Treatment of central pain
Because there is no long-term effective treatment for central pain, it is important to try all available modalities of treatment to determine systematically the best approach for an individual patient. The realistic goal of central pain treatment is to reduce the pain to a tolerable level. With this in mind, it is commonly believed that opiate narcotics are totally ineffective in the treatment of central pain, although more systematic studies are needed. Central pain also responds poorly to most conventional analgesics, better to antidepres-sants, and temporarily to sodium thiopental and propofol; it may respond to intravenous pentothal. Agents that enhance norepinephrine and dopamine neurotransmission and anti-convulsants also have some therapeutic efficacy
The temporal profile of central pain suggests that there is a slow, evolving process responsible for the onset of this condition. Because of this, it may be possible to design treatment strategies based on indications that a patient is predisposed to central pain based on symptomatology and/or the nature of a central lesion. It is conceivable that preemptive treatment for central pain may be possible once the patho-physiological mechanisms are understood. Two reviews of controlled studies related to the efficacy of pharmacological and nonpharmacological treatments of central pain are recommended for additional reading.