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Phantom limb pain and bodily awareness: current concepts and future directions

Giummarra, Melita J.a; Moseley, G. Lorimerb,c

Current Opinion in Anesthesiology: October 2011 - Volume 24 - Issue 5 - p 524–531
doi: 10.1097/ACO.0b013e32834a105f
Pain medicine: Edited by Stephan A. Schug

Purpose of review Phantom pain is a frequent consequence of amputation or deafferentation. There are many possible contributing mechanisms, including stump-related pathology, spinal and cortical changes. Phantom limb pain is notoriously difficult to treat. Continued consideration of the factors associated with phantom pain and its treatment is of utmost importance, not only to advance the scientific knowledge about the experience of the body and neuropathic pain, but also fundamentally to promote efficacious pain management.

Recent findings This review first discusses the mechanisms associated with phantom pain and summarizes the current treatments. The mechanisms underlying phantom pain primarily relate to peripheral/spinal dysfunction, and supraspinal and central plasticity in sensorimotor body representations. The most promising methods for managing phantom pain address the maladaptive changes at multiple levels of the neuraxis, for example, complementing pharmacological administration with physical, psychological or behavioural intervention. These supplementary techniques are even efficacious in isolation, perhaps by replacing the absent afferent signals from the amputated limb, thereby restoring disrupted bodily representations.

Summary Ultimately, for optimal patient outcomes, treatments should be both symptom and mechanism targeted.

aExperimental Neuropsychology Research Unit, Monash University, Clayton, Victoria

bSansom Institute for Health Research, University of South Australia, Adelaide, South Australia

cNeuroscience Research Australia, Randwick, New South Wales, Australia

Correspondence to Melita J. Giummarra, Experimental Neuropsychology Research Unit, School of Psychology and Psychiatry, Wellington Road, Clayton, VIC 3800, Australia Tel: +613 9905 6286; fax: + 613 9905 3948; e-mail: melita.giummarra@monash.edu

© 2011 Lippincott Williams & Wilkins, Inc.