Phantom limb experience in children and adults: Cognitive and affective contributions.

Abstract

This paper reviews the literature on cognitive and affective processes that contribute to phantom limb experience. The paper challenges a commonly held view that psychologically or emotionally induced sensations or pain referred to the phantom limb necessarily represent a psychopathological response to amputation. It is argued that thoughts and feelings may trigger sensations referred to the phantom limb in psychologically healthy individuals and that the painful or painless phantom limb is not a symptom of a psychological disorder. An attempt is made to address the puzzling finding that only after amputation are thoughts and feelings capable of evoking referred sensations to the (phantom) limb. A model is developed that involves a sympathetic-efferent somatic-afferent cycle of activity, initiated by higher brain centres involved in cognitive and affective processes, to explain psychologically and emotionally triggered phantom limb sensations. It is concluded that the experience of a phantom limb is determined by a complex interaction of inputs from the periphery and widespread regions of the brain subserving sensory, affective, and cognitive processes. Throughout the paper, developmental themes are highlighted, both as they relate to the time course of the phantom limb and to what little is known about the phenomenon in children and adolescents. ResumeLe rapport comporte un examen de la literature sur les processus cognitifs et affectifs qui concourrent a l'experience du membre fantome. On y remet en question l'opinion repandue selon laquelle les sensations d'ordre psychologique ou emotionnel ou la douleur du membre fant6me representent forc^ment une reponse psychopathologique a l'amputation. On fait valoir que les pensees et les sentiments peuvent declencher la sensation du membre fantome chez des individus psychologiquement sains et que le membre fantome douloureux ou non n'est pas le symptome d'un trouble psychologique. On tente d'expliquer l'observation troublante d'apres laquelle les pensees et les sentiments peuvent evoquer la sensation du membre (fantdme) seulement apris l'amputation. Un modele incluant un cycle d'activit6 efferent-sympathique afferent-somatique, mis en oeuvre par les centres nerveux superieurs qui interviennent dans les processus cognitifs et affectifs, est concu pour expliquer la sensation du

Psychological Factors Associated with Phantom Limb Pain: A Review of Recent Findings

“…The studies described above support the notion that PLP relates to both peripheral and central arousal and that PLP episodes might be influenced by emotional distress. Katz [ 63 ] proposed a model explaining the close connection between cognitive and affective processes and PLP. In amputees, the threshold for somatic sensations in the phantom limb might be lowered due to the loss of inhibitory control.…”