Thalamic pain syndrome

Central pain syndrome

Lacunar stroke
Involves ventrocaudal thalamic area
Contralateral sensory loss
Face, arms, leg
All sensory modalities
Later lead to long term chronic central Thalamic pain
Severe pain in paroxysms or exacerbated by touch
Rx: amitriptyline, Lamotrigine, Mexiletine, gabapentin, Pregablin, Lidocaine.
Opioids are not effective.