Defining post-stroke pain: diagnostic challenges – Authors' reply

Abstract

In their thoughtful letter, Roosink and colleagues raise the point that central pain mechanisms might be overlooked in patients with stroke who have pain if our proposed definition for central post-stroke pain (CPSP) is used. The essential point here is how we define central pain mechanisms. It is important to distinguish between central neuropathic pain and central mechanisms. When the nociceptive system is activated, physiologically short-lasting neuroplastic changes occur in the CNS. In persistent pain disorders, the molecular and cellular changes are more profound and sometimes irreversible, whether due to inflammation or a lesion of the nervous system.