Central neuropathic pain arises from a lesion or disease of the central somatosensory nervous system such as brain injury, spinal cord injury, stroke, multiple sclerosis or related neuroinflammatory conditions. The incidence of central neuropathic pain differs based on its underlying cause. Individuals with spinal cord injury are at the highest risk; however, central post-stroke pain is the most prevalent form of central neuropathic pain worldwide. The mechanisms that underlie central neuropathic pain are not fully understood, but the pathophysiology likely involves intricate interactions and maladaptive plasticity within spinal circuits and brain circuits associated with nociception and antinociception coupled with neuronal hyperexcitability. Modulation of neuronal activity, neuron–glia and neuro-immune interactions and targeting pain-related alterations in brain connectivity, represent potential therapeutic approaches. Current evidence-based pharmacological treatments include antidepressants and gabapentinoids as first-line options. Non-pharmacological pain management options include self-management strategies, exercise and neuromodulation. A comprehensive pain history and clinical examination form the foundation of central neuropathic pain classification, identification of potential risk factors and stratification of patients for clinical trials. Advanced neurophysiological and neuroimaging techniques hold promise to improve the understanding of mechanisms that underlie central neuropathic pain and as predictive biomarkers of treatment outcome.

中枢神经性疼痛由中枢体感神经系统的病变或疾病引起，例如脑损伤、脊髓损伤、中风、多发性硬化症或相关的神经炎症病症。中枢神经性疼痛的发病率因其根本原因而异。脊髓损伤患者的风险最高；然而，中枢性中风后疼痛是全世界最普遍的中枢神经性疼痛形式。中枢神经性疼痛的机制尚不完全清楚，但病理生理学可能涉及脊髓回路和与伤害感受和抗伤害感受以及神经元过度兴奋相关的大脑回路内复杂的相互作用和适应不良可塑性。调节神经元活动、神经元-胶质细胞和神经-免疫相互作用以及针对与疼痛相关的大脑连接改变，代表了潜在的治疗方法。目前基于证据的药物治疗包括抗抑郁药和加巴喷丁类药物作为一线选择。非药物疼痛管理选择包括自我管理策略、锻炼和神经调节。全面的疼痛病史和临床检查构成了中枢神经病理性疼痛分类、潜在危险因素识别和临床试验患者分层的基础。先进的神经生理学和神经影像技术有望提高对中枢神经病理性疼痛机制的理解，并作为治疗结果的预测生物标志物。