade pain. We have to trust the patient. Drug seeking is reasonably easy to figure out, but we should never make that our first assumption about a person who claims to be in severe pain and whose lifestyle proves it and wants opiates. Physiologically opiates theoretically should not be able to help CP because they EXCITE the Central Nervous System, whereas they INHIBIT the peripheral nervous system, which is where ordinary pain (nociceptive pain) is processed.

                        Doctors have to know CP exists before they will ever diagnose it, and the lumping into neuropathic pain cuts against this knowledge.

                        Fully elaborated CP is the most severe pain state known to man according to Ron Tasker, and they don't come any smarter or more experienced or more published than Ron Tasker (150 articles and counting).

                        No one is saying that about the peripheral neuropathies, bad though they may be. People are spending a fortune for back pain, which isn't as severe as CP in virtually all cases. Demoting central pain to the level of diabetic neuropathy is a slap in the face. There are a great many pain docs who have never seen a bona fide case of severe CP. That is because it is uncommon. Less severe pain after SCI is about one in fifteen cases of cord injury, the majority of those not being fully elaborated. Fully elaborated means the pain is centripetal, your clothing will burn you and you will have lost the precise sense of where the surface of your skin is. It also used to mean opiates are of no benefit, but there is enough debate about opiates that that criteria has been long since dropped.
                        Last edited by dejerine; 04-13-2013, 11:00 PM.

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                        • #13
                          Funny I just got a similar lecture from my pain doc, she noted that one of the more convincing symptoms I exhibited was zero response to massive amounts of narcotics while getting some relife from what I have always referred to as "mechanical" pain and the laughing at narotics for relief from the surgical pain of having the IT pump and catheter placed, I said this is a minor inconvenience, not pain.

                          She also noted CP had been grouped inappropriately into a broad category and the actual incidence is pretty rare.

                          While I'm trialing Prialt she said at least it is one last thing to try, offering more hope than I have had in a while. she did not give it more than a 1/3 chance of working at all and reduced it dramatically by the % of people who cannot tolerate it beyond a non effective dosage. BUt at least a try.

                          Lastly I have no idea what diabetics feel, I am one and have no neuropathy (emg can somehow test this??) but it really ticks me off when the odd diabetic says they know exactly how i feel.

                          God bless us one and all.

                          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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                          • #14
                            Have either of you heard of "complex regional pain syndrome"? That is what my doctor called it last week. I did google it:

                            Signs and symptoms of complex regional pain syndrome include:
                            • Continuous burning or throbbing pain, usually in your arm, leg, hand or foot
                            • Sensitivity to touch or cold
                            • Swelling of the painful area
                            • Changes in skin temperature — at times your skin may be sweaty; at other times it may be cold
                            • Changes in skin color, which can range from white and mottled to red or blue
                            • Changes in skin texture, which may become tender, thin or shiny in the affected area
                            • Changes in hair and nail growth
                            • Joint stiffness, swelling and damage
                            • Muscle spasms, weakness and loss (atrophy)
                            • Decreased ability to move the affected body part

                            Symptoms may change over time and vary from person to person. Most commonly, pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) occur first. Over time, the affected limb can become cold and pale and undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible.
                            Complex regional pain syndrome occasionally may spread from its source to elsewhere in your body, such as the opposite limb. The pain may be worsened by emotional stress.
                            In some people, signs and symptoms of complex regional pain syndrome go away on their own. In others, signs and symptoms may persist for months to years. Treatment is likely to be most effective when started early in the course of the illness.



                            http://www.mayoclinic.com/health/com...CTION=symptoms
                            T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

                            My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

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                            • #15
                              My doc has multiple regional pain syndrome patients and sees significant differences. while trialing my it pump i shared a room with one. I found his condition confusing but significantly different from my own issues and experience. Just sayin.

                              His was quite intense but very " regional" fwiw i would have traded with him in a heartbeat. Mine is mostly from thd nipples region down, his was 1 limb. I think causality is considered as well for RPS v CP.

                              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

                              Comment

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