Phantom limb pain following amputation is a neuropathic pain phenomenon. The neurobiological mechanism most supported by current evidence involves:

• A Peripheral neuroma formation at the amputation stump firing spontaneously
• B Psychological grief reaction to body image loss
• C Hypersensitivity of spinal dorsal horn neurons exclusively
• D Maladaptive cortical reorganisation of the somatosensory cortex (cortical remapping) ✓

Explanation

Current evidence strongly implicates maladaptive cortical reorganization (cortical remapping) of the somatosensory cortex as the key central mechanism of phantom limb pain. After amputation, cortical representation of adjacent body parts (e.g., face for upper limb amputees) invades the deafferented cortical zone; the magnitude of this remapping correlates with phantom pain intensity on fMRI studies. This has led to mirror therapy and graded motor imagery as effective rehabilitation strategies. Peripheral neuromas contribute to residual limb pain but are distinct from phantom pain. The mechanism is multimodal (peripheral sensitization, spinal central sensitization, and cortical remapping), but cortical reorganization is the most current and clinically supported explanation.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.