From the Guidelines
Central neuropathic pain and cervical neuropathic pain are distinct entities with different origins and locations within the nervous system, requiring accurate diagnosis and targeted treatment approaches to improve patient outcomes. Central neuropathic pain results from damage or dysfunction in the central nervous system (brain and spinal cord), often following stroke, multiple sclerosis, spinal cord injury, or other central lesions, as noted in the guidelines for adult stroke rehabilitation and recovery 1. It typically presents as burning, shooting, or electrical sensations, sometimes accompanied by allodynia (pain from normally non-painful stimuli) and hyperalgesia (increased pain sensitivity).
In contrast, cervical neuropathic pain specifically originates from nerve damage or compression in the cervical spine region, often due to herniated discs, cervical spondylosis, or trauma, as discussed in the ACR Appropriateness Criteria for cervical neck pain or cervical radiculopathy 1. This pain radiates along the affected nerve pathway into the shoulders, arms, or hands, and may be accompanied by numbness, tingling, or weakness.
Key differences between central and cervical neuropathic pain include:
- Origin: Central neuropathic pain originates from the central nervous system, while cervical neuropathic pain originates from the cervical spine region.
- Location: Central neuropathic pain can occur anywhere in the body, while cervical neuropathic pain is typically localized to the neck, shoulders, arms, or hands.
- Symptoms: Central neuropathic pain often presents with burning, shooting, or electrical sensations, while cervical neuropathic pain may present with radiating pain, numbness, tingling, or weakness.
Treatment approaches for central neuropathic pain may involve medications like gabapentinoids, tricyclic antidepressants, or SNRIs, as well as non-pharmacological options like motor cortex stimulation 1. In contrast, treatment approaches for cervical neuropathic pain may include targeted interventions like cervical epidural steroid injections, physical therapy focusing on cervical stabilization, and in severe cases, surgical decompression of affected nerves 1. Accurate diagnosis and targeted treatment are crucial to improving patient outcomes and reducing morbidity, mortality, and improving quality of life.
From the Research
Definition and Causes
- Central neuropathic pain is caused by a disease or lesion of the brain or spinal cord 2
- It can arise from various conditions such as brain injury, spinal cord injury, stroke, multiple sclerosis, or related neuroinflammatory conditions 3
- Cervical neuropathic pain, on the other hand, is not explicitly defined in the provided studies, but it can be inferred to be a type of neuropathic pain affecting the cervical region
Characteristics and Symptoms
- Central neuropathic pain is often highly distressing and difficult to treat, with no specific treatment guidelines currently available 2
- The resulting pain is often characterized by its intensity and difficulty to manage, with patients experiencing disturbed sleep and anxiety 4, 5
- Central neuropathic pain can have a significant impact on a patient's quality of life, requiring a comprehensive treatment approach 3
Treatment Options
- Current evidence-based pharmacological treatments for central neuropathic pain include antidepressants and gabapentinoids as first-line options 2, 3
- Pregabalin, an anticonvulsant, has been shown to be effective in treating central neuropathic pain, with efficacy comparable to that in peripheral neuropathic pain 4, 5
- Non-pharmacological pain management options, such as self-management strategies, exercise, and neuromodulation, may also be helpful in managing central neuropathic pain 3