Sumitani Masahiko, Miyauchi Satoru, Uematsu Hironobu, Yozu Arito, Otake Yuko, Yamada Yoshitsugu
Department of Anesthesiology and Pain Relief Center The University of Tokyo Hospital, Tokyo 113-0033.
Masui. 2010 Nov;59(11):1364-9.
Accumulated knowledge indicates that phantom limb pain is a phenomenon of the central nervous system that is related to plastic changes at several levels of the nervous systems. Especially, reports using patients with neuropathic pain clearly indicate the sensorimotor cortex as underlying mechanisms of phantom limb and its pain. Here, we focus the notion that limb amputation or deafferentation results in plasticity of connections between the brain and the body, and that the cortical motor representation of the missing or deafferented limb seemingly disappears. Meanwhile, the sensory representation of the limb does not disappear and thereby patients feel phantom limbs. We propose that dissociation between motor and sensory representations in the primary motor cortex induces pathologic pain and reconcile of sensorimotor integration of the limb would alleviate pain, on the basis of our neurorehabilitation approaches and artificial neuromodulation strategies.
积累的知识表明，幻肢痛是一种中枢神经系统现象，与神经系统多个层面的可塑性变化有关。特别是，对患有神经性疼痛患者的研究报告明确指出，感觉运动皮层是幻肢及其疼痛的潜在机制。在此，我们关注这样一种观点，即肢体截肢或传入神经阻滞会导致大脑与身体之间连接的可塑性变化，并且缺失或传入神经阻滞肢体的皮层运动表征似乎会消失。与此同时，该肢体的感觉表征并未消失，从而使患者感觉到幻肢。基于我们的神经康复方法和人工神经调节策略，我们提出，初级运动皮层中运动和感觉表征之间的分离会诱发病理性疼痛，而肢体感觉运动整合的协调将减轻疼痛。
