Skip to content. | Skip to navigation

Personal tools

Pain in Neurological Diseases

Ray Garrick

 

Downloads

 

Abstract

Pain is a cardinal symptom in a variety of primary neurological disorders.  This discussion will focus on neuropathic pain of central origin to consider pathophysiology on mechanisms and a rational approach to management.

More than 5% of patients develop central pain after acute stroke.  This is occasionally seen in the acute phase but it is more often identified in the rehabilitation phase or up to a year and a half after the stroke.  Management is often unsatisfactory because the patient may have difficulty in communicating the distribution and severity of pain.  Co-morbidities may interfere with optimal pain management.

Approximately 45% of patients with multiple sclerosis and will experience severe neuropathic pain as part of their demyelinating disease.  The mechanisms are generally logical in relation to anatomical distribution of active plaques and similar principles of management apply to M.S. patients as to stroke and spinal injury patients.

Almost 50% of patients with Parkinson's disease will have pain sufficient to require active pain management.  Treatment will only be effective if the underlying pathophysiology of pain is considered.

Other akinetic- rigidity disorders will have pain resulting from the rigidity and inability - often as the most debilitating component of their illness.

Migraine, headache disorders and facial pain blackout a substantial part of standard neurological practice - it is disappointing that the principles of effective pain management are not always employed in considering these conditions. 

Painful peripheral neuropathy constitutes a significant proportion of peripheral nerve disorders and warrants detailed discussion in another forum.

The modification of pain perception in patients with primary neuro-degenerative disorders - particularly Alzheimer's disease will influence the way pain is described by the patient and the marked sensitivity to sedative and opioid medication in this group of patients needs to be considered with caution.

Approaches to the management of painful neurological disorders will be discussed.

Document Actions