Phantom limb pain: a case of maladaptive CNS plasticity?

  title={Phantom limb pain: a case of maladaptive CNS plasticity?},
  author={Herta Flor and Lone Nikolajsen and Troels Staehelin Jensen},
  journal={Nature Reviews Neuroscience},
Phantom pain refers to pain in a body part that has been amputated or deafferented. It has often been viewed as a type of mental disorder or has been assumed to stem from pathological alterations in the region of the amputation stump. In the past decade, evidence has accumulated that phantom pain might be a phenomenon of the CNS that is related to plastic changes at several levels of the neuraxis and especially the cortex. Here, we discuss the evidence for putative pathophysiological mechanisms… 

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  • H. Flor
  • Psychology, Biology
    Expert review of neurotherapeutics
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Behavioral interventions, stimulation, feedback, feedback and pharmacological interventions that are designed to reverse these maladaptive memory traces and enhance extinction may be beneficial for the treatment and prevention of phantom limb pain.

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    Experimental neurobiology
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Recent progresses of the cortical plasticity in the anterior cingulate cortex (ACC), a critical cortical area for pain sensation, are reviewed and how they are related to abnormal sensory sensations such as phantom pain are explored.

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The EU consortium ‘EPIONE’ will challenge the status-quo of PLP treatment by actively creating natural, meaningful sensations that will restore the neuroplastic changes in the cortex and thereby control and alleviate pain.

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The pathophysiology of phantom limb pain is complex and includes changes in the peripheral nerve, the dorsal root ganglia, spinal cord and cerebral cortex, and just a few treatments have good quality studies to support its use.

Pain and Reorganization after Amputation: Is Interoceptive Prediction a Key?

Tory considerations are provided that might help integrate the data reviewed and suppose a possible additional driver of the development of phantom limb pain-namely, an error in interoceptive predictions to somatosensory sensations and movements of the missing limb.

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It is shown that anxiety, depression, stress experiences, body representation, and memory processes as well as psychosocial variables are associated with both the development of phantom limb pain and its maintenance.

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Cortical origin of pathological pain

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  • J. Katz
  • Medicine, Psychology
    Canadian journal of psychiatry. Revue canadienne de psychiatrie
  • 1992
It is concluded that the experience of a phantom limb is determined by a complex interaction of inputs from the periphery and widespread regions of the brain subserving sensory, cognitive, and emotional processes.

Phantom-limb pain: characteristics, causes, and treatment

  • H. Flor
  • Medicine, Psychology
    The Lancet Neurology
  • 2002

The mystery of phantom pain: Growing evidence for psychophysiological mechanisms

The direct, and much of the indirect, evidence supporting the existence psychophysiological mechanisms for phantom limb pain is reviewed, and the expression of phantom pain does appear to be influenced by psychological mechanisms similarly to the ways other chronic pain conditions are influenced.

Thumb in cheek? Sensory reorganization and perceptual plasticity after limb amputation.

This perceptual mapping of the (phantom) hand onto the face area modelled the form of prior pathology due to carpal tunnel syndrome and has implications for the relief of phantom pain.

Sensory disorganization and perceptual plasticity after limb amputation: a follow‐up study

A follow-up study of a patient who initially suffered from carpal tunnel syndrome in the right hand, that was alleviated by surgery, finds a new, equally disorganized, pattern of referred sensations was now found upon stimulation of the left side of the face.

Pain ‘memories’ in phantom limbs: review and clinical observations