Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2015; 3(7): 542-544
Published online Jul 16, 2015. doi: 10.12998/wjcc.v3.i7.542
Where is hidden the ghost in phantom sensations?
Michelangelo Buonocore
Michelangelo Buonocore, Unit of Clinical Neurophysiology and Neurodiagnostic Skin Biopsy, Fondazione Salvatore Maugeri, Scientific Institute of Pavia, 27100 Pavia, Italy
Author contributions: Buonocore M solely contributed to this manuscript.
Conflict-of-interest statement: The author declares no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Michelangelo Buonocore, Unit of Clinical Neurophysiology and Neurodiagnostic Skin Biopsy, Fondazione Salvatore Maugeri, Scientific Institute of Pavia,Via Maugeri 10, 27100 Pavia, Italy. michelangelo.buonocore@fsm.it
Telephone: +39-0382-592392 Fax: +39-0382-592020
Received: February 13, 2015
Peer-review started: February 21, 2015
First decision: March 20, 2015
Revised: April 7, 2015
Accepted: May 5, 2015
Article in press: May 6, 2015
Published online: July 16, 2015
Processing time: 163 Days and 20 Hours
Abstract

The term phantom sensations (PS) refers to sensations in a missing body part. They are almost universal in amputees and can be both painful and not painful. Although PS have been frequently described in limb amputees, they can also occur in other clinical conditions and several pathophysiological interpretations have been proposed, with a predominance of theories based on a central origin. Actually, different mechanisms are able to create a phantom sensation. After an amputation, PS are frequently generated by the genesis of ectopic action potentials in the interrupted nerve fibers but the PS generator can also be more proximal. Sometimes PS are not created by the stimulation of somatosensory fibers with a missing territory, but they can be the result of central sensitization or neuroplastic changes that allow for the convergence of impulses coming from different body parts (referred sensations), one of which is missing. In conclusion, PS can be generated by both neuropathic and non-neuropathic mechanisms developed in the amputated body part or in other parts of the nervous system. Since these mechanisms are not pathognomonic of amputation there are no hidden ghosts to look for in phantom sensations. The only interpretative rule is just to follow the pathophysiological principles.

Keywords: Phantom sensations; Phantom pain; Neuropathic pain; Referred pain; Pain pathophysiology

Core tip: The term phantom sensations (PS) refers to sensations in a missing body part. They are almost universal in amputees and can be both painful and not painful. Several pathophysiological interpretations have been proposed, with a predominance of theories based on a central origin. Actually, PS can be generated by both neuropathic (ectopic) and non-neuropathic (referred) mechanisms developed in the amputated body part or in other parts of the nervous system. Since these mechanisms are not pathognomonic of amputation there are no hidden ghosts to look for in phantom sensations. The only interpretative rule is just to follow the pathophysiological principles.