Phantom pain: The role of maladaptive plasticity and emotional and cognitive variables

Abstract

Phantom pain is a frequent sequel of the amputation of a limb or another body part and must be differentiated from residual limb pain, postoperative pain, and other chronic pain problems such as back pain that may occur simultaneously. In this chapter, we first discuss how maladaptive plasticity of the central nervous system in interaction with peripheral variables may contribute to phantom pain and then examine how emotional and cognitive variables modulate the phantom pain experience. We show that anxiety, depression, stress experiences, body representation, and memory processes as well as psychosocial variables are associated with both the development of phantom limb pain and its maintenance. In examining this issue, pain and disability-related emotional and cognitive factors must be differentiated. An integration of the described physiological changes with the psychological variables is still missing. We propose a model that integrates psychological and physiological variables in phantom limb pain and discuss implications for both pain assessment and treatment.