Central post stroke pain: What are the new insights?

Abstract

Stroke causes disability with high morbidity and mortality in the world, causes a variety of disabilities and symptoms including disturbances in motor function, sensory, and cognitive. Sensory disability in post stroke patient can be categorized into two group; the one is stimulated by peripheral mechanism which we often called post stroke pain, and another one is stimulated by central mechanism which we called central post stroke pain (CPSP). Pain after stroke is usually underdiagnosed and poorly understood. In 1906, CPSP was called the thalamus pain syndrome by Dejerine and Roussy, but then it is known that CPSP can also developed in extra-thalamic stroke lesion. The prevalence of CPSP is approximately 1-12% in all around the world. CPSP occurs in one-third of overall post-stroke pain cases. In most cases, the onset of CPSP is within 1 month and then the incidence decreases with time. The most common manifestations are allodynia and dysesthesia. The pathophysiology itself remains clearly unknown in detail. Various theories such as central sensitization, disinhibition of medial thalamus, and central imbalance theory thought to be contribute in CPSP pathophysiology. This complexity make CPSP very difficult to manage. Some pharmacotherapies and non-pharmacotherapies have been studied to relieve pain in order to improve the quality life of CPSP sufferers. The aim of this article is to discuss the general view of central post stroke pain to increase the understanding and awareness of health giver in order to give sooner and better management for patient that can affect prognosis of the patient.