PHANTOM-LIMB PAIN AS A PERCEPTUAL CORRELATE OF CORTICAL REORGANIZATION FOLLOWING ARM AMPUTATION

ALTHOUGH phantom-limb pain is a frequent consequence of the amputation of an extremity, little is known about its origin(1-4). On the basis of the demonstration of substantial plasticity of the somatosensory cortex after amputation(5) or somatosensory deafferentation in adult monkeys(6), 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) function(2,5,7,8). Theoretical and empirical work on chronic back pain(9,10) 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 humans(11-13), 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.