Richardson Cliff, Olleveant Nicola, Crawford Kath, Kulkarni Jai
University of Manchester, Manchester, UK.
University of Manchester, Manchester, UK.
Pain Manag Nurs. 2018 Dec;19(6):599-607. doi: 10.1016/j.pmn.2018.04.004. Epub 2018 Jun 19.
Cortical reorganization and pain memory are theories to explain phantom limb pain and other postamputation phantom phenomena. This study was undertaken to identify evidence of cortical reorganization in lower limb amputees and to find evidence for the pain memory theory.
This was a qualitative interview study using structured questionnaires with lower limb amputees. Participants were asked to identify body areas and activities that stimulate postamputation phantom phenomena to confirm the cortical reorganization theory. We tested the pain memory theory by comparing traumatic amputees with surgical amputees.
A total of 122 participants (response rate 42%) were recruited. Prevalence of postamputation phantom phenomena was similar to previous studies with phantom pain reported as 84%. Twenty (16.3%) identified body regions that could stimulate postamputation phantom phenomena and 32 (26%) identified activities that could stimulate postamputation phantom phenomena. Not all body areas or activities were related to somatotopic regions adjacent to the leg on the sensory homunculus. Overall, 47 (38.2%) exhibited attributes suggestive of cortical reorganization into areas adjacent to the leg. No associations were found between presence of pain or length of time in pain before amputation and the presence of phantom pain (p = .1-1.0). No statistical difference was found between surgical and traumatic amputees for any postamputation phantom phenomena (p = .3-1.0).
The cortical reorganization and pain memory theories for the development and maintenance of postamputation phantom phenomena have only limited support from our data. Taking this into account, it may be worth reopening the debate on the mechanism for postamputation phantom phenomena, including phantom limb pain. The cortical reorganization theory and memory theory for the mechanism of phantom limb pain are questioned by these results. Both may play a role, but neither can explain the presence of postamputation phantom phenomena on their own.
皮质重组和疼痛记忆是解释幻肢痛及其他截肢后幻肢现象的理论。本研究旨在确定下肢截肢者皮质重组的证据，并寻找疼痛记忆理论的证据。
这是一项对下肢截肢者使用结构化问卷的定性访谈研究。参与者被要求指出能刺激截肢后幻肢现象的身体部位和活动，以证实皮质重组理论。我们通过比较创伤性截肢者和手术截肢者来检验疼痛记忆理论。
共招募了122名参与者（应答率42%）。截肢后幻肢现象的发生率与之前报道幻肢痛的研究相似，为84%。20名（16.3%）参与者指出了能刺激截肢后幻肢现象的身体区域，32名（26%）参与者指出了能刺激截肢后幻肢现象的活动。并非所有身体部位或活动都与感觉小人像上腿部相邻的躯体定位区域有关。总体而言，47名（38.2%）参与者表现出提示皮质重组到腿部相邻区域的特征。截肢前疼痛的存在或疼痛持续时间与幻肢痛的存在之间未发现关联（p = 0.1 - 1.0）。对于任何截肢后幻肢现象，手术截肢者和创伤性截肢者之间未发现统计学差异（p = 0.3 - 1.0）。
截肢后幻肢现象发生和维持的皮质重组及疼痛记忆理论仅从我们的数据中获得有限支持。考虑到这一点，可能值得重新开启关于截肢后幻肢现象（包括幻肢痛）机制的辩论。这些结果对幻肢痛机制的皮质重组理论和记忆理论提出了质疑。两者可能都起作用，但单独任何一个都无法解释截肢后幻肢现象的存在。
