Allodynia in Relation to Lesion Site in Central Post-Stroke Pain

Bowsher, David

doi:10.1016/j.jpain.2005.06.009

Cited by 42 publications

(52 citation statements)

References 10 publications

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“…15 The percentage may be higher in patients with strokes involving the spinothalamic pathway or central pain processing areas. [16][17][18] Antidepressants are considered the first line of treatment, followed by anticonvulsants and opiates.…”

Section: Discussionmentioning

confidence: 99%

The Nucleus Accumbens as a Potential Target for Central Poststroke Pain

Mallory

Abulseoud

Hwang

et al. 2012

Mayo Clinic Proceedings

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Although deep brain stimulation (DBS) has been found to be efficacious for some chronic pain syndromes, its usefulness in patients with central poststroke pain (CPSP) has been disappointing. The most common DBS targets for pain are the periventricular gray region (PVG) and the ventralis caudalis of the thalamus. Despite the limited success of DBS for CPSP, few alternative targets have been explored. The nucleus accumbens (NAC), a limbic structure within the ventral striatum that is involved in reward and pain processing, has emerged as an effective target for psychiatric disease. There is also evidence that it may be an effective target for pain. We describe a 72-year-old woman with a large right hemisphere infarct who subsequently experienced refractory left hemibody pain. She underwent placement of 3 electrodes in the right PVG, ventralis caudalis of the thalamus, and NAC. Individual stimulation of the NAC and PVG provided substantial improvement in pain rating. The patient underwent implantation of permanent electrodes in both targets, and combined stimulation has provided sustained pain relief at nearly 1 year after the procedure. These results suggest that the NAC may be an effective DBS target for CPSP.

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Section: Discussionmentioning

confidence: 99%

The Nucleus Accumbens as a Potential Target for Central Poststroke Pain

Mallory

Abulseoud

Hwang

et al. 2012

Mayo Clinic Proceedings

View full text Add to dashboard Cite

show abstract

“…Many reviews have been written on the clinical presentation of PSSP and the multiple determinants associated with its development. 4,8,33,44,47,53 Traditionally, PSSP is regarded as nociceptive pain resulting from tissue damage due to biomechanical changes around the shoulder joint. PSSP has been related to clinical conditions such as spasticity, glenohumeral subluxation, capsular inflammation, peripheral neuropathy, CPSP and autonomic dysfunction.…”

Section: Post-stroke Shoulder Painmentioning

confidence: 99%

“…77 However, this questionnaire is only validated for the English language. Neuropathic pain may be assessed using the neuropathic pain diagnostic questionnaire (DN4) 8,80 or the Leeds assessment of neuropathic symptoms and signs. 3 These neuropathic pain questionnaires generally consist of a selected list of pain descriptors associated with neuropathic pain syndromes and have been validated for the detection of various types of neuropathic pain in a clinical context.…”

Section: Symptomsmentioning

confidence: 99%

“…From experimental studies it is known that cold allodynia 3,21 , punctate hyperalgesia 59 and tactile (dynamic mechanical) allodynia 26 are (partly or completely) caused by central sensitization. Moreover, a reduction in pain thresholds in an unaffected region of patients with chronic pain is considered to be mediated by central sensitization and/or central disinhibition 8,40,48 , although a reduction in cold pain tolerance has also been related to disturbed cognitive and emotional aspects of clinical and experimental pain 19 .…”

Section: Positive Somatosensory Signsmentioning

confidence: 99%

“…8 Stimulation was, thus, never nociceptive-specific, although subjects were stimulated with a low intensity (clear non-painful pricking sensation) and a high intensity (clear painful pricking sensation) stimulus. All EP components that were studied in this experiment were observed after stimulation with either the low or high intensity stimulus, with similar effects, so that data could be pooled.…”

Section: Intracutaneous Electostimulation and Epsmentioning

confidence: 99%

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