Phantom body pain in paraplegics: Evidence for a central “pattern generating mechanism” for pain

Phantom body pain in paraplegic patients is the most mysterious of all pain phenomena. It has been traditionally assumed [45] that the essential cause of pain in any part of the body is activity in the receptor-fiber units that innervate it. In this paper, however, we shall describe paraplegic patients who had undergone removal of an entire section of the spinal cord (segmental cordectomy) in the attempt to alleviate phantom body pain, yet they still suffered severe pain in the denervated areas of the body. There is no reason to believe that the pain was due to depression or neurosis. Furthermore, the possibility that the pain was produced by nociceptive signals transmitted along the sympathetic chain is ruled out because the pain was not relieved by bilateral sympathetic blocks. The perception of severe, chronic pain in the absence of any input from those parts of the body in which pain is felt has profound implications for theories of pain. The purpose of this paper is to examine the properties of phantom body pains in paraplegics and to propose a theoretical concept to explain them.

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