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WIREs Cogn Sci
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Phantom limbs: pain, embodiment, and scientific advances in integrative therapies

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Research over the past two decades has begun to identify some of the key mechanisms underlying phantom limb pain and sensations; however, this continues to be a clinically challenging condition to manage. Treatment of phantom pain, like all chronic pain conditions, demands a holistic approach that takes into consideration peripheral, spinal, and central neuroplastic mechanisms. In this review, we focus on nonpharmacological treatments tailored to reverse the maladaptive neuroplasticity associated with phantom pain. Recent scientific advances emerging from interdisciplinary research between neuroscience, virtual reality, robotics, and prosthetics show the greatest promise for alternative embodiment and maintaining the integrity of the multifaceted representation of the body in the brain. Importantly, these advances have been found to prevent and reduce phantom limb pain. In particular, therapies that involve sensory and/or motor retraining, most naturally through the use of integrative prosthetic devices, as well as peripheral (e.g., transcutaneous electrical nerve stimulation) or central (e.g., transcranial magnetic stimulation or deep brain stimulation) stimulation techniques, have been found to both restore the neural representation of the missing limb and to reduce the intensity of phantom pain. While the evidence for the efficacy of these therapies is mounting, but well‐controlled and large‐scale studies are still needed. WIREs Cogn Sci 2014, 5:221–231. doi: 10.1002/wcs.1277 This article is categorized under: Philosophy > Consciousness Neuroscience > Clinical Neuroscience Neuroscience > Plasticity
Schematic illustration of cortical reorganization in primary sensorimotor areas after hand amputation.
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Key treatments used to reverse cortical reorganization, including (a) stimulation techniques such as transcranial magnetic stimulation, transcutaneous electrical nerve stimulation, and caloric vestibular stimulation; (b) holistic embodiment therapies including virtual reality; and (c) sensorimotor training such as graded motor imagery with laterality training, mental imagery, and mirror movements.
[ Normal View | Magnified View ]

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Philosophy > Consciousness
Neuroscience > Plasticity
Neuroscience > Clinical Neuroscience

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