Symptoms and Treatment of Thalamic Pain Syndrome

Thalamic pain syndrome is a clinical condition that usually manifests with chronic pain and other sensory disturbances.

Today’s article will discuss thalamic pain syndrome. Although you may not be aware of it, the thalamus is one of the most studied brain structures. This is because it performs many important functions. In addition, the thalamus is a crossroads of neural pathways.

Furthermore, a lesion in this structure can lead to a thalamic syndrome, a clinical picture of a low frequency of occurrence that mainly afflicts the elderly. You’re about to learn what it is and the consequences it entails.

Symptoms of thalamic pain syndrome

Thalamic pain syndrome, also known as Déjerine-Roussy syndrome, was first described in 1903. Its main characteristics are various signs and symptoms. Tingling sensations and numbness in parts of the body, loss of tactile sensation or hypersensitivity to environmental stimuli, total or partial paralysis, and involuntary movements among them.

Long-lasting, intense pain is often present as a symptomatic component of this syndrome.

The most common symptoms of thalamic pain syndrome are:

• Intense and persistent pain in the extremities.
• Stimuli such as emotional stress, superficial touch, or cold or warm temperatures often trigger the exacerbated painful sensation.
• The reaction to pain is often exaggerated, even to stimuli that usually leads to no physical harm.
• Weakness or paralysis in the affected limbs.
• Abnormal involuntary movements.
• Loss of the sense of position, characterized, above all, by difficulty in locating the specific position of a limb.

Common causes

One of the most common causes of this syndrome is the irruption of the blood flow that provides the necessary nutrients to maintain cells alive. This lack of irrigation could be due to the blockage or rupture of a vessel that nourishes the thalamus. In addition, perhaps a different expansive process has cut off the flow, by pressure, of any of the vessels responsible for supplying blood to the thalamus.

Some lesions of the thalamus are of a different nature though, such as those of metabolic or neoplastic origin, which also cause thalamic pain syndrome.

Furthermore, some factors may predispose a person to cerebral infarction and increase their probabilities of thalamic pain syndrome, such as:

• Cardiac arrhythmias.
• Arterial hypertension.
• High levels of bad cholesterol.
• Sedentary lifestyle.
• Genetic predisposition.

In most cases, the diagnosis of thalamic pain syndrome happens through a process of exclusion diagnosis. Those with a history of cerebrovascular events with pain or abnormal sensations must endure an exhaustive process of elimination of possible sources of pain.

Then, the physician may diagnose thalamic pain syndrome with greater certainty if there’s no other explanation for the presence of pain. However, they must support this diagnosis through neuroimaging studies.

Treatment

After assuring the survival of an individual, the first line of treatment is symptomatic. The goal is to address the secondary symptoms of this condition, mostly sensory and motor disturbances.

Regarding the pharmacotherapy approach, the most frequently used drugs are:

• Opioids.
• Antidepressants.
• Anticonvulsants.
• Topical pain medications.

The use of electrode implantation to stimulate the affected regions is currently under investigation and so are spinal cord stimulation techniques.

As far as preventive measures are concerned, there are currently no truly effective techniques to avoid thalamic pain syndrome. However, one can adopt some measures to manage any predisposing factors. These are generally related to lifestyle and general health.

In most cases, the main determinant of the prognosis of this disease is the severity of the lesion. It’s usually a neurological problem that can be palliated but not completely resolved. Thus, it’s often necessary to adhere to lifelong analgesic drug treatments.

Thalamic pain syndrome is equally likely to occur in males and females

In general terms, some of the most serious complications of thalamic pain syndrome are related to quality of life. Chronic pain often remains as a residual symptom, along with hypersensitivity to touch and other external stimuli, which significantly leads to discomfort in an affected person.