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Thalamic Syndrome - CPSP - what's the difference

Nige

I have found a paper which records how the term used to describe central neuropathic pain following a stroke changed over time.

Le syndrome thalamique was identified in 1906 and a paper published in 1907. At that time and the experiments carried out were all focussed on strokes in the thalamus, hence thalamic pain was thought to be the only cause of this pain type, perfectly reasonable. Central pain wasn’t identified until much later. It was identified that central pain could arise due to damage along the spinothalamocortical tract not just restricted to the thalamus. So thalamic pain was no longer suitable as a one word capture all. Thalamic syndrome is therefore one type of central stroke pain. Cpsp or Central Post Stroke Pain exists as a term from the 1950s.
Thalamic pain doesn’t cover all types of cpsp but CPSP does include thalamic syndrome amongst other drivers of the pain. I cannot find the previous paper but from memory I think CPSP arises about 30% of the time from thalamus damage, it is the single biggest cause.

Simon

Nige

I am constantly surprised that discussion of everything stroke still refers to the damaged location within the brain.

the medical profession isn’t very knowledgeable about how the brain works
But
It does know that there are several key networks and many subsidiary networks.

It seems therefore bloody obvious to me that post stroke deficiencies are attributable to networks that are no longer functioning as they should.
Since the physical locations participate in the correct operation of many networks then stroke characteristics could and I feel should be referred to and explicitly linked to the networks that have been damaged and No longer direct function correctly and NOT the areas that have been damaged.
This continuing miss application of model is obscuring the discussion of the correct cause and effect linkages.

I feel that if intellectual effort was applied to the correct underlying model insights than we would surface correlations and progress would be speeded

I think it was Einstein who said the trouble with learning is what I already know. An example that has stuck with me for a long time is that the geocentric view of the earth that the Roman Catholic church held until middle of last century was sufficient to grow crops. It was insufficient for global navigation. That had to change to a heliocentric model which still grew crops but religious doctrine suppressed for a couple of hundred years beyond the pointer which it was scientifically irrefutable

🙁

Nige

Simon people do not like change ?
For people in power, like the church, if you were wrong about this, maybe your are wrong about other things ? What if …….

Nige

Simon on the network point, absolutely, end to end it isn’t working correctly. There does seem to be a bit of doubt though as to why that might be.
If a damaged thalamus is sending some element of touch, temperature signals to the pain receptors and the body might be requesting signals at higher volume, both of those combined are leading to severe pain and an increase of it.
If you are in pain, the body tenses instantly ready for fight or flight. Its on high alert,firing signals around the body like a coiled spring just waiting for a trigger. The body might well move before any critical brain evaluation.

If I was to guess what’s happening, perhaps as the pain hasn’t gone away, the body will amplify it, trying to force you to react. Fight it or flee it, decision needed, yet you can do neither.

Nige

Simon

Nige
I fully agree this is a hypothesis that accounts for known facts.

I suspect that the fact that we can construct it suggests others with greater training in the relevant areas could also construct it and then refine it and then use quality control processes to confirm or deny elements of the mechanisms.

What I’m surprised by is that we don’t see evidence of that process in the published works.

I’m questioning therefore whether our understanding of disciplines outside of medicine brings insight to processes that are not used but could be used beneficially

This is why I think we should have some outreach as a shared voice.

I think my poster words for ELASF 25 Should have an extra sentence to highlight this potential.

I also think that once again it is an area where we see that the stroke association does not have the mechanisms to be heard by those with the knowledge and motivation to elevate concerns of that affect many who are less able to represent themselves.

@Andrew This might be a better way of expressing the bit you and I were uncomfortable about the phrasing of?

Caio
Simon

Nige

Simon For all of the experts, not one can actually feel what we feel. They are at a disadvantage and must rely on the power of description. By its nature, you have to use something that you think the other person would know how it feels. If I describe the pain round my eye, I say it’s like it’s been rubbed by a nettle. Or that it’s like bad sunburn. Does it actually feel like a nettle sting ? No, it’s not quite as sharp. It like a very fast burning pain but how many people have experienced that, pretty much no one.
I suspect that might be why terms like pins and needles might be used. I would be interested to know if anyone with cpsp would use that term ?
I know I wouldn’t.

Simon

Nige

Let’s start a convo with links back to here on the pain network.

I searched CPSP and didn’t get a single hit !!!!!

Comparison to them you’ve created a great deal more info!
We should sign post it 🙂

3¢

Scroll-Me :)\<-&->


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