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How does phantom pain affect people, and how does it start?                                                                                             

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How does phantom pain affect people, and how does it start?                                                                                             

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How cortical shifts affect phantom pains

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How cortical shifts affect phantom pains

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Cause and effect

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It hurts at the stump of the amputation site because of the brain sending signals to the missing limb

the pain can be reduced by changing your brain's beliefs, so it can realize, "oh, my entire left leg isn't there, silly me".

It affects you after an amputation, while your brain still believe that the limb is still present

Chronological

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Amputating a limb is like remodeling your house, it's completely new for your brain

The phantom pain comes from this "remodeling", where your brain still think the old "house" is still there. It sends those signals or the missing limb, but there is no limb and it causes pain

The big change ( cortical shift) is the main cause of phantom pain

cause and effect

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Phantom limb pain: a case of maladaptive CNS plasticity?

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Phantom limb pain: a case of maladaptive CNS plasticity?

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*Phantom pain is from reorganization of the brain map.

*Phantom pain is also from a body image illusion of your brain still thinking your limb is still present

*using a mirror to change your brain's beliefs can help to reduce the pain

*the pain is greater depending on the pathological alteration

*Rats with spinal cord injuries also felt phantom pain.

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References

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Acknowledgements

This article is dedicated to the memory of T. Pons, whose work inspired many of the findings reported here. This work was supported by the Deutsche Forschungsgemeinschaft, the Bundesministerium für Bildung und Forschung (German Neuropathic Pain Network) and the Lundbeck Foundation, Denmark. The authors would like to thank W. Jänig for helpful comments on an earlier version of this article and M. Lotze for help with the figures.

Author information

Authors and Affiliations

1. Department of Clinical and Cognitive Neuroscience, University of Heidelberg, Central Institute of Mental Health, Mannheim, D-68159, Germany

Herta Flor

2. Department of Anesthesiology and Danish Pain Research Center, Aarhus University Hospital, Aarhus C, DK-8000, Denmark

Lone Nikolajsen

3. Department of Neurology and Danish Pain Research Center, Aarhus University Hospital, Aarhus C, DK-8000, Denmark

Troels Staehelin Jensen

Corresponding author

Correspondence to Herta Flor.

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Competing interests

The authors declare no competing financial interests.

Related links

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FURTHER INFORMATION

Flor's laboratory

Glossary

Neuroma

When a limb is severed, a terminal swelling or 'endbulb' is formed and axonal sprouting occurs. In the case of an amputation, sprouting and endbulb formation lead to a neuroma, a tangled mass that forms when the axons cannot reconnect or can only partially reconnect, as is the case in partial lesions. These neuromas generate abnormal activity that is called ectopic because it does not originate from the nerve endings.

Dorsal root ganglion

A nodule on a dorsal root that contains cell bodies of afferent spinal neurons, which convey somatosensory input to the CNS.

Paraesthesia

An abnormal skin sensation such as tingling or itching.

Microglia

Glial cells are the 'glue' of the nervous system, and support and protect the neurons. Microglia are a special form of small glial cells; they have immune functions and can be involved in inflammatory actions.

Substance P

A neuropeptide that plays an important role in nociception and is released by the primary somatosensory afferents in the spinal cord.

C-afferents

Unmyelinated fibres, 0.4-1.2 μm in diameter, conducting nerve impulses at a velocity of 0.7-2.3 ms −1. They conduct secondary, delayed pain.

Aδ afferents

Thinly myelinated nerve fibres with a conduction velocity of 10-30 ms −1 that convey nociceptive information to the spinal cord. These receptors convey first, sharp, pricking pain and are located mainly on hairy skin.

Aβ fibres

Large-diameter myelinated fibres that have a conduction velocity of ∼40 ms −1 and normally carry non-nociceptive information.

Myoelectric prosthesis

A motor-driven prosthesis that can, for example, be used for grip movements and is operated through the use of electromyographic signals from muscles.

Complex regional pain syndrome

(CRPS). A chronic neuropathic pain syndrome of two types. CRPS1 occurs most often in the arms or legs after a minor or major injury and is accompanied by severe pain, swelling, oedema, sudomotor abnormalities and increased sensitivity to touch. CRPS2 is related to an identified nerve injury.

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Flor, H., Nikolajsen, L. & Staehelin Jensen, T. Phantom limb pain: a case of maladaptive CNS plasticity?. Nat Rev Neurosci 7, 873-881 (2006). https://doi.org/10.1038/nrn1991
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# data[].attributes.attachment_link.title
Phantom limb pain: a case of maladaptive CNS plasticity? - Nature Reviews Neuroscience

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Phantom limb pain frequently occurs following limb amputation or deafferentiation. Emerging evidence suggests that in addition to peripheral changes, plasticity in the CNS has an important role in the pathophysiological mechanisms of phantom pain, highlighting potential targets for therapeutic interventions.

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Article organizer: https://docs.google.com/document/d/1lTtnMdngADcUWiM6vFjcxq_jbxzXaXaycZV0kfKonLU/edit?tab=t.0

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Central Idea: Phantom Pain is caused by your brain sending signals to your missing limbs.

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Central Idea: Phantom Pain is caused by your brain sending signals to your missing limbs.

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The changes in your body mess with your brain, and the residing phantom pain is caused by the confusion

The internal belief in your brain that your limb is still there causes the pains

The phantom pain is from the non changed belief that a cortical shift didn't happen

cause and effect

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The damage to your nerves can cause the pain to happen, because of your brain sending signals to the damaged nerves and them feeling the pain.

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The belief of your limb still being present can make your brain send signals to that missing limbs causing the pain.

Beliefs are important because even if you don't know, there is an internal belief that all your limbs are there

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It's caused because of your brain sending signals to parts of your body that aren't present anymore.

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You can dampen it by using a mirror to trick your brain, and it makes your brain remap and dampens the pain.

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The problem with your brain if you have phantom pain is it is basically hallucinating. Your brain is purely going off beliefs, and isn't taking in the new information because it doesn't want to feel uncertain about it's beliefs.

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It hurts you by sending nerve signals to your missing limbs, which aren't there anymore.

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The pain hurts you depending on where the limb was amputated and how much your brain needs to remap, thing like a finger, because of touch will cause more pain than a toe. The finger, because it is so much more complex will need more change.

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Your beliefs affect phantom pain by being the primary cause of how it start