Abstract
The aim of this study was to investigate whether a special prosthetic training in phantom limb pain patients aimed at increasing the functional use of the prosthesis leads to neural morphological plasticity of brain structures and a reduction in phantom limb pain. For chronic pain disorders, it was shown that morphological alterations due to pain might become at least partially reversed by pain therapies. Phantom limb pain is a chronic pain disorder that is frequently followed by neural plasticity of anatomical brain structures. In our study, 10 patients with amputation of the upper limb participated in a two-week training with a myoelectric prosthesis with somatosensory feedback. Grip strength was fed back with electrocutaneous stimulus patterns applied to the stump. Phantom limb pain was assessed before and after the two-week training. Similarly, two T1 weighted MRI scans were conducted for longitudinal thickness analyses of cortical brain structures. As result of this treatment, patients experienced a reduction in phantom limb pain and a gain in prosthesis functionality. Furthermore, we found a change of cortical thickness in small brain areas in the visual stream and the post-central gyrus ipsilateral to the amputation indicating morphological alterations in brain areas involved in vision and pain processing.
Highlights
After amputation of a limb, up to 80% of patients experience painful sensations in the missing body part (Desmond and Maclachlan, 2010)
Patients were requested to provide ratings on a 5 point Likert scale ranging from 1 (“appropriate”) to 5 (“not at all”) at the first and at the last day of training in response to the following statements: “I can interpret and evaluate the electrocutaneous feedback very well” (Q_EF); “I succeeded in muscular triggering of the myoelectric prosthesis” (Q_MT); “I feel confident about using the myoelectric prosthesis” (Q_CO)
Patients showed improved performance according to the statements: “I can interpret and evaluate the electrocutaneous feedback very well”: Meanpre = 6.0, SDpre = 1.8, Meanpost = 8.5, SDpost = 1.4; df=1.13 = 0.36, p < 0.05; “I succeeded in muscular triggering of the myoelectric prosthesis”: Meanpre = 7.1, SDpre = 1.5, Meanpost = 8.7, SDpost = 1.4; df=1.13 = 0.63, p < 0.05; “I feel confident about using the myoelectric prosthesis”: Meanpre = 7.0, SDpre = 1.4, Meanpost = 8.8, SDpost = 1.1; df=1.13 = 0.38, p < 0.05
Summary
After amputation of a limb, up to 80% of patients experience painful sensations in the missing body part (Desmond and Maclachlan, 2010) Such painful sensations are termed phantom limb pain (PLP; Mitchell, 1871). It was assumed that sensory areas formerly representing the amputated structure of the body became “enslaved” by the neural representations of neighboring body structures in SI or still receive some input from the stump and other parts of the afferent neural system. The amount of such functional cortical reorganization was highly correlated with PLP intensity (Flor et al, 1995)
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