Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Review Article Volume 3 Issue 8

Centralized Pain: Status Review and Medical Management

Ihsan F Shanti1, Bilal F Shanti2*, Ali Otom3, Ali Al Rjoub4 and Khalil Al-Abbadi5

1The American Clinic for Interventional Pain and Spine, Amman, Jordan
2Omnia Pain Consultants, Pain Medicine, Phoenix, Arizona, USA
3Royal Specialty Center for Spine and Musculoskeletal Disorders, Amman, Jordan
4Department of Physical Medicine and Rehabilitation, Al Bashir Hospital, Amman, Jordan
5Senior Consultant, Physical Medicine and Neurorehabilitation, Amman, Jordan

*Corresponding Author: Bilal F Shanti, Omnia Pain Consultants, Pain Medicine, Phoenix, Arizona, USA.

Received: June 20, 2020; Published: July 30, 2020



 Centralized pain is non-fatal disorder linked to permanent changes and chaotic imprinting of pain inputs within the central nervous system. This occurs without obvious logical reasons that we know of. This persistent heightened alert of the nervous system is very exhausting to the patients and their families. The magnitude of other symptom comorbidities makes this pain entity even more challenging to diagnose and treat. Fortunately, recent research discoveries have introduced a few theories such the concept of glial activation and neuroinflammation as having some plausible role in this complex syndrome. This review manuscript will seek to explain and simplify some of the non-procedural clinical medical management options available to date, as tools for us, clinicians, to fight this painful entity.

Keywords: Centralized Pain; Central Nervous System (CNS); Amino Acids



  1. Jay W. “Classic central pain syndrome: review of neurologic causes of pain”. Practical Pain Management7 (2012): 48-63.
  2. Henry DE., et al. “Central nervous system reorganization in a variety of chronic pain states: a review”. PMR12 (2011): 1116-1125.
  3. Tennant F. “The Critical Necessity to Diagnose Pain That Is Centralized”. Practical Pain Management3 (2012).
  4. Tennant F. “Glial Cell Activation and Neuroinflammation: How They Cause Centralized Pain”. Practical Pain Management5 (2014).
  5. May A. “Chronic pain may change the structure of the brain”. Pain1 (2008): 7-15.
  6. Latremoliere A and Woolf CJ. “Central sensitization: a generator of pain hypersensitivity by central neural plasticity”. Journal of Pain9 (2009): 895-926.
  7. Urban MK. “COX-2 specific inhibitors offer improved advantages over traditional NSAIDS”. Orthopedics23 (2000): S761-764.
  8. Finnerup NB. “Anticonvulsants in central pain”. Expert Opinion on Pharmacotherapy10 (2002): 1411-1420.
  9. Kim JS. “Post-stroke pain”. Expert Review of Neurotherapeutics5 (2009): 711-721.
  10. Malanga G. “Update on Tizanidine For Muscle Spasticity and Emerging Indications”.Expert Opinion on Pharmacotherapy12 (2008): 2209-2215.
  11. Natale M. “Long-term effects of intrathecal baclofen in multiple sclerosis”. Clinical Neurology and Neurosurgery143 (2016): 121-125.
  12. McCormick ZL. Intrathecal Versus Oral Baclofen: A Matched Cohort Study of Spasticity, Pain, Sleep, Fatigue, and Quality of Life”. PM&R6 (2016): 553-562.
  13. Zucchi, R., et al. “The sarcoplasmic reticulum Ca2+ channel/ryanodine receptor: modulation by endogenous effectors, drugs and disease states”. Pharmacological reviews1 (1997): 1–51.
  14. Shakespeare DT., et al. “Anti-spasticity agents for multiple sclerosis”. The Cochrane Database of Systematic Reviews4 (2000): CD001332.
  15. Gold R., et al. “Advances in the management of multiple sclerosis spasticity: multiple sclerosis spasticity guidelines”. Expert Review of Neurotherapeutics. 13 (2013): 55-59.
  16. Intiso D., et al. “Botulinum Toxin Type A for the Treatment of Neuropathic Pain in Neuro-Rehabilitation”. Toxins (Basel). 7.7 (2015): 2454-2480.
  17. Alviar MJ., et al. “Pharmacologic interventions for treating phantom limb pain”.The Cochrane Database of Systematic Reviews10 (2016): CD006380.
  18. Kumar A., et al. “Clonidine for management of chronic pain: A brief review of the current evidences”.Saudi Journal ofAnaesthesia1 (2014): 92-96.
  19. Motsch J., et al. “Alpha 2-adrenergic agonists. Use in chronic pain--a meta-analysis”. Schmerz5 (1997): 339-344.
  20. Mease PJ. Further strategies for treating fibromyalgia: the role of serotonin and norepinephrine reuptake inhibitors”.American Journal of Medicine 122 (2009): S44-55.
  21. Moore RA., et al. “Amitriptyline for neuropathic pain in adults”.The Cochrane Database of Systematic Reviews7 (2015): CD008242.
  22. Nijs J., et al. “Treatment of central sensitization in patients with 'unexplained' chronic pain: an update”.Expert Opinion on Pharmacotherapy12 (2014): 1671-1683.
  23. Mika J., et al. “Neuronal and immunological basis of action of antidepressants in chronic pain - clinical and experimental studies”.Pharmacology Report6 (2013): 1611-21.
  24. Dharmshaktu P., et al. “Efficacy of antidepressants as analgesics: a review”. Journal of Clinical Pharmacology1 (2012): 6-17.
  25. Verdu B., et al. “Antidepressants for the treatment of chronic pain”. Drugs18 (2008): 2611-2632.
  26. Arnold LM. “Duloxetine and other antidepressants in the treatment of patients with fibromyalgia”. Pain Medicine (2007): S63-74.
  27. Krusz JC. “IV Treatment of Centralized Pain and Headache”. Practical Pain Management8 (2016).
  28. Kvarnström A., et al. “The analgesic effect of Intravenous ketamine and Lidocaine on Pain after Spinal Cord Injury”.Acta Anaesthesiologica Scandinavica 4 (2004): 498-506.
  29. Morel V., et al. “Low doses of dextromethorphan have a beneficial effect in the treatment of neuropathic pain”.Fundamental Clinical Pharmacology6 (2014): 671-680.
  30. Prommer E. “Ziconotide: a new option for refractory pain”. Drugs Today (Barc). 42.6 (2006): 369-78.
  31. Schmidtko A., et al. “Ziconotide for Treatment of Severe Chronic Pain”. Lancet9725 (2010): 1569-1577.
  32. Sanford M. “Intrathecal ziconotide: a review of its use in patients with chronic pain refractory to other systemic or intrathecal analgesics”. CNS Drugs11 (2013): 989-1002.
  33. Tennant F. “Ultra-high Dose Opioid Therapy: Uncommon and Declining, But Still Needed”. Practical Pain Management4 (2013).
  34. Tennant F. “Don't Flinch From Prescribing Pain Medications!”.Practical Pain Management3 (2016).
  35. Haroutiunian S., et al. “Methadone for chronic non-cancer pain in adults”.The Cochrane Database of Systematic Reviews 11 (2012): CD008025.
  36. Geneen LJ., et al. “Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews”.The Cochrane Database of Systematic Reviews1 (2017): CD011279.
  37. Nijs J., et al. “Dysfunctional endogenous analgesia during exercise in patients with chronic pain: to exercise or not to exercise?”Pain Physician15 (2012): ES205-213.
  38. Erlemans HM., et al. “Pain and reduced mobility in complex regional pain syndrome I: outcome of a prospective randomized controlled clinical trial of adjuvant physical therapy versus occupational therapy”. Pain83 (1999): 77-83.
  39. Van de Meent H., et al. “Safety of “pain exposure” physical therapy in patients with complex regional pain syndrome type 1”. Pain152 (2011): 1431-1438.
  40. , et al. “Complex regional pain syndrome: an optimistic perspective. Views and reviews”.Neurology (2015): P89-96.
  41. Tian GH., et al. “Electroacupuncture Treatment Alleviates Central Poststroke Pain by Inhibiting Brain Neuronal Apoptosis and Aberrant Astrocyte Activation”. Neural Plasticity (2016): 1437148.
  42. Zhao ZQ. “Neural mechanism underlying acupuncture analgesia”. Progress in Neurobiology4 (2008): 355-375.
  43. Martin DP., et al. “Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial”. Mayo Clinic Proceedings 6 (2006): 749-757.
  44. Backus D., et al. “Impact of Massage Therapy on Fatigue, Pain, and Spasticity in People with Multiple Sclerosis: a Pilot Study”. The International Journal of Therapeutic Massage and Bodywork 4 (2016): 4-13.
  45. Lovas J., et al. “Managing pain and fatigue in people with spinal cord injury: a randomized controlled trial feasibility study examining the efficacy of massage therapy”. Spinal Cord (2016).
  46. Hilton L., et al. “Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis”. Annals of Behavioral Medicine 51 (2017): 199-213.
  47. Hassed C.“Mind-body therapies--use in chronic pain management”. Australian Family Physician77 (2012): 237-46.
  48. Tsao J. “Current Treatments for Phantom Limb Pain”. Practical Pain Management5 (2011).


Citation: Bilal F Shanti., et al. “Centralized Pain: Status Review and Medical Management". Acta Scientific Neurology 3.8 (2020): 16-23.


Acceptance rate32%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is May 30, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US