[Cortical reorganization and pain. Empirical findings and therapeutic implication using the example of phantom pain]

The neuroscientific research of the past years has shown that extensive plastic change occurs in the adult human brain. The functional reorganization of the somatosensory and motor maps related to phantom limb pain is described. Subsequent to deafferentation amputees with phantom limb pain show a shift of neighbouring representation zones into the deafferented zone of the somatosensory and motor cortex that can be detected with noninvasive neuroimaging methods. This reorganization of the sensory and motor maps is not found in painfree amputees and persons with congenital loss of a limb. We discuss a model of the development of phantom limb pain that incorporates both peripheral and central factors and assigns an important role to chronic pain before the amputation. The modulation of plasticity and phantom limb pain by anesthesiological interventions is described and the results of preemptive analgesia for the prevention of phantom limb pain are discussed. Opioid treatment and behaviorally relevant stimulation are effective means to eliminate phantom limb pain and cortical somatosensory pain memories.