Central Pain Syndrome

What is central pain syndrome (CPS)?

Central pain syndrome (CPS) is a chronic condition where you feel ongoing pain because of an issue with your nervous system. It can happen because of damage to your brain or spinal cord, or because of a malfunction in your nervous system that can happen when you live with chronic pain.

When central pain syndrome happens because of an injury or damage, the affected brain or nerve cells malfunction and send constant pain signals. Central pain syndrome from chronic pain happens because your nerve cells become too sensitive to pain signals. That can cause them to send pain signals mistakenly or to wrongly interpret other signals as painful.

This condition is often difficult to treat. Pain relievers, even stronger drugs like opioid medications, commonly won’t bring relief from the pain. But experts have uncovered newer treatment methods and medications that can often help people with this condition.

Is central pain syndrome the same as fibromyalgia?

CPS and fibromyalgia aren’t the same thing, but they’re often connected. Fibromyalgia is a chronic pain condition that affects your joints and muscles. People with fibromyalgia are much more likely to develop central pain syndrome because chronic pain alters how their nervous system works.

Who does it affect?

Central pain syndrome can affect anyone with damage to their central nervous system, which includes your brain and spinal cord. It can also happen to anyone who experiences chronic pain. It’s also much more likely to happen to people with certain neurological (brain or nervous system) issues. The following percentages are estimates of people with the listed condition who also have CPS:

• Stroke: 8% to 10%.
• Spinal cord injuries: 20% to 40%.
• Multiple sclerosis: About 30%.

How common is this condition?

Central pain syndrome affects as many as 7 million people around the world.

What are the symptoms of central pain syndrome?

Central pain syndrome involves changes to the way you feel pain, like:

• Where it hurts. The location of the pain depends on the affected part of your nervous system.
• When it hurts. The pain with CPS is usually constant (though, for some people, it might come and go). The pain also happens without something happening to your body that would cause the pain.
• How much it hurts. The intensity of the pain is usually moderate to severe. For some people, it might get better sometimes and then more severe at other times.
• Changes in sense of touch. People with CPS often have changes in their sense of touch, which is related to pain. That can cause numbness or sensations like tingling or a “pins and needles” feeling (paresthesia).
• When it starts. CPS can start within weeks, months or even years of an illness, injury or another related event.
• Environmental effects. Pain with CPS might feel more intense when you’re cold, upset, stressed or startled. Your level of physical activity can also affect the pain.
• Your pain threshold. People with CPS often have a higher pain threshold when it comes to pain that comes from an outside cause.

Descriptions for the pain

People with CPS often describe pain in similar ways. The most common descriptions include:

• Burning.
• Sharp or stabbing.
• Severe itching.
• Painful numbness or tingling.
• Deep tissue or muscle pain.
• Aching or intense pressure.
• Cutting or slicing.

Other conditions and symptoms that happen with CPS

Living with chronic pain can take a toll on a person’s mental health and well-being. As a result, people with pain-related conditions like CPS often also have the following:

• Anxiety.
• Depression (often with suicidal thoughts or behaviors).
• Memory loss or brain fog.
• Fatigue or exhaustion.
• Trouble sleeping.

What causes the condition?

Central pain syndrome happens for two main reasons: Injury or damage to your brain or spinal cord or because of chronic pain.

Conditions that can injure or damage the brain or spinal cord

Several conditions can damage your brain and spinal cord, but some are more common than others, including:

• Brain cancer or benign (noncancerous) tumors.
• Brain surgery or spinal surgery.
• Concussions or traumatic brain injuries.
• Degenerative or inflammatory conditions like multiple sclerosis or Parkinson’s disease.
• Epilepsy and nonepileptic seizures.
• Infections.
• Spinal cord injuries.
• Stroke.

Conditions that cause chronic pain

Any condition that causes chronic pain can also cause central pain syndrome. Because of that, experts have connected CPS with several chronic pain-linked conditions. Some of those include:

• Arthritis-related conditions such as osteoarthritis.
• Back pain.
• Cancer.
• Chronic fatigue syndrome.
• Chronic pelvic pain.
• Complex regional pain syndrome (CRPS).
• Fibromyalgia.
• Inflammatory conditions like rheumatoid arthritis, psoriatic arthritis, lupus or Sjögren’s syndrome.
• Irritable bowel syndrome.
• Joint pain.
• Migraines.
• Peripheral neuropathy (nerve damage in your arms or legs), which most commonly happens because of Type 2 diabetes.
• Postherpetic neuralgia (pain from nerve damage that’s a side effect of shingles).
• Temporomandibular joint (TMJ) disorders.

Genetics

Experts have also uncovered evidence that genetics play a role in developing central pain syndrome and conditions linked to it. That connection is especially clear in first-degree relatives, which are your biological parents, siblings or children. People with a first-degree relative with central pain syndrome have a risk of developing pain problems that are eight times higher than people without a family history. But experts have yet to pinpoint specific genetic mutations that explain this increased risk.

How does this condition affect my body?

One way to think about pain and its effects is to imagine your body as a complex building. Your nervous system’s ability to feel and process pain throughout your body acts very much like the fire alarm system of the building. When your nervous system picks up signs of damage and injury to your body, it sets off the alarm to let you know there’s a problem.

There are two kinds of pain:

• Acute pain: This type of pain is your body’s reaction to an illness or injury. It goes away in fewer than three months as you recover or your injury heals.
• Chronic pain: When acute pain lasts longer than three to six months, it becomes chronic pain.

Normal pain processes

There are nerve endings that are sensitive to different causes of pain throughout your body, much like a fire alarm system’s network of smoke detectors or heat sensors. Damage to nearby cells releases certain chemical warning markers into your blood. Your nerve endings notice those chemicals and send high-priority signals to your brain (via your spinal cord). Your brain interprets them as pain and then sends signals to other parts of your brain to act to protect you, like moving away or stopping whatever is causing the pain. For example, when your hand touches a surface that’s hot enough to burn your hand slightly, nerve endings detect those markers and send signals to your brain, which prompts you to move your hand away from the heat.

What central pain syndrome does

Central pain syndrome is like a malfunction in the fire alarm system for the building that is your body. Those malfunctions can happen in different ways.

Changes from injuries or damage

Central pain syndrome from injuries or damage happens differently depending on location:

• Brain: Damage to your brain can cause problems with how your brain processes pain signals. This can cause your brain to incorrectly process and send signals like it would if something were causing you physical pain.
• Spinal cord: Signals headed to your brain from most parts of your body have to reach your spinal cord before they head to your brain. Spinal cord damage can cause malfunctions in the affected nerve cells, causing them to send pain signals as if something painful were happening to part of your body. Those signals aren’t happening because of a real injury (but they do feel real).

Changes from chronic pain

Your body treats pain signals as a high priority because they’re supposed to protect you from more damage. But when you have chronic pain, your nervous system must handle these high-priority signals more often and for longer periods than it would under normal circumstances.

Over time, your nervous system and brain start to process pain signals. That usually involves your nervous system becoming too sensitive to pain or becoming so sensitive it interprets non-pain signals as painful.

• Hyperalgesia: This comes from Greek and means “too much pain.” This happens when your nervous system amplifies pain signals, making it feel much worse than it should.
• Allodynia: This also comes from Greek and means “other pain.” This happens when there’s a disruption in the sending, relaying or processing of non-pain signals, causing pain from things that shouldn’t hurt. An example of this would be feeling pain just from touching a piece of cloth.

Because pain also causes activation of other systems in your body, especially ones involving hormones, your immune system and your body’s self-repair processes, chronic pain and CPS can also disrupt how those systems work. That can affect your endocrine system, leading to adrenal disorders.

How is it diagnosed?

Diagnosing central pain syndrome (CPS) is often tricky because pain feels different from person to person. Because of that, a healthcare provider will need to gather a detailed history of your pain, including the following information:

• Location: Where does it hurt? Is the pain in one place or on one side only?
• Description: What does the pain feel like?
• Timing: When did the pain start? Does it happen at certain times of the day or in certain circumstances?
• Effects from outside circumstances: Does the pain change depending on your circumstances (such as the temperature around you, loud noises, stress or anxiety in your life)?
• Medical history: Do you have any injuries, problems or conditions that could contribute to the pain?
• Other symptoms: Have you noticed any other symptoms? Even ones that might not seem connected to your pain? Is there any swelling, tenderness or other symptoms around the painful area?

What tests will be done to diagnose this condition?

Depending on the circumstances, providers may also run diagnostic, imaging or lab tests. Lab tests are most likely to check if you have an undiagnosed inflammatory or immune disorder that could cause the kind of pain you have. Your healthcare provider is the best person to explain what kind of tests they recommend for your specific circumstances and case and why they recommend those.

Diagnostic and imaging tests can sometimes help pinpoint central pain syndrome due to a brain or spinal cord injury. The tests that often help with this include:

• Electroencephalography (EEG).
• Magnetic resonance imaging (MRI).
• Magnetoencephalography (MEG).
• Positron emission tomography (PET) scans.

There’s also a variant of MRI that can help in cases like this. That variant, known as “functional MRI (fMRI),” can detect activity in your brain, including when different areas of your brain are or aren’t working together.

How is CPS treated, and is there a cure?

Currently, there’s no cure for central pain syndrome, but there are many treatment options available. When central pain syndrome happens because of an underlying condition, treating or curing the underlying condition can help CPS.

Medications

Most treatment plans start with various types of pain medications. Those range from nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, to controlled substance pain relievers, such as opioid drugs.

But many of these more-common painkillers, even the stronger opioid medications, often aren’t effective in treating CPS. If those don’t work, providers may try one or more of the following medications (either separately or in combinations):

• Antiseizure medications like gabapentin or lamotrigine.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs), which are a type of antidepressant, such as duloxetine and venlafaxine.
• Tricyclic antidepressants (TCAs) such as amitriptyline or nortriptyline.
• Surface anesthetics (which you apply to the skin in cream or patch forms) like lidocaine.

Some experimental treatments include drugs best known for recreational use, but that are now the focus of ongoing research. These may one day become part of standard treatment for CPS.

• Cannabis (medical marijuana).
• Ketamine injections.

Nonmedication methods

A wide range of nonmedication methods, some approved and some experimental, might help with CPS. A few examples include:

• Acupuncture.
• Deep brain stimulation (DBS).
• Frequency-specific microcurrent (FSM).
• Transcranial magnetic stimulation (TMS).
• Transcutaneous electrical nerve stimulation (TENS).

Other treatments

Because mental health conditions are so common with pain conditions, experts often build mental healthcare options into treatment plans for central pain syndrome. For example, cognitive behavioral therapy (CBT) can help you learn and develop coping techniques for mental health concerns that often happen alongside CPS.

Physical therapy can help you adapt to your condition. It can also help improve your muscle strength, flexibility and coordination.

Complications/side effects of the treatment

The complications and side effects that are possible with treatments for central pain syndrome vary greatly, depending on which treatments you receive. Your healthcare provider is the best person to tell you the specifics of what you can expect.

How to take care of myself or manage my symptoms?

CPS isn’t a condition you can diagnose on your own, so you shouldn’t attempt to treat it by yourself. If you think you might have this condition, you should see a healthcare provider. They can diagnose your condition and guide you to treatments.

How soon after treatment will I feel better?

The time it takes to feel better or recover from treatments related to CPS varies greatly. Ask your healthcare provider about the timeline you can expect for treatment and recovery. They can best tell you what to expect based on your specific circumstances.

How can I reduce my risk or prevent central pain syndrome?

CPS happens unpredictably based on several factors, most of which you can’t control. Because of that, this condition isn’t preventable.

When central pain syndrome happens because of injuries or damage to your brain or spinal cord, there’s very little you can do to reduce your risk of developing it. Wearing safety equipment and gear to avoid head and spinal cord injuries can reduce your risk slightly by preventing injuries that could lead to CPS.

The best way to reduce your risk of developing CPS related to chronic pain is to get treatment for pain-related conditions sooner rather than later. It’s also important to follow your healthcare provider’s guidance in treating those conditions. Doing both reduces the risk of developing chronic pain that could lead to CPS in the future.

What is the outlook for this condition?

Central pain syndrome can have major effects on your quality of life, especially your ability to do what you enjoy.

The outlook for this condition depends strongly on if it has any underlying causes. In cases where there’s an underlying cause that’s curable, it’s more likely that you can treat or reverse some of the effects of this condition.

In cases where the underlying cause isn’t curable, the best approach is to treat the symptoms of CPS and prevent them from getting worse.

Early diagnosis and treatment are also important. It’s also important to make sure you see mental health providers as needed and recommended. That’s because people with this condition have a higher risk of developing anxiety and depression, as well as a higher risk of dying by suicide.

How long does central pain syndrome last?

Central pain syndrome is usually a permanent condition. In some cases, the effects are reversible depending on why it happens and how soon you receive treatment.

How do I take care of myself?

If you have central pain syndrome, you should follow your healthcare provider’s guidance on how to take care of yourself and treat your condition. The best things you can do include the following:

• Take medications as prescribed.
• Avoid activities or situations that make your pain worse.
• Don’t neglect your mental health.

When should I see my healthcare provider?

You should see your healthcare provider as they recommend. They’ll most likely schedule regular appointments to see how you’re doing and adjust treatments as needed. You should also see them if you notice changes in your symptoms, especially changes that happen quickly or disrupt your usual activities and routine.

When should I go to the ER?

You should get emergency medical care if your symptoms change or become especially severe in a short period. This is especially true if your CPS symptoms include any stroke symptoms. Your healthcare provider can also tell you any signs or symptoms specific to you that mean you should get emergency medical care.

A note from Cleveland Clinic

Central pain syndrome (CPS) is a serious condition that can have a major impact on your life. It can be a source of stress and pain, keeping you from living your life the way you want. While central pain syndrome has a well-earned reputation for being difficult to treat, researchers are developing promising therapy methods, medications and treatment approaches. As research continues, even more opportunities to treat this condition are likely, offering hope and relief to those with this condition.