Referred cramping phantom hand pain elicited in the face and eliminated by peripheral nerve block

  • Caroline Dietrich
  • Sandra Nehrdich
  • Annette Zimmer
  • Alexander Ritter
  • Gunther O. Hofmann
  • Wolfgang H. R. Miltner
  • Thomas Weiss
Research Article
  • 2 Downloads

Abstract

Phantom limb pain is a restricting condition for a substantial number of amputees with quite different characteristics of pain. Here, we report on a forearm amputee with constant phantom pain in the hand, in whom we could regularly elicit the rare phenomenon of referred cramping phantom pain by touching the face. To clarify the underlying mechanisms, we followed the cramp during the course of an axillary blockade of the brachial plexus. During the blockade, both phantom pain and the referred cramp were abolished, while a referred sensation of “being touched at the phantom” persisted. Furthermore, to identify the cortical substrate, we elicited the cramp during functional magnetic imaging. Imaging revealed that referred cramping phantom limb pain was associated with brain activation of the hand representation in the primary sensorimotor cortex. The results support the hypothesis that referred cramping phantom limb pain in this case is associated with a substantial brain activation in the hand area of the deafferented sensorimotor cortex. However, this alone is not sufficient to elicit referred cramping phantom limb pain. Peripheral inputs, both, from the arm nerves affected by the amputation and from the skin in the face at which the referred cramp is evoked, are a precondition for referred cramping phantom limb pain to occur, at least in this case.

Keywords

Phantom limb pain Cramping Brachial plexus Referred sensation Sensorimotor cortex 

Notes

Acknowledgements

Thanks to Gerd F. Volk, Winfried Meissner, and Holger Hecht for help with data acquisition. This work was supported by the German Social Accident Insurance (DGUV-FR145 and FR196). DGUV neither influenced the study goals of study design; authors are fully responsible for goals, design, and results. The funding source had no involvement in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.

Compliance with ethical standards

Conflict of interest

There is no conflict of interest for any author of this study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Caroline Dietrich
    • 1
  • Sandra Nehrdich
    • 1
  • Annette Zimmer
    • 2
  • Alexander Ritter
    • 3
  • Gunther O. Hofmann
    • 4
    • 5
  • Wolfgang H. R. Miltner
    • 1
  • Thomas Weiss
    • 1
  1. 1.Department of Clinical PsychologyFriedrich Schiller UniversityJenaGermany
  2. 2.Department of Anesthesiology and Intensive Care MedicineUniversity Hospital JenaJenaGermany
  3. 3.Department of Neurology, Section Neurological RehabilitationUniversity Hospital JenaJenaGermany
  4. 4.Berufsgenossenschaftliche Kliniken Bergmannstrost Halle/SaaleHalleGermany
  5. 5.Department of Trauma, Hand and Reconstructive SurgeryUniversity Hospital JenaJenaGermany

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