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Herta Flor - One of the best experts on this subject based on the ideXlab platform.
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relationship of prosthesis ownership and Phantom Limb Pain results of a survey in 2383 Limb amputees
Pain, 2021Co-Authors: Robin Bekraterbodmann, Herta Flor, Martin Diers, Iris Reinhard, Xaver FuchsAbstract:ABSTRACT Phantom Limb Pain (PLP) accounts for a significant reduction in quality of life and is difficult to treat. Prosthesis use has been shown to negatively covary with PLP. Recent research on body perception in amputees suggest that prosthesis ownership, defined as the extent to which a prosthesis is experienced as being part of the body rather than an artificial device foreign to the body, might interact with PLP. We used survey data from 2383 unilateral prosthesis-using upper-Limb or lower-Limb amputees and performed regression analyses to determine the relationship between prosthesis ownership and PLP. To test for specificity, we examined the role of prosthesis ownership also for residual Limb Pain (RLP) and nonPainful Phantom Limb sensations (npPLS). Prosthesis ownership was reduced in older participants and higher in lower-Limb compared to upper-Limb amputees. A longer residual Limb and more frequent prosthesis use as well as a longer time since amputation also yielded higher values. Prostheses based on natural principles were associated with higher prosthesis ownership. Phantom Limb Pain and RLP were lower with higher prosthesis ownership, and RLP but not PLP was lower when prosthesis use was frequent. There were no significant associations for npPLS. The regression results differ in some aspects from those revealed by univariate analyses, emphasizing the importance of multivariate statistical approaches. Our findings provide insights into the interplay of body- and Pain-related sensations after amputation, and could help to develop new treatment approaches for both PLP and RLP.
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mirrored imagined and executed movements differentially activate sensorimotor cortex in amputees with and without Phantom Limb Pain
Pain, 2010Co-Authors: Martin Diers, Christoph Christmann, Caroline Koeppe, Matthias Ruf, Herta FlorAbstract:Extended viewing of movements of the intact hand in a mirror as well as motor imagery has been shown to decrease Pain in Phantom Pain patients. We used functional magnetic resonance imaging to assess the neural correlates of mirrored, imagined and executed hand movements in 14 upper extremity amputees – 7 with Phantom Limb Pain (PLP) and 7 without Phantom Limb Pain (non-PLP) and 9 healthy controls (HC). Executed movement activated the contralateral sensorimotor area in all three groups but ipsilateral cortex was only activated in the non-PLP and HC group. Mirrored movements activated the sensorimotor cortex contralateral to the hand seen in the mirror in the non-PLP and the HC but not in the PLP. Imagined movement activated the supplementary motor area in all groups and the contralateral primary sensorimotor cortex in the non-PLP and HC but not in the PLP. Mirror- and movement-related activation in the bilateral sensorimotor cortex in the mirror movement condition and activation in the sensorimotor cortex ipsilateral to the moved hand in the executed movement condition were significantly negatively correlated with the magnitude of Phantom Limb Pain in the amputee group. Further research must identify the causal mechanisms related to mirror treatment, imagined movements or movements of the other hand and associated changes in Pain perception.
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maladaptive plasticity memory for Pain and Phantom Limb Pain review and suggestions for new therapies
Expert Review of Neurotherapeutics, 2008Co-Authors: Herta FlorAbstract:A number of studies have shown that Phantom Limb Pain is associated with plastic changes along the neuraxis, with a close correlation between changes in the cortical representation of the affected Limb and Phantom Limb Pain. Mechanisms underlying these maladaptive plastic changes are related to a loss of GABAergic inhibition, glutamate-mediated long-term potentiation-like changes and structural alterations such as axonal sprouting. These plastic changes and Phantom Limb Pain seem to be more extensive when chronic Pain precedes the amputation. Behavioral interventions, stimulation, feedback and pharmacological interventions that are designed to reverse these maladaptive memory traces and enhance extinction may be beneficial for the treatment and prevention of Phantom Limb Pain.
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neuroelectric source imaging of steady state movement related cortical potentials in human upper extremity amputees with and without Phantom Limb Pain
Pain, 2004Co-Authors: Anke Karl, Werner Muhlnickel, Ralf Kurth, Herta FlorAbstract:Whereas several studies reported a close relationship between changes in the somatotopic organization of primary somatosensory cortex and Phantom Limb Pain, the relationship between alterations in the motor cortex and amputation-related phenomena has not yet been explored in detail. This study used steady-state movement-related cortical potentials (MRCPs) combined with neuroelectric source imaging to assess the relationship of changes in motor cortex and amputation-related phenomena such as Painful and non-Painful Phantom and residual Limb sensations, telescoping, and prosthesis use. Eight upper Limb amputees were investigated. A significant positive relationship between reorganization of the motor cortex (distance of the MRCP source location from the mirrored source for hand movement) and Phantom Limb Pain was found. Non-Painful Phantom sensations as well as Painful and non-Painful residual Limb sensations were unrelated to motor cortical reorganization. A higher amount of motor reorganization was associated with less daily prosthesis use, which also tended to be related to more severe Phantom Limb Pain. These results extend previous findings of a positive relationship between somatosensory reorganization and Phantom Limb Pain to the motor domain and suggest a potential positive effect of prosthesis use on Phantom Limb Pain and cortical reorganization.
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Phantom Limb Pain characteristics causes and treatment
Lancet Neurology, 2002Co-Authors: Herta FlorAbstract: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.
Niels Birbaumer - One of the best experts on this subject based on the ideXlab platform.
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reorganization of motor and somatosensory cortex in upper extremity amputees with Phantom Limb Pain
The Journal of Neuroscience, 2001Co-Authors: Anke Karl, Niels Birbaumer, Werner Lutzenberger, Leonardo G Cohen, Herta FlorAbstract: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.
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the effect of opioids on Phantom Limb Pain and cortical reorganization
Pain, 2001Co-Authors: Ellena Huse, Wolfgang Larbig, Herta Flor, Niels BirbaumerAbstract:Abstract The efficacy of oral retarded morphine sulphate (MST®) was tested against placebo in a double-blind crossover design in 12 patients with Phantom Limb Pain after unilateral leg or arm amputation. Two counterbalanced treatment phases of 4 weeks each were initiated with an intravenous test infusion of MST® or Placebo. The titration phase was 2 weeks. The dose of MST® was titrated to at least 70 mg/day and at highest 300 mg/day. Pain intensity was assessed hourly on visual analog scales during a 4-week treatment-free phase, both treatment phases and at two follow-ups (6 and 12 months). Reorganization of somatosensory cortex, electric perception and Pain thresholds as well as selective attention were measured pre- and post-treatment. A significant Pain reduction was found during MST® but not during placebo. A clinically relevant response to MST® (Pain reduction of more than 50%) was evident in 42%, a partial response (Pain reduction of 25–50%) in 8% of the patients. Neuromagnetic source imaging of three patients showed initial evidence for reduced cortical reorganization under MST® concurrent with the reduction in Pain intensity. Perception and Pain thresholds were not significantly altered whereas attention was significantly lower under MST®. Thus, opioids show efficacy in the treatment of Phantom Limb Pain and may potentially influence also cortical reorganization. These data need to be replicated in larger patient samples.
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the cortical somatotopic map and Phantom phenomena in subjects with congenital Limb atrophy and traumatic amputees with Phantom Limb Pain
European Journal of Neuroscience, 1998Co-Authors: Pedro Montoya, Wolfgang Larbig, Herta Flor, Werner Lutzenberger, Wolfgang Grodd, Ellena Huse, Stephanie Topfner, Karin Ritter, Christoph Braun, Niels BirbaumerAbstract:The extent of the cortical somatotopic map and its relationship to Phantom phenomena was tested in five subjects with congenital absence of an upper Limb, four traumatic amputees with Phantom Limb Pain and five healthy controls. Cortical maps of the first and fifth digit of the intact hand, the lower lip and the first toe (bilaterally) were obtained using neuroelectric source imaging. The subjects with congenital upper Limb atrophy showed symmetric positions of the left and right side of the lower lip and the first toe, whereas the traumatic amputees with Pain showed a significant shift (about 2.4 cm) of the cortical representation of the lower lip towards the hand region contralateral to the amputation side but no shift for the toe representation. In healthy controls, no significant hemispheric differences between the cortical representation of the digits, lower lip or first toe were found. Phantom phenomena were absent in the congenital but extensive in the traumatic amputees. These data confirm the assumption that congenital absence of a Limb does not lead to cortical reorganization or Phantom Limbs whereas traumatic amputations that are accompanied by Phantom Limb Pain show shifts of the cortical areas adjacent to the amputation zone towards the representation of the deafferented body part.
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Phantom Limb Pain as a perceptual correlate of cortical reorganization following arm amputation
Nature, 1995Co-Authors: Herta Flor, Christian Wienbruch, Wolfgang Larbig, Thomas Elbert, Stefan Knecht, Christo Pantev, Niels Birbaumer, Edward TaubAbstract:ALTHOUGH Phantom-Limb Pain is a frequent consequence of the amputation of an extremity, little is known about its origin1-4. On the basis of the demonstration of substantial plasticity of the somatosensory cortex after amputation5 or somatosensory deafferentation in adult monkeys6, it has been suggested that cortical reorganization could account for some non-Painful Phantom-Limb phenomena in amputees and that cortical reorganization has an adaptive (that is, Pain-preventing) function2,5,7,8. Theoretical and empirical work on chronic back Pain9,10 has revealed a positive relationship between the amount of cortical alteration and the magnitude of Pain, so we predicted that cortical reorganization and Phantom-Limb Pain should be positively related. Using non-invasive neuromagnetic imaging techniques to determine cortical reorganization in humans11-13, we report a very strong direct relationship (r = 0.93) between the amount of cortical reorganization and the magnitude of Phantom Limb Pain (but not non-Painful Phantom phenomena) experienced after arm amputation. These data indicate that Phantom-Limb Pain is related to, and may be a consequence of, plastic changes in primary somatosensory cortex.
Anna Beurskens - One of the best experts on this subject based on the ideXlab platform.
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traditional and augmented reality mirror therapy for patients with chronic Phantom Limb Pain pact study results of a three group multicentre single blind randomized controlled trial
Clinical Rehabilitation, 2018Co-Authors: Andreas Rothgangel, Anna Beurskens, Susy Braun, Bjorn Winkens, Rob J E M SmeetsAbstract:Objective:To compare the effects of traditional mirror therapy (MT), a patient-centred teletreatment (PACT) and sensomotor exercises without a mirror on Phantom Limb Pain (PLP).Design:Three-arm mul...
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the pact trial patient centered telerehabilitation effectiveness of software supported and traditional mirror therapy in patients with Phantom Limb Pain following lower Limb amputation protocol of a multicentre randomised controlled trial
Journal of Physiotherapy, 2015Co-Authors: Andreas Rothgangel, Susy M Braun, Ralf Joachim Schulz, Matthias Kraemer, Luc P De Witte, Anna BeurskensAbstract:INTRODUCTION: Non-pharmacological interventions such as mirror therapy are gaining increased recognition in the treatment of Phantom Limb Pain; however, the evidence in people with Phantom Limb Pain is still weak. In addition, compliance to self-delivered exercises is generally low. The aim of this randomised controlled study is to investigate the effectiveness of mirror therapy supported by telerehabilitation on the intensity, duration and frequency of Phantom Limb Pain and limitations in daily activities compared to traditional mirror therapy and care as usual in people following lower Limb amputation. METHOD: A three-arm multi-centre randomised controlled trial will be performed. Participants will be randomly assigned to care as usual, traditional mirror therapy or mirror therapy supported by telerehabilitation. During the first 4 weeks, at least 10 individual sessions will take place in every group. After the first 4 weeks, participants will be encouraged to perform self-delivered exercises over a period of 6 weeks. Outcomes will be assessed at 4 and 10 weeks after baseline and at 6 months follow-up. The primary outcome measure is the average intensity of Phantom Limb Pain during the last week. Secondary outcome measures include the different dimensions of Phantom Limb Pain, Pain-related limitations in daily activities, global perceived effect, Pain-specific self-efficacy, and quality of life. DISCUSSION: Several questions concerning the study design that emerged during the preparation of this trial will be discussed. This will include how these questions were addressed and arguments for the choices that were made.
Martin Diers - One of the best experts on this subject based on the ideXlab platform.
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Phantom Limb Pain after unilateral arm amputation is associated with decreased heat Pain thresholds in the face
European Journal of Pain, 2021Co-Authors: Robin Bekraterbodmann, Martin Diers, Xaver Fuchs, Jorg Trojan, Pinar Kirsch, Christopher Milde, Mariela RanceAbstract:BACKGROUND The mechanisms underlying chronic Phantom Limb Pain (PLP) are complex and insufficiently understood. Altered sensory thresholds are often associated with chronic Pain but quantitative sensory testing (QST) in PLP has so far been inconclusive due to large methodological variation between studies and small sample sizes. METHODS In this study, we applied QST in 37 unilateral upper-Limb amputees (23 with and 14 without PLP) and 19 healthy controls. We assessed heat Pain (HPT), pressure Pain, warmth detection and two-point discrimination thresholds at the residual Limb, a homologous point and the thenar of the intact Limb as well as both corners of the mouth. RESULTS We did not find significant differences in any of the thresholds between the groups. However, PLP intensity was negatively associated with HPT at all measured body sites except for the residual Limb, indicating lower Pain thresholds with higher PLP levels. Correlations between HPT and PLP were strongest in the contralateral face (r = -0.65, p < 0.001). Facial HPT were specifically associated with PLP, independent of residual Limb Pain (RLP) and various other covariates. HPT at the residual Limb, however, were significantly associated with RLP, but not with PLP. CONCLUSION We conclude that the association between PLP and, especially facial, HPT could be related to central mechanisms. SIGNIFICANCE Phantom Limb Pain (PLP) is still poorly understood. We show that PLP intensity is associated with lower heat Pain thresholds, especially in the face. This finding could be related to central nervous changes in PLP.
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relationship of prosthesis ownership and Phantom Limb Pain results of a survey in 2383 Limb amputees
Pain, 2021Co-Authors: Robin Bekraterbodmann, Herta Flor, Martin Diers, Iris Reinhard, Xaver FuchsAbstract:ABSTRACT Phantom Limb Pain (PLP) accounts for a significant reduction in quality of life and is difficult to treat. Prosthesis use has been shown to negatively covary with PLP. Recent research on body perception in amputees suggest that prosthesis ownership, defined as the extent to which a prosthesis is experienced as being part of the body rather than an artificial device foreign to the body, might interact with PLP. We used survey data from 2383 unilateral prosthesis-using upper-Limb or lower-Limb amputees and performed regression analyses to determine the relationship between prosthesis ownership and PLP. To test for specificity, we examined the role of prosthesis ownership also for residual Limb Pain (RLP) and nonPainful Phantom Limb sensations (npPLS). Prosthesis ownership was reduced in older participants and higher in lower-Limb compared to upper-Limb amputees. A longer residual Limb and more frequent prosthesis use as well as a longer time since amputation also yielded higher values. Prostheses based on natural principles were associated with higher prosthesis ownership. Phantom Limb Pain and RLP were lower with higher prosthesis ownership, and RLP but not PLP was lower when prosthesis use was frequent. There were no significant associations for npPLS. The regression results differ in some aspects from those revealed by univariate analyses, emphasizing the importance of multivariate statistical approaches. Our findings provide insights into the interplay of body- and Pain-related sensations after amputation, and could help to develop new treatment approaches for both PLP and RLP.
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mirrored imagined and executed movements differentially activate sensorimotor cortex in amputees with and without Phantom Limb Pain
Pain, 2010Co-Authors: Martin Diers, Christoph Christmann, Caroline Koeppe, Matthias Ruf, Herta FlorAbstract:Extended viewing of movements of the intact hand in a mirror as well as motor imagery has been shown to decrease Pain in Phantom Pain patients. We used functional magnetic resonance imaging to assess the neural correlates of mirrored, imagined and executed hand movements in 14 upper extremity amputees – 7 with Phantom Limb Pain (PLP) and 7 without Phantom Limb Pain (non-PLP) and 9 healthy controls (HC). Executed movement activated the contralateral sensorimotor area in all three groups but ipsilateral cortex was only activated in the non-PLP and HC group. Mirrored movements activated the sensorimotor cortex contralateral to the hand seen in the mirror in the non-PLP and the HC but not in the PLP. Imagined movement activated the supplementary motor area in all groups and the contralateral primary sensorimotor cortex in the non-PLP and HC but not in the PLP. Mirror- and movement-related activation in the bilateral sensorimotor cortex in the mirror movement condition and activation in the sensorimotor cortex ipsilateral to the moved hand in the executed movement condition were significantly negatively correlated with the magnitude of Phantom Limb Pain in the amputee group. Further research must identify the causal mechanisms related to mirror treatment, imagined movements or movements of the other hand and associated changes in Pain perception.
Xaver Fuchs - One of the best experts on this subject based on the ideXlab platform.
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Phantom Limb Pain after unilateral arm amputation is associated with decreased heat Pain thresholds in the face
European Journal of Pain, 2021Co-Authors: Robin Bekraterbodmann, Martin Diers, Xaver Fuchs, Jorg Trojan, Pinar Kirsch, Christopher Milde, Mariela RanceAbstract:BACKGROUND The mechanisms underlying chronic Phantom Limb Pain (PLP) are complex and insufficiently understood. Altered sensory thresholds are often associated with chronic Pain but quantitative sensory testing (QST) in PLP has so far been inconclusive due to large methodological variation between studies and small sample sizes. METHODS In this study, we applied QST in 37 unilateral upper-Limb amputees (23 with and 14 without PLP) and 19 healthy controls. We assessed heat Pain (HPT), pressure Pain, warmth detection and two-point discrimination thresholds at the residual Limb, a homologous point and the thenar of the intact Limb as well as both corners of the mouth. RESULTS We did not find significant differences in any of the thresholds between the groups. However, PLP intensity was negatively associated with HPT at all measured body sites except for the residual Limb, indicating lower Pain thresholds with higher PLP levels. Correlations between HPT and PLP were strongest in the contralateral face (r = -0.65, p < 0.001). Facial HPT were specifically associated with PLP, independent of residual Limb Pain (RLP) and various other covariates. HPT at the residual Limb, however, were significantly associated with RLP, but not with PLP. CONCLUSION We conclude that the association between PLP and, especially facial, HPT could be related to central mechanisms. SIGNIFICANCE Phantom Limb Pain (PLP) is still poorly understood. We show that PLP intensity is associated with lower heat Pain thresholds, especially in the face. This finding could be related to central nervous changes in PLP.
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relationship of prosthesis ownership and Phantom Limb Pain results of a survey in 2383 Limb amputees
Pain, 2021Co-Authors: Robin Bekraterbodmann, Herta Flor, Martin Diers, Iris Reinhard, Xaver FuchsAbstract:ABSTRACT Phantom Limb Pain (PLP) accounts for a significant reduction in quality of life and is difficult to treat. Prosthesis use has been shown to negatively covary with PLP. Recent research on body perception in amputees suggest that prosthesis ownership, defined as the extent to which a prosthesis is experienced as being part of the body rather than an artificial device foreign to the body, might interact with PLP. We used survey data from 2383 unilateral prosthesis-using upper-Limb or lower-Limb amputees and performed regression analyses to determine the relationship between prosthesis ownership and PLP. To test for specificity, we examined the role of prosthesis ownership also for residual Limb Pain (RLP) and nonPainful Phantom Limb sensations (npPLS). Prosthesis ownership was reduced in older participants and higher in lower-Limb compared to upper-Limb amputees. A longer residual Limb and more frequent prosthesis use as well as a longer time since amputation also yielded higher values. Prostheses based on natural principles were associated with higher prosthesis ownership. Phantom Limb Pain and RLP were lower with higher prosthesis ownership, and RLP but not PLP was lower when prosthesis use was frequent. There were no significant associations for npPLS. The regression results differ in some aspects from those revealed by univariate analyses, emphasizing the importance of multivariate statistical approaches. Our findings provide insights into the interplay of body- and Pain-related sensations after amputation, and could help to develop new treatment approaches for both PLP and RLP.