Clinical Manifestations Related to Thalamus Site in Intracerebral Hemorrhage

Currently, a multistep pharmacologic approach is endorsed by some experts specializing in CPSP treatment; however, no trials are yet published, supporting a polypharmacy algorithm. Some pain physicians advocate tricyclic antidepressants and gabapentin as first-line treatment. If improvement in pain intensity is not seen and the pain has a shooting characteristic, then anticonvulsants, such as carbamazepine, are added to the medication regimen. The timing of incorporation of opioids must be tailored to individual patient risk factors for drug-dependent behavior.

Invasive procedures include deep brain, spinal cord, motor cortex stimulation, and various ablative approaches are reported in small series with modest and, unfortunately, often short-lived therapeutic benefit. Patients with CPSP sometimes also benefit from psychologic treatment addressing chronic pain behaviors, and the poststroke rehabilitation seems to be of utmost importance in this group of patients.

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