Neurology
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Central pain syndromes represent a form of neuropathic pain that is associated with lesions of the brain or the spinal cord after a stroke or other traumatic injury. Although spinal cord injury (SCI) pain and central post-stroke pain (CPSP) are both classified as central pain syndromes, they may have differing etiologies. The pathophysiology of SCI pain and CPSP has yet to be completely elucidated, but both spinal and supraspinal pathways may be involved. ⋯ Pharmacologic interventions that have demonstrated efficacy in central pain syndromes include iv lidocaine and opioids as well as the tricyclic antidepressant amitriptyline and the AEDs gabapentin and lamotrigine. Nonpharmacologic interventions have also demonstrated benefit in some patients who are refractory to pharmacologic treatments. Additional studies are needed to further evaluate the efficacy and safety of both pharmacologic and nonpharmacologic treatments for central pain syndromes.