Neurophysiological models of phantom limb pain: what can be learnt
Artikel i vetenskaplig tidskrift, 2021

Phantom Limb Pain (PLP) is a dysesthesic painful sensations perceived in the lost limb, resulting from complex interactions between structural and functional nervous systems changes. We analyze its main pathogenetic models and speculate on candidate therapeutic targets. The neuroma model considers PLP to arise from spontaneous activity of residual limb injured axons. Other peripheral-origin models attribute PLP to damage of somatosensory receptors or vascular changes. According to the cortical remapping model, the loss of bidirectional nervous flow and the need to enhance alternative functions trigger reorganization and arm and face skin afferents "invade" the hand territory. On the contrary, the persistent representation model suggests that continued inputs preserve the lost limb representation and that, instead to a shrinkage, PLP is associated with larger representation and stronger cortical activity. In the neuromatrix model, the mismatch between body representation, which remains intact despite limb amputation, and real body appearance generates pain. Another hypothesis is that proprioceptive memories associate specific limb positions with pre-amputation pain and may be recalled by those positions. Finally, the stochastic entanglement model offers a direct relationship between sensorimotor neural reorganization and pain. Amputation disrupts motor and somatosensory circuits, allowing for maladaptive wiring with pain circuits and causing pain without nociception. Relief of PLP depends solely on motor and somatosensory circuitry engagement, making anthropomorphic visual feedback dispensable. Existing and apparently contradicting theories might not be mutually exclusive. All of them involve several intertwined potential mechanisms by which replacing the amputated limb by an artificial one could counteract PLP.

Författare

Giovanni DI Pino

Università Campus Bio-Medico di Roma

Valeria Piombino

Università Campus Bio-Medico di Roma

Massimiliano Carassiti

Università Campus Bio-Medico di Roma

Max Jair Ortiz Catalan

Chalmers, Elektroteknik, System- och reglerteknik, Bionik

Sahlgrenska universitetssjukhuset

Center for Bionics and Pain Research

Göteborgs universitet

Minerva anestesiologica

18271596 (eISSN)

Vol. 87 4 481-487

Ämneskategorier

Neurovetenskaper

Biofysik

Bioinformatik (beräkningsbiologi)

Styrkeområden

Hälsa och teknik

DOI

10.23736/S0375-9393.20.15067-3

PubMed

33432796

Mer information

Senast uppdaterat

2021-05-06