Abstract
Central pain due to stroke, spinal cord injury and surgical or traumatic brain injury is frequently refractory, and therefore, electrical stimulation therapy including stimulation of the spinal cord, thalamus and cerebral cortex is indicated. In this report, we discuss a strategy for dealing with central pain.
Spinal cord stimulation has been thought to be ineffective as a treatment for central pain. However, it is a less invasive therapy and is sometimes effective even on the post-stroke pain of extremities. On the other hand, cerebral cortex stimulation has recently been more popular as a treatment for post-stroke pain, and successful cases of treatment have also been documented following spinal cord injury. At the present time, it is difficult to conclude whether cerebral cortex or thalamic stimulation is more effective in the treatment of spinal cord pain.
We discuss our strategy for central pain. Medication and observation for at least one year is needed before surgical therapy is considered. If medication is not effective, spinal cord stimulation should be considered. Next, cerebral cortex stimulation is recommended, and depending on the patient's condition, thalamic stimulation may also be indicated.
