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Critical Reviews™ in Physical and Rehabilitation Medicine

Publicado 4 números por año

ISSN Imprimir: 0896-2960

ISSN En Línea: 2162-6553

SJR: 0.141 SNIP: 0.129 CiteScore™:: 0.6 H-Index: 18

Indexed in

Central Pain States: Etiology and Management in Rehabilitation

Volumen 17, Edición 2, 2005, pp. 131-162
DOI: 10.1615/CritRevPhysRehabilMed.v17.i2.30
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SINOPSIS

Central pain occurs when the central nervous system is damaged and results from either brain or spinal cord injury. Damage to the spinothalamic tracts and associated pathways is necessary to lead to central pain but is not sufficient to cause this condition. The symptoms and quality of pain perceived in conditions giving rise to central pain differ considerably from pain arising from non-neural tissue damage. The hyperalgesia that occurs in central pain states results from alterations in NMDA receptor activity associated with the influx of calcium into neurons. Differentiation needs to be made between pain arising from musculoskeletal strains and from spasticity before treating central painful conditions. The treatment ladder includes tricyclic antidepressants and anticonvulsants as first-line treatments; NMDA antagonists, such as ketamine; followed by motor cortex stimulation or stereotactic neurosurgical techniques, if drugs are unsuccessful. The opioid drugs are much less effective in central pain conditions in which there is reduced opioid-receptor availability.

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