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Weiss T, Koehler H, Croy I. Pain and Reorganization after Amputation: Is Interoceptive Prediction a Key? Neuroscientist 2023; 29:665-675. [PMID: 35950521 PMCID: PMC10623598 DOI: 10.1177/10738584221112591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is an ongoing discussion on the relevance of brain reorganization following amputation for phantom limb pain. Recent attempts to provide explanations for seemingly controversial findings-specifically, maladaptive plasticity versus persistent functional representation as a complementary process-acknowledged that reorganization in the primary somatosensory cortex is not sufficient to explain phantom limb pain satisfactorily. Here we provide theoretical considerations that might help integrate the data reviewed and suppose a possible additional driver of the development of phantom limb pain-namely, an error in interoceptive predictions to somatosensory sensations and movements of the missing limb. Finally, we derive empirically testable consequences based on our considerations to guide future research.
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Affiliation(s)
- Thomas Weiss
- Department of Psychology, Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Hanna Koehler
- Department of Psychology, Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
- Biomagnetic Center, Jena University Hospital, Jena, Germany
| | - Ilona Croy
- Department of Psychology, Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
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Ritter C, Geisler M, Blume KR, Nehrdich S, Hofmann GO, Koehler H, Miltner WHR, Weiss T. Stimulation of peroneal nerves reveals maintained somatosensory representation in transtibial amputees. Front Hum Neurosci 2023; 17:1240937. [PMID: 37746055 PMCID: PMC10512738 DOI: 10.3389/fnhum.2023.1240937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Several studies have found changes in the organization of the primary somatosensory cortex (SI) after amputation. This SI reorganization was mainly investigated by stimulating neighboring areas to amputation. Unexpectedly, the somatosensory representation of the deafferented limb has rarely been directly tested. Methods We stimulated the truncated peroneal nerve in 24 unilateral transtibial amputees and 15 healthy controls. The stimulation intensity was adjusted to make the elicited percept comparable between both stimulation sides. Neural sources of the somatosensory-evoked magnetic fields (SEFs) to peroneal stimulation were localized in the contralateral foot/leg areas of SI in 19 patients and 14 healthy controls. Results We demonstrated the activation of functionally preserved cortical representations of amputated lower limbs. None of the patients reported evoked phantom limb pain (PLP) during stimulation. Stimulation that evoked perceptions in the foot required stronger intensities on the amputated side than on the intact side. In addition to this, stronger stimulation intensities were required for amputees than for healthy controls. Exploratorily, PLP intensity was neither associated with stimulation intensity nor dipole strength nor with differences in Euclidean distances (between SEF sources of the healthy peroneus and mirrored SEF sources of the truncated peroneus). Discussion Our results provide hope that the truncated nerve may be used to establish both motor control and somatosensory feedback via the nerve trunk when a permanently functional connection between the nerve trunk and the prosthesis becomes available.
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Affiliation(s)
- Caroline Ritter
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Clinic for Psychosomatics and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Maria Geisler
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Clinic for Psychosomatics and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Kathrin R. Blume
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Sandra Nehrdich
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Clinic for Psychosomatics and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Gunther O. Hofmann
- Berufsgenossenschaftliche Kliniken Bergmannstrost Halle/Saale, Halle, Germany
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
| | - Hanna Koehler
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
- Biomagnetic Center, Department of Neurology, University Hospital Jena, Jena, Germany
| | - Wolfgang H. R. Miltner
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Thomas Weiss
- Department of Clinical Psychology, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
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Osumi M, Sano Y, Ichinose A, Wake N, Yozu A, Kumagaya SI, Kuniyoshi Y, Morioka S, Sumitani M. Direct evidence of EEG coherence in alleviating phantom limb pain by virtual referred sensation: Case report. Neurocase 2020; 26:55-59. [PMID: 31762364 DOI: 10.1080/13554794.2019.1696368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Virtual reality (VR) systems have been integrated into rehabilitation techniques for phantom limb pain (PLP). In this case report, we used electroencephalography (EEG) to analyze corticocortical coherence between the bilateral sensorimotor cortices during vibrotactile stimulation in conjunction with VR rehabilitation in two PLP patients. As a result, we observed PLP alleviation and increased alpha wave coherence during VR rehabilitation when stimulation was delivered to the cheek and shoulder (referred sensation areas) of the affected side. Vibrotactile stimulation with VR rehabilitation may enhance the awareness and movement of the phantom hand.
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Affiliation(s)
- Michihiro Osumi
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Yuko Sano
- Intelligent Systems and Informatics Laboratory, Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Akimichi Ichinose
- Intelligent Systems and Informatics Laboratory, Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Naoki Wake
- Intelligent Systems and Informatics Laboratory, Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Arito Yozu
- Center of Medical Science, Ibaraki Prefectural University of Health Science, Tokyo, Japan
| | - Shin-Ichiro Kumagaya
- Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Yasuo Kuniyoshi
- Intelligent Systems and Informatics Laboratory, Department of Mechano-Informatics, Graduate School of Information Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Shu Morioka
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
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