A review of central neuropathic pain states

Purpose of review Central neuropathic pain is an important and disabling but often neglected problem following central nervous system lesions. The present review highlights recent advances in the understanding of the underlying mechanisms and in the diagnosis and treatment of central pain. Recent findings Within the past year, the field of central pain has moved toward a more integrative understanding of central pain. The involvement of nonneuronal cells and interaction between multiple areas of the central nervous system has been recognized as important in the underlying mechanisms. The interest for conditions other than spinal cord injury, multiple sclerosis, and stroke has increased, and continued discussions on clear clinical diagnostic criteria are needed. The treatment of central pain is still a great challenge, but recent evidence points to tricyclic antidepressants, gabapentin and pregabalin, and selective serotonin-noradrenaline reuptake inhibitors as first-line drugs in central pain. An increased understanding of the psychosocial aspects of central pain also has implications for the treatment. Summary Increased insight into the mechanisms of central pain will hopefully lead to increased efforts to study mechanism-based treatment of central pain.