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Volume 17, Number 14, Issue of July 15, 1997 pp. 5503-5508
Copyright ©1997 Society for Neuroscience

Effects of Regional Anesthesia on Phantom Limb Pain Are Mirrored in Changes in Cortical Reorganization

Received Feb. 21, 1997; revised April 24, 1997; accepted April 28, 1997.

Niels Birbaumer1, 4, Werner Lutzenberger1, Pedro Montoya1, Wolfgang Larbig1, Klaus Unertl2, Stephanie Töpfner2, Wolfgang Grodd3, Edward Taub5, and Herta Flor6

1 Institute of Medical Psychology and Behavioral Neurobiology, and Departments of 2 Anesthesiology and 3 Neuroradiology, University of Tübingen, D-72074 Tübingen, Germany, 4 Department of Psychology, University of Padova, I-35131 Padova, Italy, 5 Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama 35294-1170, and 6 Department of Psychology, Humboldt-University, D-10117 Berlin, Germany

The causes underlying phantom limb pain are still unknown. Recent studies on the consequences of nervous system damage in animals and humans reported substantial reorganization of primary somatosensory cortex subsequent to amputation, and one study showed that cortical reorganization is positively correlated with phantom limb pain. This paper examined the hypothesis of a functional relationship between cortical reorganization and phantom limb pain. Neuroelectric source imaging was used to determine changes in cortical reorganization in somatosensory cortex after anesthesia of an amputation stump produced by brachial plexus blockade in six phantom limb pain patients and four pain-free amputees. Three of six phantom limb subjects experienced a virtual elimination of current phantom pain attributable to anesthesia (mean change: 3.8 on an 11-point scale; Z = -1.83; p < 0.05) that was mirrored by a very rapid elimination of cortical reorganization in somatosensory cortex (change = 19.8 mm; t(2) = 5.60; p < 0.05). Cortical reorganization remained unchanged (mean change = 1.6 mm) in three phantom limb pain amputees whose pain was not reduced by brachial plexus blockade and in the phantom pain-free amputation controls. These findings suggest that cortical reorganization and phantom limb pain might have a causal relationship. Methods designed to alter cortical reorganization should be examined for their efficacy in the treatment of phantom limb pain.

Key words: phantom limb pain; cortical reorganization; brachial plexus anesthesia; neuroelectric source imaging; human; pain treatment; plasticity; EEG




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