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Referred cramping phantom hand pain elicited in the face and eliminated by peripheral nerve block.
- Source :
-
Experimental brain research [Exp Brain Res] 2018 Jun; Vol. 236 (6), pp. 1815-1824. Date of Electronic Publication: 2018 Apr 17. - Publication Year :
- 2018
-
Abstract
- Phantom limb pain is a restricting condition for a substantial number of amputees with quite different characteristics of pain. Here, we report on a forearm amputee with constant phantom pain in the hand, in whom we could regularly elicit the rare phenomenon of referred cramping phantom pain by touching the face. To clarify the underlying mechanisms, we followed the cramp during the course of an axillary blockade of the brachial plexus. During the blockade, both phantom pain and the referred cramp were abolished, while a referred sensation of "being touched at the phantom" persisted. Furthermore, to identify the cortical substrate, we elicited the cramp during functional magnetic imaging. Imaging revealed that referred cramping phantom limb pain was associated with brain activation of the hand representation in the primary sensorimotor cortex. The results support the hypothesis that referred cramping phantom limb pain in this case is associated with a substantial brain activation in the hand area of the deafferented sensorimotor cortex. However, this alone is not sufficient to elicit referred cramping phantom limb pain. Peripheral inputs, both, from the arm nerves affected by the amputation and from the skin in the face at which the referred cramp is evoked, are a precondition for referred cramping phantom limb pain to occur, at least in this case.
- Subjects :
- Amputees
Anesthetics, Local pharmacology
Brachial Plexus drug effects
Bupivacaine pharmacology
Female
Humans
Magnetic Resonance Imaging
Middle Aged
Phantom Limb diagnostic imaging
Somatosensory Cortex diagnostic imaging
Touch Perception drug effects
Face physiology
Hand physiopathology
Muscle Cramp physiopathology
Nerve Block methods
Pain, Referred physiopathology
Phantom Limb physiopathology
Somatosensory Cortex physiopathology
Touch Perception physiology
Subjects
Details
- Language :
- English
- ISSN :
- 1432-1106
- Volume :
- 236
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Experimental brain research
- Publication Type :
- Academic Journal
- Accession number :
- 29666885
- Full Text :
- https://doi.org/10.1007/s00221-018-5262-y