Andoh J, Milde C, Tsao J W, Flor H
Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, D-68159 Mannheim, Germany.
Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, D-68159 Mannheim, Germany.
Neuroscience. 2018 Sep 1;387:85-91. doi: 10.1016/j.neuroscience.2017.11.015. Epub 2017 Nov 16.
Cortical reorganization has been proposed as a major factor involved in phantom pain with prior nociceptive input to the deafferented region and input from the non-deafferented cortex creating neuronal activity that is perceived as phantom pain. There is substantial evidence that these processes play a role in neuropathic pain, although causal evidence is lacking. Recently it has been suggested that a maintenance of the cortical representation of the former hand area is related to phantom pain. Although interesting, evidence for this process is so far scarce. In addition, peripheral factors have been proposed as important for phantom limb pain. Although often introduced as contradictory, we suggest that cortical reorganization, preserved limb function and peripheral factors interact to create the various painful and nonpainful aspects of the phantom limb experience. In addition, the type of task (sensory versus motor), the interaction of injury- and use-dependent plasticity, the type of data analysis, contextual factors such as the body representation and psychological variables determine the outcome and need to be considered in models of phantom limb pain. Longitudinal studies are needed to determine the formation of the phantom pain experience.
皮质重组被认为是牵涉性痛的一个主要因素，先前向去传入区域的伤害性输入以及来自未去传入皮质的输入会产生被感知为牵涉性痛的神经活动。有大量证据表明这些过程在神经性疼痛中起作用，尽管缺乏因果证据。最近有人提出，先前手部区域皮质表征的维持与牵涉性痛有关。尽管这一观点很有趣，但目前关于这一过程的证据还很稀少。此外，外周因素也被认为对幻肢痛很重要。尽管这些因素通常被认为是相互矛盾的，但我们认为皮质重组、保留的肢体功能和外周因素相互作用，共同构成了幻肢体验中各种疼痛和非疼痛的方面。此外，任务类型（感觉与运动）、损伤和使用依赖性可塑性的相互作用、数据分析类型、诸如身体表征和心理变量等背景因素决定了结果，并且在幻肢痛模型中需要加以考虑。需要进行纵向研究来确定牵涉性痛体验的形成。
