The diagnosis of central poststroke pain (CPSP) can be quite difficult because there are no pathognomonic features, uniform signs, or diagnostic tests, and CPSP can mimic other pain syndromes. This chapter presents the theories on the pathophysiology of complex condition and provides guidance for CPSP treatment, including pharmacologic and nonpharmacologic approaches. It provides a framework for diagnosis and management, with a menu of treatment options. There are reports that damage to the lateral medulla or posterolateral thalamus leads to the development of CPSP with a higher frequency than does damage to other structures. The differential diagnosis for CPSP includes, but is not limited to, complex regional pain syndrome (CRPS), radiculopathy, plexopathy, peripheral mononeuropathy, hemiparetic shoulder pain (HSP), deep venous thrombosis (DVT), and conversion disorder. Deep brain stimulation for CPSP has been explored, but there is conflicting evidence with regard to efficacy.