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Phantom limb pain intensity is associated with generalized hyperalgesia

View ORCID ProfileXaver Fuchs, Martin Diers, Jörg Trojan, Pinar Kirsch, Christopher Milde, Robin Bekrater-Bodmann, Mariela Rance, Jens Foell, Jamila Andoh, Susanne Becker, Herta Flor
doi: https://doi.org/10.1101/538207
Xaver Fuchs
1Biopsychology and Cognitive Neuroscience, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
2Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Martin Diers
3Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
2Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Jörg Trojan
4Department of Psychology, University of Koblenz-Landau, Landau, Germany
2Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Pinar Kirsch
2Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Christopher Milde
4Department of Psychology, University of Koblenz-Landau, Landau, Germany
2Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Robin Bekrater-Bodmann
2Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Mariela Rance
5Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
2Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Jens Foell
6Department of Psychology, Florida State University, Tallahassee, Florida, USA
2Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Jamila Andoh
2Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Susanne Becker
2Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Herta Flor
2Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Abstract

After limb amputation, most amputees suffer from phantom limb pain (PLP). The mechanisms underlying this condition are complex and insufficiently understood. Altered somatosensory sensitivity (either heightened or lowered) might contribute to PLP. Recent studies have tested this assumption but mainly focused on the residual limb. However, altered somatosensation in PLP might be generalized. In this study, we applied quantitative sensory testing to 37 unilateral upper-limb amputees (23 with PLP, 14 without PLP) and 19 healthy controls. We assessed thresholds to heat pain (HPT), pressure pain (PPT), warmth detection (WDT), and two-point discrimination (2PDT) at the residual limb, a homologous point and the thenar of the intact limb, and both corners of the mouth. We did not find significant differences in any of the thresholds between the groups. However, higher PLP intensity was significantly related to lower HPT at all measured body sites except for the residual limb. At the residual limb, lower HPT were observed in more distal amputations and in amputees showing a higher degree of prosthesis use. Although WDT did by itself not significantly correlate with PLP intensity at any of the body sites, multiple regression analysis showed the highest multiple correlations with PLP intensity for a combination of high WDT and low HPT at the corners of the mouth. In this model, the combination of HPT and WDT shared 58% of the variance with PLP intensity. Other factors of potential importance, especially residual limb pain, were not significantly associated to any sensory threshold. We conclude that the intensity, but not the presence of PLP is positively associated with higher heat pain sensitivity. Since this association was observed at various, distributed body sites, we suggest that central mechanisms might be underlying such generalized hyperalgesia.

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Posted February 01, 2019.
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Phantom limb pain intensity is associated with generalized hyperalgesia
Xaver Fuchs, Martin Diers, Jörg Trojan, Pinar Kirsch, Christopher Milde, Robin Bekrater-Bodmann, Mariela Rance, Jens Foell, Jamila Andoh, Susanne Becker, Herta Flor
bioRxiv 538207; doi: https://doi.org/10.1101/538207
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Phantom limb pain intensity is associated with generalized hyperalgesia
Xaver Fuchs, Martin Diers, Jörg Trojan, Pinar Kirsch, Christopher Milde, Robin Bekrater-Bodmann, Mariela Rance, Jens Foell, Jamila Andoh, Susanne Becker, Herta Flor
bioRxiv 538207; doi: https://doi.org/10.1101/538207

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