Propioceptive movement feedback to tackle peripheral and central sources of phantom limb pain in amputees and provide an innovative treatment – PhantomPain

In addition to cognitive distress and problems with own-body image, most amputees suffer from phantom limb pain. The neural underpinnings of phantom pain, which relate to neural disruption at both the peripheral and central level, are not fully elucidated. “Mirror therapy” which consists of looking at the image of their healthy limb in a mirror, in place of the stump, in order to alleviate phantom pain, has proved to be of limited impact.
By combining neuroimaging and microneurography, the present proposal aims to tackle multiple facets of phantom limb pain with a new rehabilitation method, based on proprioceptive feedback relating to the missing limb. Activating residual muscle afferents from the stump and feeding the brain with more realistic proprioceptive feedback that simulates movements of the missing limb should restore appropriate spontaneous afferent firing, spinal activity, cortical organization and functional brain connectivity to finally alleviate phantom pain. In addition, proprioceptive feedback should facilitate the sense of ownership of the prosthesis and its incorporation into the patients' body schema, which is necessary to prevent the too frequent rejection of the prosthesis.
In addition to its clinical goal, this ambitious project aims to better understand the mechanisms of pain and phantom limb through innovative approaches such as functional imaging of the spinal cord and brain, as well as a microneurography approach to record peripheral nerve activity directly from the residual limb of amputee patients.
The results of this project should therefore offer new perspectives in the field of rehabilitation and the fundamental knowledge of phantom pain but also in the longer term in the field of neuroprosthetic development.