Neuropathic Pain: Thalamic Pain Syndrome

00:01 When we think about central neuropathic pain, another common area that can cause neuropathic pain is the thalamus.

00:08 Here, we're looking at a schematic of the thalamus and all of the nuclei that are involved in the thalamus.

00:13 I don't need you to remember them all, except to note that the thalamus is the sensory relay center for the entire brain.

00:21 So something that affects the thalamus can contribute to abnormal sensation anywhere in the body.

00:27 One pain syndrome that we think about that comes from thalamic dysfunction is thalamic pain syndrome.

00:34 This was previously referred to as Dejerine-Roussy syndrome.

00:37 Classically, this occurs in patients who have had a stroke than affects the thalamus, a unilateral thalamic stroke, a subcortical lacunar stroke.

00:47 It can also occur with other insults such as tumors and other pathology that affects the thalamus.

00:53 Pain often begins several months after the occurrence of the stroke or after the development of the tumor or even after treatment of the tumor.

01:01 Pain occurs in a hemibody and there's often hemibody sensory loss initially, followed by severe neuropathic pain in that hemibody overtime.

01:11 The pain can be severe and progressive.

01:14 This is often an unrelenting pain where every time we see the patient, the pain is worse and worse and worse.

01:23 Mechanisms of thalamic pain syndrome may result from loss of central inhibition or loss of central gaiting. Inhibition of pain sensation from the central nervous system, releasing the peripheral nervous system to feel hypersensitivity.

01:40 Some of the treatments we think about include topical neuropathic agents, oral agents, but many of these have limited efficacy.