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Herta Flor - One of the best experts on this subject based on the ideXlab platform.

  • Phantom Limb Pain
    2016
    Co-Authors: Herta Flor, Xaver Fuchs
    Abstract:

    Phantom Limb Pain occurs following Limb amputations and is characterzed by Pain emanating from the no longer existing Limb. In many cases, this problem develops into pervasive chronic Pain impairing the amputees' quality of life. In this article, we describe phenomena observable in amputees and distinguish phantom Limb Pain from non-Painful phantom Limb sensations, referred sensations and residual Limb Pain. We review and discuss research on both the role of the peripheral and the central nervous system and of how they interact with psychological factors. Clinical implications and treatment approaches based on these mechanisms are discussed.

  • Phantom Limb Pain. Psychological treatment strategies
    Schmerz (Berlin Germany), 2013
    Co-Authors: Martin Diers, Herta Flor
    Abstract:

    Similar to other Pain syndromes phantom Limb Pain is characterized by learning and memory processes that maintain the Pain and increase maladaptive plastic changes of the brain: therefore, psychological interventions that change maladaptive memory processes are useful. In addition to traditional psychological interventions, such as Pain management training and biofeedback, more recent developments that involve sensory discrimination training, mirror treatment, graded motor imagery, prosthesis training and training in virtual reality are interesting. These interventions not only reduce phantom Limb Pain but also reverse the associated maladaptive brain changes.

  • phantom Limb Pain after lower Limb trauma origins and treatments
    The International Journal of Lower Extremity Wounds, 2011
    Co-Authors: Jens Foell, Herta Flor, Robin Bekraterbodmann, Jonathan Cole
    Abstract:

    Phantom sensations, that is, sensations perceived in a body part that has been lost, are a common consequence of accidental or clinical extremity amputations. Most amputation patients report a continuing presence of the Limb, with some describing additional sensations such as numbness, tickling, or cramping of the phantom Limb. The type, frequency, and stability of these phantom sensations can vary immensely. The phenomenon of Painful phantom sensations, that is, phantom Limb Pain, presents a challenge for practitioners and researchers and is often detrimental to the patient’s quality of life. In addition to the use of conventional therapies for chronic Pain disorders, recent years have seen the development of novel treatments for phantom Limb Pain, based on an increasing body of research on neurophysiological changes after amputation. This article describes the current state of research in regard to the demographics, causal factors, and treatments of phantom Limb Pain.

  • phantom Limb Pain characteristics causes and treatment
    Lancet Neurology, 2002
    Co-Authors: Herta Flor
    Abstract:

    Phantom-Limb Pain is a common sequela of amputation, occurring in up to 80% of people who undergo the procedure. It must be differentiated from non-Painful phantom phenomena, residual-Limb Pain, and non-Painful residual-Limb phenomena. Central changes seem to be a major determinant of phantom-Limb Pain; however, peripheral and psychological factors may contribute to it. A comprehensive model of phantom-Limb Pain is presented that assigns major roles to Pain occurring before the amputation and to central as well as peripheral changes related to it. So far, few mechanism-based treatments for phantom-Limb Pain have been proposed. Most published reports are based on anecdotal evidence. Interventions targeting central changes seem promising. The prevention of phantom-Limb Pain by peripheral analgesia has not yielded consistent results. Additional measures that reverse or prevent the formation of central memory processes might be more effective.

  • effect of sensory discrimination training on cortical reorganisation and phantom Limb Pain
    The Lancet, 2001
    Co-Authors: Herta Flor, Claudia Denke, Michael Schaefer, Sabine M Grusser
    Abstract:

    Summary Phantom Limb Pain is a frequent consequence of the amputation of a body part. Based on the finding that phantom Limb Pain is closely associated with plastic changes in the primary somatosensory cortex and animal data showing that behaviourally relevant training alters the cortical map, we devised a sensory discrimination training programme for patients with intractable phantom Limb Pain. Compared with a control group of medically treated patients, the training group had significant reductions in phantom Limb Pain (p=0002) and cortical reorganisation (p=0–05) that were positively associated with improved sensory discrimination ability.

Niels Birbaumer - One of the best experts on this subject based on the ideXlab platform.

  • reorganization of motor and somatosensory cortex in upper extremity amputees with phantom Limb Pain
    The Journal of Neuroscience, 2001
    Co-Authors: Anke Karl, Niels Birbaumer, Werner Lutzenberger, Leonardo G Cohen, Herta Flor
    Abstract:

    Phantom Limb Pain (PLP) in amputees is associated with reorganizational changes in the somatosensory system. To investigate the relationship between somatosensory and motor reorganization and phantom Limb Pain, we used focal transcranial magnetic stimulation (TMS) of the motor cortex and neuroelectric source imaging of the somatosensory cortex (SI) in patients with and without phantom Limb Pain. For transcranial magnetic stimulation, recordings were made bilaterally from the biceps brachii, zygomaticus, and depressor labii inferioris muscles. Neuroelectric source imaging of the EEG was obtained after somatosensory stimulation of the skin overlying face and hand. Patients with phantom Limb Pain had larger motor-evoked potentials from the biceps brachii, and the map of outputs was larger for muscles on the amputated side compared with the intact side. The optimal scalp positions for stimulation of the zygomaticus and depressor labii inferioris muscles were displaced significantly more medially (toward the missing hand representation) in patients with phantom Limb Pain only. Neuroelectric source imaging revealed a similar medial displacement of the dipole center for face stimulation in patients with phantom Limb Pain. There was a high correlation between the magnitude of the shift of the cortical representation of the mouth into the hand area in motor and somatosensory cortex and phantom Limb Pain. These results show enhanced plasticity in both the motor and somatosensory domains in amputees with phantom Limb Pain.

  • does use of a myoelectric prosthesis prevent cortical reorganization and phantom Limb Pain
    Nature Neuroscience, 1999
    Co-Authors: Martin Lotze, Niels Birbaumer, Wolfgang Grodd, Michael Erb, Ellena Huse, Herta Flor
    Abstract:

    Injury, stimulation or training can induce changes in the homuncular organization of primary somatosensory (S1) and motor cortex (M1)1,2,3,4,5,6. Phantom Limb Pain was identified as a perceptual correlate of this cortical reorganization2,7. Using functional magnetic resonance imaging (fMRI), we found that enhanced use of a myoelectric prosthesis in upper extremity amputees was associated with reduced phantom Limb Pain and reduced cortical reorganization. Extensive use of a myoelectric prosthesis might have beneficial effects on phantom Limb Pain.

  • effects of regional anesthesia on phantom Limb Pain are mirrored in changes in cortical reorganization
    The Journal of Neuroscience, 1997
    Co-Authors: Niels Birbaumer, Werner Lutzenberger, Pedro Montoya, Edward Taub, Wolfgang Grodd, W Larbig, K Unertl, Stephanie Topfner, Herta Flor
    Abstract:

    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.

  • The relationship of phantom Limb Pain to other phantom Limb phenomena in upper extremity amputees.
    Pain, 1997
    Co-Authors: Pedro Montoya, Herta Flor, Wolfgang Larbig, Norbert Grulke, Edward Taub, Niels Birbaumer
    Abstract:

    In thirty-two unilateral upper extremity amputees with and without phantom Limb Pain, various phantom Limb phenomena were investigated. In general, the incidence of non-Painful phantom Limb sensations was higher in patients with phantom Limb Pain than in Pain-free amputees. Kinesthetic and kinetic phantom Limb sensations were reported more frequently than exteroceptive cutaneous sensations. There was a significant positive correlation between phantom Limb Pain and stump Pain. Patients more frequently assigned sensory than affective Pain qualities to their phantom Limb Pain, whereas no differences between Pain qualities were observed for stump Pain. No support was found for a relationship between the presence of telescoping (i.e., shrinkage of the phantom Limb) and phantom Limb Pain. These findings point to central as well as to peripheral factors contributing to phantom Limb Pain.

  • Evidence for a change in neural processing in phantom Limb Pain patients
    Pain, 1996
    Co-Authors: Wolfgang Larbig, Herta Flor, Pedro Montoya, Henning Bilow, Siegfried Weller, Niels Birbaumer
    Abstract:

    Abstract The present study was designed to investigate differences in neural processing of Pain-related semantic information in amputees with and without chronic phantom Limb Pain and healthy controls. One-hundred-and-twenty words (40 neutral, 40 body-related, 40 Pain-related) were presented in pseudorandom order to probe group differences in the perception of Pain-related information. Visual evoked potentials (VEP) to the words were recorded from 11 scalp locations, EMG was measured at the stump and the contralateral side and bilaterally from the M. corrugator. In addition, heart rate and skin conductance responses were obtained. Both early and late VEP components were altered. Pain-free amputees showed a reduced N100 amplitude compared to phantom Limb Pain patients and healthy controls whereas the phantom Limb Pain patients displayed a significantly enhanced late positivity (500–800 msec after word onset). VEP components were unaffected by word type. The peripheral EMG responses were significantly different among the groups: phantom Limb Pain patients showed larger EMG reactions on the stump than on the contralateral side, whereas Pain-free amputees showed the opposite effect. The data suggest an enhanced central and peripheral processing of visual stimuli in phantom Limb Pain patients.

Pedro Montoya - One of the best experts on this subject based on the ideXlab platform.

  • effects of regional anesthesia on phantom Limb Pain are mirrored in changes in cortical reorganization
    The Journal of Neuroscience, 1997
    Co-Authors: Niels Birbaumer, Werner Lutzenberger, Pedro Montoya, Edward Taub, Wolfgang Grodd, W Larbig, K Unertl, Stephanie Topfner, Herta Flor
    Abstract:

    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.

  • The relationship of phantom Limb Pain to other phantom Limb phenomena in upper extremity amputees.
    Pain, 1997
    Co-Authors: Pedro Montoya, Herta Flor, Wolfgang Larbig, Norbert Grulke, Edward Taub, Niels Birbaumer
    Abstract:

    In thirty-two unilateral upper extremity amputees with and without phantom Limb Pain, various phantom Limb phenomena were investigated. In general, the incidence of non-Painful phantom Limb sensations was higher in patients with phantom Limb Pain than in Pain-free amputees. Kinesthetic and kinetic phantom Limb sensations were reported more frequently than exteroceptive cutaneous sensations. There was a significant positive correlation between phantom Limb Pain and stump Pain. Patients more frequently assigned sensory than affective Pain qualities to their phantom Limb Pain, whereas no differences between Pain qualities were observed for stump Pain. No support was found for a relationship between the presence of telescoping (i.e., shrinkage of the phantom Limb) and phantom Limb Pain. These findings point to central as well as to peripheral factors contributing to phantom Limb Pain.

  • Evidence for a change in neural processing in phantom Limb Pain patients
    Pain, 1996
    Co-Authors: Wolfgang Larbig, Herta Flor, Pedro Montoya, Henning Bilow, Siegfried Weller, Niels Birbaumer
    Abstract:

    Abstract The present study was designed to investigate differences in neural processing of Pain-related semantic information in amputees with and without chronic phantom Limb Pain and healthy controls. One-hundred-and-twenty words (40 neutral, 40 body-related, 40 Pain-related) were presented in pseudorandom order to probe group differences in the perception of Pain-related information. Visual evoked potentials (VEP) to the words were recorded from 11 scalp locations, EMG was measured at the stump and the contralateral side and bilaterally from the M. corrugator. In addition, heart rate and skin conductance responses were obtained. Both early and late VEP components were altered. Pain-free amputees showed a reduced N100 amplitude compared to phantom Limb Pain patients and healthy controls whereas the phantom Limb Pain patients displayed a significantly enhanced late positivity (500–800 msec after word onset). VEP components were unaffected by word type. The peripheral EMG responses were significantly different among the groups: phantom Limb Pain patients showed larger EMG reactions on the stump than on the contralateral side, whereas Pain-free amputees showed the opposite effect. The data suggest an enhanced central and peripheral processing of visual stimuli in phantom Limb Pain patients.

Malcolm Maclachlan - One of the best experts on this subject based on the ideXlab platform.

  • Prevalence and characteristics of phantom Limb Pain and residual Limb Pain in the long term after upper Limb amputation.
    International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de reada, 2010
    Co-Authors: Deirdre Desmond, Malcolm Maclachlan
    Abstract:

    This study aims to describe the prevalence and characteristics of phantom Limb Pain and residual Limb Pain after upper Limb amputation. One-hundred and forty-one participants (139 males; mean age 74.8 years; mean time since amputation 50.1 years) completed a self-report questionnaire assessing resid

  • phantom Limb Pain and residual Limb Pain following lower Limb amputation a descriptive analysis
    Disability and Rehabilitation, 2001
    Co-Authors: Pamela Gallagher, David Allen, Malcolm Maclachlan
    Abstract:

    Purpose: This research aimed to develop a clearer picture of the experience of residual Limb Pain and phantom Limb Pain following a lower Limb amputation and to gain a greater understanding of their relationships with physical and psychosocial variables. Method: One hundred and four participants completed the Trinity Amputation and Prosthesis Experience Scales (TAPES), which includes a section on each of, psychosocial issues, activity restriction, satisfaction with a prosthesis and Pain (incidence, duration, level and extent of interference). Results: The results showed that 48.1% of the sample experienced residual Limb Pain and 69.2% experienced phantom Limb Pain. While fewer people experienced residual Limb Pain, those who did, experienced it for longer periods, at a greater level of intensity and with a greater amount of interference in their daily lifestyle, than people who were experiencing phantom Limb Pain. The experience of residual Limb Pain was associated with other medical problems and low leve...

Lawrence R Robinson - One of the best experts on this subject based on the ideXlab platform.

  • cognitions coping and social environment predict adjustment to phantom Limb Pain
    Pain, 2002
    Co-Authors: Mark P. Jensen, Dawn M. Ehde, Joseph M. Czerniecki, Amy J Hoffman, David R Patterson, Lawrence R Robinson
    Abstract:

    Biopsychosocial models of chronic Pain hypothesize a role for psychological and environmental factors in adjustment to chronic Pain. To test the utility of such models for understanding phantom Limb Pain, 61 persons with recent amputations were administered measures of average phantom Limb Pain intensity, Pain interference, depression, Pain coping use, Pain cognitions and appraisals, and social environmental variables 1 month post-amputation, and the measures of Pain intensity, Pain interference, and depression again 5 months later. Multiple regression analyses showed that the psychosocial predictors made a statistically significant contribution to the concurrent prediction of average phantom Limb Pain, Pain interference, and depression at the initial assessment, and a significant contribution to the prediction of subsequent change in Pain interference and depression over the course of 5 months. The results support the utility of studying phantom Limb Pain from a biopsychosocial perspective, and identify specific biopsychosocial factors (e.g., catastrophizing cognitions, social support, solicitous responses from family members, and resting as a coping response) that may play an important role in adjustment to phantom Limb Pain.

  • chronic phantom sensations phantom Pain residual Limb Pain and other regional Pain after lower Limb amputation
    Archives of Physical Medicine and Rehabilitation, 2000
    Co-Authors: Dawn M. Ehde, Kellye M Campbell, Thomas W Edwards, Douglas G. Smith, Joseph M. Czerniecki, Mark P. Jensen, Lawrence R Robinson
    Abstract:

    Abstract Ehde DM, Czerniecki JM, Smith DG, Campbell KM, Edwards WT, Jensen MP, Robinson LR. Chronic phantom sensations, phantom Pain, residual Limb Pain, and other regional Pain after lower Limb amputation. Arch Phys Med Rehabil 2000;81:1039-44. Objectives: To determine the characteristics of phantom Limb sensation, phantom Limb Pain, and residual Limb Pain, and to evaluate Pain-related disability associated with phantom Limb Pain. Design: Retrospective, cross-sectional survey. Six or more months after lower Limb amputation, participants ( n = 255) completed an amputation Pain questionnaire that included several standardized Pain measures. Setting: Community-based survey from clinical databases. Participants: A community-based sample of persons with lower Limb amputations. Main Outcome Measures: Frequency, duration, intensity, and quality of phantom Limb and residual Limb Pain, and Pain-related disability as measured by the Chronic Pain Grade. Results: Of the respondents, 79% reported phantom Limb sensations, 72% reported phantom Limb Pain, and 74% reported residual Limb Pain. Many described their phantom Limb and residual Limb Pain as episodic and not particularly bothersome. Most participants with phantom Limb Pain were classified into the two low Pain-related disability categories: grade I, low disability/low Pain intensity (47%) or grade II, low disability/high Pain intensity (28%). Many participants reported having Pain in other anatomic locations, including the back (52%). Conclusions: Phantom Limb and residual Limb Pain are common after a lower Limb amputation. For most, the Pain is episodic and not particularly disabling. However, for a notable subset, the Pain may be quite disabling. Pain after amputation should be viewed from a broad perspective that considers other anatomic sites as well as the impact of Pain on functioning. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation