Journal article
Neural basis of induced phantom limb pain relief
- Abstract:
-
Objective
Phantom limb pain (PLP) is notoriously difficult to treat, partly due to an incomplete understanding of PLP‐related disease mechanisms. Noninvasive brain stimulation (NIBS) is used to modulate plasticity in various neuropathological diseases, including chronic pain. Although NIBS can alleviate neuropathic pain (including PLP), both disease and treatment mechanisms remain tenuous. Insight into the mechanisms underlying both PLP and NIBS‐induced PLP relief is needed for future implementation of such treatment and generalization to related conditions.
Methods
We used a within‐participants, double‐blind, and sham‐controlled design to alleviate PLP via task‐concurrent NIBS over the primary sensorimotor missing hand cortex (S1/M1). To specifically influence missing hand signal processing, amputees performed phantom hand movements during anodal transcranial direct current stimulation. Brain activity was monitored using neuroimaging during and after NIBS. PLP ratings were obtained throughout the week after stimulation.
Results
A single session of intervention NIBS significantly relieved PLP, with effects lasting at least 1 week. PLP relief associated with reduced activity in the S1/M1 missing hand cortex after stimulation. Critically, PLP relief and reduced S1/M1 activity correlated with preceding activity changes during stimulation in the mid‐ and posterior insula and secondary somatosensory cortex (S2).
Interpretation
The observed correlation between PLP relief and decreased S1/M1 activity confirms our previous findings linking PLP with increased S1/M1 activity. Our results further highlight the driving role of the mid‐ and posterior insula, as well as S2, in modulating PLP. Lastly, our novel PLP intervention using task‐concurrent NIBS opens new avenues for developing treatment for PLP and related pain conditions.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
Actions
Access Document
- Files:
-
-
(Preview, Version of record, pdf, 3.9MB, Terms of use)
-
- Publisher copy:
- 10.1002/ana.25371
Authors
- Funding agency for:
- Tracey, I
- Grant:
- Strategic Award
- Funding agency for:
- Johansen-Berg, H
- Tracey, I
- Makin, TR
- Grant:
- 110027/Z/15/Z
- Strategic Award
- 104128/Z/14/Z
- Funding agency for:
- O'Shea, J
- Makin, TR
- Grant:
- Dorothy Hodgkin Fellowship
- 104128/Z/14/Z
- Publisher:
- Wiley
- Journal:
- Annals of Neurology More from this journal
- Volume:
- 85
- Issue:
- 1
- Pages:
- 59-73
- Publication date:
- 2018-11-01
- Acceptance date:
- 2018-10-29
- DOI:
- EISSN:
-
1531-8249
- ISSN:
-
0364-5134
- Pmid:
-
30383312
- Language:
-
English
- Pubs id:
-
pubs:936576
- UUID:
-
uuid:efddf56d-6539-478a-8067-0b62f3681b6e
- Local pid:
-
pubs:936576
- Source identifiers:
-
936576
- Deposit date:
-
2018-11-12
Terms of use
- Copyright holder:
- Kikkert et al
- Copyright date:
- 2018
- Notes:
-
© 2018 The Authors. Annals of Neurology published by Wiley Periodicals, Inc. on behalf of American Neurological Association.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- Licence:
- CC Attribution (CC BY)
If you are the owner of this record, you can report an update to it here: Report update to this record