Thalamic Pain Syndrome

The thalamus is the part of the brain where many different functions are carried out. The thalamus acts as a relay center in the brain where various impulses come and go to and from different parts of the body. The thalamus is responsible for regulating sleep and wakefulness levels of the person. One of the common pathologies that can affect the thalamus function is a stroke, which is nothing but decreased amount of blood supply to this portion of the brain, which may lead to infarction of that region of the brain. More often than not, a person manages to recover from a stroke but then, a small percentage of people land with what is known as thalamic pain syndrome. Given below are details regarding this condition.

Causes
The exact etiology of thalamic pain syndrome is not known and it is not known as to why only a few people who have suffered from a stroke end up suffering from this condition, also known as 'Dejerine-Roussy disease', named after Joseph Dejerine, a neurologist and Gustave Roussy, a neuropathologist. It is seen that an initial stroke to the region of the thalamus may lead to loss of sensation or disturbed sensation in the opposite side of the body (as the right side of the brain controls the left side of the body and vice versa). Hence, initially, when the stroke recovery takes place, the person still feels pain. And if this pain persists for weeks or even months after the stroke, then it is indicative of post thalamic pain syndrome.

Symptoms
Initially, the symptoms may include pain and slight stinging sensation, which may occur in one part of, or throughout the entire body. While this pain may initially be mild and stinging in nature, it often eventually transgresses into severe and unbearable pain, mimicking stroke symptoms. This pain may be present at all times as a dull and gnawing pain and at times, it may become severe and unbearable. The nature of pain varies from person to person; while some people claim that this pain is lancinating and throbbing in nature, others complain of a burning sensation. This pain or may not be due to a stimulus, like touch or rubbing of clothes.

Treatment
The sad part is that thalamic pain syndrome symptoms may improve over the course of time, however, more often than not, the syndrome and the pain associated with it is permanent. Thus, the course of treatment is a prolonged one, where trial and error is the only way to go. Due to the nature of the pain, usual pain killers are not strong enough to bring about any kind of substantial relief. Hence, these analgesics are usually combined with narcotics, although off late, epileptic drugs have also shown encouraging results. In severe cases, where the pain is absolutely unrelenting, more severe and invasive pain management options can also be tried out, like pumps that are implanted directly in the spinal cord and which deliver medication there, surgical destruction of a portion of the thalamus, or deep brain stimulation. None of these treatments guarantee results and the outcome and degree of relief obtained has been different for different patients who have undergone these treatments.

Equally difficult as the treatment is establishing a diagnosis of this condition. This is usually done by an expert neurologist who has treated many patients who have suffered from a stroke. This is a condition that is relatively rare but statistics do not matter to a patient that is suffering from this debilitating disease. Hence, when people with a history of strokes present with these symptoms, thalamic pain syndrome must be considered as a possible diagnosis.