Thalamic Pain Syndrome

Thalamic pain syndrome, also known as central poststroke pain or historically Dejerine-Roussy syndrome, is a common yet challenging consequence of cerebrovascular accidents (CVA). This condition involves centralized, neuropathic pain often exacerbated by temperature changes and is characterized by symptoms, eg, hyperalgesia and allodynia. Although as many as 8% of stroke patients may develop this syndrome, diagnosis can be difficult. The onset of symptoms typically occurs well after the initial stroke event, sometimes delaying significant pain for months or even years. Thalamic pain syndrome specifically pertains to pain that stems from damage to the thalamus area poststroke, a subset of the broader category of central poststroke pain, which involves injury to the spinothalamic tract. Research on thalamic pain syndrome remains limited, and the diagnosis should be considered in patients with a history of chronic centralized pain and a prior CVA. Treatment options are few and vary in effectiveness, ranging from neuropathic pain medications and opioid analgesics to more invasive techniques, eg, deep brain stimulation, surgery, and neuromodulation. Given the complex nature of thalamic pain syndrome, management typically requires an interprofessional approach involving neurologists, pain medicine specialists, or neurosurgeons. The prognosis for this condition is generally guarded, emphasizing the need for healthcare practitioners to include thalamic pain syndrome in their differential diagnosis when evaluating patients with poststroke neuropathic pain symptoms. Alternative and integrative treatment approaches are also recommended to enhance pain management and improve quality of life.