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Musculoskeletal593 papers

Central pain syndrome

Last edited: 4/14/2026

Overview

Central pain syndrome refers to chronic pain conditions arising from damage to the central nervous system, often characterized by neuropathic pain that is disproportionate to any identifiable stimulus 2315.

Diagnosis

  • Clinical history and neurological examination essential 215.
  • Quantitative sensory testing (QST) can assess sensory disturbances 11.
  • Imaging studies (MRI, CT) may identify underlying CNS lesions 215.
  • Differential diagnosis includes other neuropathic pain conditions 215.

    • Management

  • First-line treatments:
    • - Non-pharmacological interventions (e.g., physical therapy, psychological support) 4215. - Neuromodulation techniques (e.g., spinal cord stimulation) 6811.
  • Pharmacological treatments:
    • - Antidepressants (e.g., tricyclic antidepressants, SNRIs) 15. - Anticonvulsants (e.g., gabapentin, pregabalin) 15.
  • Adjunctive therapies:
    • - Botulinum toxin injections for localized pain syndromes 14. - Electroconvulsive therapy (ECT) for refractory cases 15.

    Special Populations

  • Pediatrics: Limited evidence; conservative management preferred 15.
  • Elderly: Consider polypharmacy risks; multidisciplinary approach recommended 15.
  • Comorbidities: Tailor treatment considering coexisting conditions like psychiatric disorders 15.

    • Key Recommendations

  • Utilize multidisciplinary approaches including psychological support and physical therapy for comprehensive management (Evidence: Moderate 42).
  • Consider spinal cord stimulation as an effective adjunctive treatment for refractory cases (Evidence: Moderate 68).
  • Evaluate and manage potential comorbid psychiatric conditions, as they significantly impact pain perception and treatment outcomes (Evidence: Expert opinion 15).

    • References

    1 Corona G, Capogrosso P, Baldini S, Rastrelli G, Vignozzi L, Romero-Otero J et al.. Hyaluronic acid and chondroitin sulphate instillation in chronic bladder diseases: a meta-analysis. BJU international 2026. link 2 Rauch M, Hattingen E. Interventional pain treatment in radiology: An overview of practical approaches. Clinical imaging 2025. link 3 Rostami Z, Azizzadeh Forouzi M, Faris Abdulghani M, Mangolian Shahrbabaki P, Canillas-Dufau T, Dehghan M. Swedish massage for shoulder function and postmastectomy pain syndrome: randomised controlled trial. BMJ supportive & palliative care 2025. link 4 Gónima Valero E, Rodríguez Miranda CD, Contreras Arrieta S, Daza Morelli MI, Seija Butnaru D, Reyes Carrillo M et al.. Nonpharmacological Interventions for Postmastectomy Pain Syndrome-A Systematic Review of the Literature. Clinical breast cancer 2025. link 5 Wang Y, Li H, Zhang D, Zhao T, Liu Z, Chen J et al.. Core Training for Pain Management and Functional Improvement in Patients With Patellofemoral Pain Syndrome: A Systematic Review and Meta-analysis. American journal of physical medicine & rehabilitation 2024. link 6 Kurt E, Kollenburg L, Joosten S, van Dongen R, Engels Y, Henssen D et al.. Preoperative Counseling in Spinal Cord Stimulation: A Designated Driver in Implantable Pulse Generator-Related Inconveniences?. Neuromodulation : journal of the International Neuromodulation Society 2024. link 7 Kayll SA, Hinman RS, Bryant AL, Bennell KL, Rowe PL, Paterson KL. Do biomechanical foot-based interventions reduce patellofemoral joint loads in adults with and without patellofemoral pain or osteoarthritis? A systematic review and meta-analysis. British journal of sports medicine 2023. link 8 van Heteren EPZ, van Roosendaal BWP, van Gorp EJAA, Bronkhorst EM, Kallewaard JW, Wegener JT et al.. Spinal Cord Stimulation With Additional Peripheral Nerve/Field Stimulation Versus Spinal Cord Stimulation Alone on Back Pain and Quality of Life in Patients With Persistent Spinal Pain Syndrome. Neuromodulation : journal of the International Neuromodulation Society 2023. link 9 Tuulik VR, Kumm M, Tuulik V, Veraksitš A, Päll T. The therapeutic effect of Värska mud and Värska mineral water baths on the overuse pain and muscle tension syndromes in the working age population. Environmental geochemistry and health 2022. link 10 Eliason A, Harringe M, Engström B, Sunding K, Werner S. Bilateral ultrasound findings in patients with unilateral subacromial pain syndrome. Physiotherapy theory and practice 2022. link 11 Plantaz YJGM, van Dongen RTM, Witkam RL, Vissers KCP, Timmerman H. Changes in quantitative sensory testing and patient perspectives following spinal cord stimulation for persistent spinal pain syndrome: An observational study with long-term follow-up. European journal of pain (London, England) 2022. link 12 Goshima K. Editorial Commentary: Does Patellofemoral Degenerative Progression After Open-Wedge High Tibial Osteotomy Adversely Affect Clinical Outcomes?. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2019. link 13 Veen EJD, Stevens M, Koorevaar CT, Diercks RL. Appropriate care for orthopedic patients: effect of implementation of the Clinical Practice Guideline for Diagnosis and Treatment of Subacromial Pain Syndrome in the Netherlands. Acta orthopaedica 2019. link 14 Rashid S, Fields AR, Baumrucker SJ. Subcutaneous Botulinum Toxin Injection for Post-Thoracotomy Pain Syndrome in Palliative Care: A Case Report. The American journal of hospice & palliative care 2018. link 15 Strand JJ, Warner LL, Kamdar MM, Flaherty AW, Jackson VA. It is Electric! Electroconvulsive Therapy for Refractory Central Pain and Comorbid Psychiatric Disease. Journal of palliative medicine 2018. link 16 Solinsky R, Beaupre GS, Fredericson M. Variable criteria for patellofemoral bracing among sports medicine professionals. PM & R : the journal of injury, function, and rehabilitation 2014. link 17 Juel NG, Natvig B. Shoulder diagnoses in secondary care, a one year cohort. BMC musculoskeletal disorders 2014. link 18 Peltekis G, Palaskas D, Anyfantakis D, Symvoulakis EK, Kyrmizakis DE. Severe throat pain in patients with negative oropharyngeal examination: four case reports and overview of the literature. Folia medica 2012. link 19 Draper CE, Besier TF, Fredericson M, Santos JM, Beaupre GS, Delp SL et al.. Differences in patellofemoral kinematics between weight-bearing and non-weight-bearing conditions in patients with patellofemoral pain. Journal of orthopaedic research : official publication of the Orthopaedic Research Society 2011. link 20 Harrison AD, Ford KR, Myer GD, Hewett TE. Sex differences in force attenuation: a clinical assessment of single-leg hop performance on a portable force plate. British journal of sports medicine 2011. link 21 Nakagawa TH, Baldon Rde M, Muniz TB, Serrão FV. Relationship among eccentric hip and knee torques, symptom severity and functional capacity in females with patellofemoral pain syndrome. Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine 2011. link 22 Hanno P, Lin A, Nordling J, Nyberg L, van Ophoven A, Ueda T et al.. Bladder Pain Syndrome Committee of the International Consultation on Incontinence. Neurourology and urodynamics 2010. link 23 Hanno P, Nordling J, van Ophoven A. What is new in bladder pain syndrome/interstitial cystitis?. Current opinion in urology 2008. link 24 Aminaka N, Gribble PA. Patellar taping, patellofemoral pain syndrome, lower extremity kinematics, and dynamic postural control. Journal of athletic training 2008. link 25 Fishman SM. The role of the pain psychologist, trigger point injections, reflex sympathetic dystrophy. Journal of pain & palliative care pharmacotherapy 2006. link 26 Kulka PJ, Toker H, Heim J, Joist A, Jakschik J. Suspected central anticholinergic syndrome in a 6-week-old infant. Anesthesia and analgesia 2004. link 27 Katsanoulas K, Papaioannou A, Fraidakis O, Michaloudis D. Undiagnosed central anticholinergic syndrome may lead to dangerous complications. European journal of anaesthesiology 1999. link 28 Coakley FV, Varghese SL, Hricak H. CT and MRI of pelvic varices in women. Journal of computer assisted tomography 1999. link 29 Koyama T, Arakawa Y, Shibata M, Mashimo T, Yoshiya I. Effect of barbiturate on central pain: difference between intravenous administration and oral administration. The Clinical journal of pain 1998. link 30 Tarazov PG, Prozorovskij KV, Ryzhkov VK. Pelvic pain syndrome caused by ovarian varices. Treatment by transcatheter embolization. Acta radiologica (Stockholm, Sweden : 1987) 1997. link 31 Bornstein J, Zarfati D, Goldshmid N, Stolar Z, Lahat N, Abramovici H. Vestibulodynia--a subset of vulvar vestibulitis or a novel syndrome?. American journal of obstetrics and gynecology 1997. link70088-7) 32 Canavero S. Bilateral central pain. Acta neurologica Belgica 1996. link 33 Migita K, Uozumi T, Arita K, Monden S. Transcranial magnetic coil stimulation of motor cortex in patients with central pain. Neurosurgery 1995. link 34 Taira T, Kawamura H, Tanikawa T, Iseki H, Kawabatake H, Takakura K. A new approach to control central deafferentation pain: spinal intrathecal baclofen. Stereotactic and functional neurosurgery 1995. link 35 Post WR, Fulkerson JP. Distal realignment of the patellofemoral joint. Indications, effects, results, and recommendations. The Orthopedic clinics of North America 1992. link 36 Heath C, Murtagh J. Diagnosis of patellofemoral pain syndrome. Australian family physician 1990. link 37 Bowsher DR, Foy PM, Shaw MD. Central pain complicating infarction following subarachnoid haemorrhage. British journal of neurosurgery 1989. link 38 Fulkerson JP, Schutzer SF. After failure of conservative treatment for painful patellofemoral malalignment: lateral release or realignment?. The Orthopedic clinics of North America 1986. link 39 Chrisman OD. The role of articular cartilage in patellofemoral pain. The Orthopedic clinics of North America 1986. link 40 Le Jeune JJ, Rochcongar P, Vazelle F, Bernard AM, Herry JY, Ramée A. Pubic pain syndrome in sportsmen: comparison of radiographic and scintigraphic findings. European journal of nuclear medicine 1984. link 41 Waisbrod H, Treiman N. Anterior displacement of tibial tuberosity for patellofemoral disorders: a preliminary report. Clinical orthopaedics and related research 1980. link 42 Kummel BM. The treatment of patellofemoral problems. Primary care 1980. link 43 Pevsner DN, Johnson JR, Blazina ME. The patellofemoral joint and its implications in the rehabilitation of the knee. Physical therapy 1979. link 44 Dehaven KE, Dolan WA, Mayer PJ. Chondromalacia patellae in athletes. Clinical presentation and conservative management. The American journal of sports medicine 1979. link

    Original source

    1. [1]
      Hyaluronic acid and chondroitin sulphate instillation in chronic bladder diseases: a meta-analysis. — Corona G, Capogrosso P, Baldini S, Rastrelli G, Vignozzi L, Romero-Otero J et al. BJU international (2026)
    2. [2]
      Interventional pain treatment in radiology: An overview of practical approaches. — Rauch M, Hattingen E Clinical imaging (2025)
    3. [3]
      Swedish massage for shoulder function and postmastectomy pain syndrome: randomised controlled trial. — Rostami Z, Azizzadeh Forouzi M, Faris Abdulghani M, Mangolian Shahrbabaki P, Canillas-Dufau T, Dehghan M BMJ supportive & palliative care (2025)
    4. [4]
      Nonpharmacological Interventions for Postmastectomy Pain Syndrome-A Systematic Review of the Literature. — Gónima Valero E, Rodríguez Miranda CD, Contreras Arrieta S, Daza Morelli MI, Seija Butnaru D, Reyes Carrillo M et al. Clinical breast cancer (2025)
    5. [5]
      Core Training for Pain Management and Functional Improvement in Patients With Patellofemoral Pain Syndrome: A Systematic Review and Meta-analysis. — Wang Y, Li H, Zhang D, Zhao T, Liu Z, Chen J et al. American journal of physical medicine & rehabilitation (2024)
    6. [6]
      Preoperative Counseling in Spinal Cord Stimulation: A Designated Driver in Implantable Pulse Generator-Related Inconveniences? — Kurt E, Kollenburg L, Joosten S, van Dongen R, Engels Y, Henssen D et al. Neuromodulation : journal of the International Neuromodulation Society (2024)
    7. [7]
      Do biomechanical foot-based interventions reduce patellofemoral joint loads in adults with and without patellofemoral pain or osteoarthritis? A systematic review and meta-analysis. — Kayll SA, Hinman RS, Bryant AL, Bennell KL, Rowe PL, Paterson KL British journal of sports medicine (2023)
    8. [8]
      Spinal Cord Stimulation With Additional Peripheral Nerve/Field Stimulation Versus Spinal Cord Stimulation Alone on Back Pain and Quality of Life in Patients With Persistent Spinal Pain Syndrome. — van Heteren EPZ, van Roosendaal BWP, van Gorp EJAA, Bronkhorst EM, Kallewaard JW, Wegener JT et al. Neuromodulation : journal of the International Neuromodulation Society (2023)
    9. [9]
      The therapeutic effect of Värska mud and Värska mineral water baths on the overuse pain and muscle tension syndromes in the working age population. — Tuulik VR, Kumm M, Tuulik V, Veraksitš A, Päll T Environmental geochemistry and health (2022)
    10. [10]
      Bilateral ultrasound findings in patients with unilateral subacromial pain syndrome. — Eliason A, Harringe M, Engström B, Sunding K, Werner S Physiotherapy theory and practice (2022)
    11. [11]
      Changes in quantitative sensory testing and patient perspectives following spinal cord stimulation for persistent spinal pain syndrome: An observational study with long-term follow-up. — Plantaz YJGM, van Dongen RTM, Witkam RL, Vissers KCP, Timmerman H European journal of pain (London, England) (2022)
    12. [12]
      Editorial Commentary: Does Patellofemoral Degenerative Progression After Open-Wedge High Tibial Osteotomy Adversely Affect Clinical Outcomes? — Goshima K Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association (2019)
    13. [13]
      Appropriate care for orthopedic patients: effect of implementation of the Clinical Practice Guideline for Diagnosis and Treatment of Subacromial Pain Syndrome in the Netherlands. — Veen EJD, Stevens M, Koorevaar CT, Diercks RL Acta orthopaedica (2019)
    14. [14]
      Subcutaneous Botulinum Toxin Injection for Post-Thoracotomy Pain Syndrome in Palliative Care: A Case Report. — Rashid S, Fields AR, Baumrucker SJ The American journal of hospice & palliative care (2018)
    15. [15]
      It is Electric! Electroconvulsive Therapy for Refractory Central Pain and Comorbid Psychiatric Disease. — Strand JJ, Warner LL, Kamdar MM, Flaherty AW, Jackson VA Journal of palliative medicine (2018)
    16. [16]
      Variable criteria for patellofemoral bracing among sports medicine professionals. — Solinsky R, Beaupre GS, Fredericson M PM & R : the journal of injury, function, and rehabilitation (2014)
    17. [17]
      Shoulder diagnoses in secondary care, a one year cohort. — Juel NG, Natvig B BMC musculoskeletal disorders (2014)
    18. [18]
      Severe throat pain in patients with negative oropharyngeal examination: four case reports and overview of the literature. — Peltekis G, Palaskas D, Anyfantakis D, Symvoulakis EK, Kyrmizakis DE Folia medica (2012)
    19. [19]
      Differences in patellofemoral kinematics between weight-bearing and non-weight-bearing conditions in patients with patellofemoral pain. — Draper CE, Besier TF, Fredericson M, Santos JM, Beaupre GS, Delp SL et al. Journal of orthopaedic research : official publication of the Orthopaedic Research Society (2011)
    20. [20]
      Sex differences in force attenuation: a clinical assessment of single-leg hop performance on a portable force plate. — Harrison AD, Ford KR, Myer GD, Hewett TE British journal of sports medicine (2011)
    21. [21]
      Relationship among eccentric hip and knee torques, symptom severity and functional capacity in females with patellofemoral pain syndrome. — Nakagawa TH, Baldon Rde M, Muniz TB, Serrão FV Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine (2011)
    22. [22]
      Bladder Pain Syndrome Committee of the International Consultation on Incontinence. — Hanno P, Lin A, Nordling J, Nyberg L, van Ophoven A, Ueda T et al. Neurourology and urodynamics (2010)
    23. [23]
      What is new in bladder pain syndrome/interstitial cystitis? — Hanno P, Nordling J, van Ophoven A Current opinion in urology (2008)
    24. [24]
      Patellar taping, patellofemoral pain syndrome, lower extremity kinematics, and dynamic postural control. — Aminaka N, Gribble PA Journal of athletic training (2008)
    25. [25]
      The role of the pain psychologist, trigger point injections, reflex sympathetic dystrophy. — Fishman SM Journal of pain & palliative care pharmacotherapy (2006)
    26. [26]
      Suspected central anticholinergic syndrome in a 6-week-old infant. — Kulka PJ, Toker H, Heim J, Joist A, Jakschik J Anesthesia and analgesia (2004)
    27. [27]
      Undiagnosed central anticholinergic syndrome may lead to dangerous complications. — Katsanoulas K, Papaioannou A, Fraidakis O, Michaloudis D European journal of anaesthesiology (1999)
    28. [28]
      CT and MRI of pelvic varices in women. — Coakley FV, Varghese SL, Hricak H Journal of computer assisted tomography (1999)
    29. [29]
      Effect of barbiturate on central pain: difference between intravenous administration and oral administration. — Koyama T, Arakawa Y, Shibata M, Mashimo T, Yoshiya I The Clinical journal of pain (1998)
    30. [30]
      Pelvic pain syndrome caused by ovarian varices. Treatment by transcatheter embolization. — Tarazov PG, Prozorovskij KV, Ryzhkov VK Acta radiologica (Stockholm, Sweden : 1987) (1997)
    31. [31]
      Vestibulodynia--a subset of vulvar vestibulitis or a novel syndrome? — Bornstein J, Zarfati D, Goldshmid N, Stolar Z, Lahat N, Abramovici H American journal of obstetrics and gynecology (1997)
    32. [32]
      Bilateral central pain. — Canavero S Acta neurologica Belgica (1996)
    33. [33]
      Transcranial magnetic coil stimulation of motor cortex in patients with central pain. — Migita K, Uozumi T, Arita K, Monden S Neurosurgery (1995)
    34. [34]
      A new approach to control central deafferentation pain: spinal intrathecal baclofen. — Taira T, Kawamura H, Tanikawa T, Iseki H, Kawabatake H, Takakura K Stereotactic and functional neurosurgery (1995)
    35. [35]
      Distal realignment of the patellofemoral joint. Indications, effects, results, and recommendations. — Post WR, Fulkerson JP The Orthopedic clinics of North America (1992)
    36. [36]
      Diagnosis of patellofemoral pain syndrome. — Heath C, Murtagh J Australian family physician (1990)
    37. [37]
      Central pain complicating infarction following subarachnoid haemorrhage. — Bowsher DR, Foy PM, Shaw MD British journal of neurosurgery (1989)
    38. [38]
      After failure of conservative treatment for painful patellofemoral malalignment: lateral release or realignment? — Fulkerson JP, Schutzer SF The Orthopedic clinics of North America (1986)
    39. [39]
      The role of articular cartilage in patellofemoral pain. — Chrisman OD The Orthopedic clinics of North America (1986)
    40. [40]
      Pubic pain syndrome in sportsmen: comparison of radiographic and scintigraphic findings. — Le Jeune JJ, Rochcongar P, Vazelle F, Bernard AM, Herry JY, Ramée A European journal of nuclear medicine (1984)
    41. [41]
      Anterior displacement of tibial tuberosity for patellofemoral disorders: a preliminary report. — Waisbrod H, Treiman N Clinical orthopaedics and related research (1980)
    42. [42]
      The treatment of patellofemoral problems. — Kummel BM Primary care (1980)
    43. [43]
      The patellofemoral joint and its implications in the rehabilitation of the knee. — Pevsner DN, Johnson JR, Blazina ME Physical therapy (1979)
    44. [44]
      Chondromalacia patellae in athletes. Clinical presentation and conservative management. — Dehaven KE, Dolan WA, Mayer PJ The American journal of sports medicine (1979)
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