title: Analgesia in conjunction with normalisation of thermal sensation following deep brain stimulation for central post-stroke pain.
abstract: The aetiology of central post-stroke pain (CPSP) is poorly understood and such pains are often refractory to treatment. We report the case of a 56-year-old man, who, following a temporo-parietal infarct, suffered from debilitating and refractory hemi-body cold dysaesthesia and severe tactile allodynia. This was associated with thermal and tactile hypoaesthesia and hypoalgesia on his affected side. Implantation of a deep brain stimulating electrode in his periventricular gray (PVG) region produced an improvement in his pain that was associated with a striking normalisation of his deficits in somatosensory perception. This improvement in pain and thermal sensibility was reversed as stimulation became less effective, because of increased electrode impedance. Therefore, we postulate that the analgesic benefit may have occurred as a consequence of the normalisation of somatosensory function and we discuss these findings in relation to the theories of central pain generation and the potential to engage useful plasticity in central circuits.
authors.affiliation: Department of Physiology and Pharmacology, School of Medical Sciences, University of Bristol, Bristol, UK. Tony.Pickering@Bristol.ac.uk
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Pickering
authors.forename: Simon R
authors.initials: SR
authors.lastname: Thornton
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Love-Jones
authors.forename: Charlotte
authors.initials: C
authors.lastname: Steeds
authors.forename: Nikunj K
authors.initials: NK
authors.lastname: Patel
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology*; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods; D017288:Pain Threshold / Q000502:physiology; D010812:Physical Stimulation / Q000379:methods; D020521:Stroke / Q000150:complications*; D013697:Thermosensing / Q000502:physiology*