Critical Reviews™ in Physical and Rehabilitation Medicine

ISSN for PRINT: 0896-2960

For Online Access

Best Paper Award Selection - Editorial Board Site

2005, Volume17

Issue 2

84 pages

DOI: 10.1615/CritRevPhysRehabilMed.v17.i2

Issue price - $163.00

Stephen Tyrer, FRCPsych
Regional Neurological Rehabilitation Centre, Hunters Moor Hospital, Newcastle-Upon-Tyne; and Department of Psychiatry, Royal Victoria Infirmary, University of Newcastle, NE1 4LP UK

Elizabeth Davis, MRCP
Regional Neurological Rehabilitation Centre, Hunters Moor Hospital, Newcastle-Upon-Tyne, NE2 4NR UK

Central pain occurs when the central nervous system is damaged and results from either brain or spinal cord injury. Damage to the spinothalamic tracts and associated pathways is necessary to lead to central pain but is not sufficient to cause this condition. The symptoms and quality of pain perceived in conditions giving rise to central pain differ considerably from pain arising from non-neural tissue damage. The hyperalgesia that occurs in central pain states results from alterations in NMDA receptor activity associated with the influx of calcium into neurons. Differentiation needs to be made between pain arising from musculoskeletal strains and from spasticity before treating central painful conditions. The treatment ladder includes tricyclic antidepressants and anticonvulsants as first-line treatments; NMDA antagonists, such as ketamine; followed by motor cortex stimulation or stereotactic neurosurgical techniques, if drugs are unsuccessful. The opioid drugs are much less effective in central pain conditions in which there is reduced opioid-receptor availability.

DOI: 10.1615/CritRevPhysRehabilMed.v17.i2.30 Download article, 131-162 pages

Article price - $65.00

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