Phantom limb pain: a case of maladaptive CNS plasticity?

• Published in: Nature reviews. Neuroscience Vol. 7; no. 11; pp. 873 - 881
• Main Authors: Flor, Herta, Nikolajsen, Lone, Staehelin Jensen, Troels
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group 01-11-2006
• Subjects: Adaptation, Physiological; Amputation; Animals; Biological and medical sciences; Central Nervous System - physiopathology; Electric Stimulation Therapy - methods; Electric Stimulation Therapy - trends; Fundamental and applied biological sciences. Psychology; General aspects. Models. Methods; Humans; Neuronal Plasticity; Neurosciences; Pain; Pain, Intractable - physiopathology; Pain, Intractable - therapy; Phantom limb; Phantom Limb - physiopathology; Phantom Limb - therapy; Sensory Receptor Cells - physiopathology; Somatosensory Cortex - physiopathology; Somesthesis and somesthetic pathways (proprioception, exteroception, nociception); interoception; electrolocation. Sensory receptors; Spinal cord; Spinal Cord - physiopathology; Vertebrates: nervous system and sense organs; Denmark; Aarhus Denmark; Human; Nervous system diseases; Pain; Amputation; Plasticity; Central nervous system; Mental disorder; Review; Neurological disorder; Phantom limb; Stump; Test object
• ISSN: 1471-003X; 1471-0048; 1471-0048; 1469-3178
• DOI: 10.1038/nrn1991

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 with an emphasis on central, and in particular cortical, changes. We cite both animal and human studies and derive suggestions for innovative interventions aimed at alleviating phantom pain.