Cognitive-emotional sensitization contributes to wind-up-like pain in phantom limb pain patients

Abstract

Peripheral mechanisms are known to play a role in phantom pain following limb amputation, and more recently it has been suggested that central mechanisms may also be of importance. Some patients seem to have a psychological sensitivity that predisposes them to react with pain catastrophizing after amputation of a limb, and this coping style may contribute to increased facilitation, impaired modulation of nociceptive signals, or both. To investigate how pain catastrophizing, independently of anxiety and depression, may contribute to phantom limb pain and to alterations in pain processing twenty-four upper-limb amputees with various levels of phantom limb pain were included in the study. Patients' level of pain catastrophizing, anxiety and depression was assessed and they went through quantitative sensory testing (QST) of thresholds (mechanical and thermal) and wind-up-like pain (brush and pinprick). Catastrophizing accounted for 35% of the variance in phantom limb pain (p=0.001) independently of anxiety and depression. Catastrophizing was also positively associated with wind-up-like pain in non-medicated patients (p=0.015), but not to pain thresholds. These findings suggest that cognitive-emotional sensitization contributes to the altered nociceptive processing seen in phantom limb pain patients. The possible interactions between pain catastrophizing, wind-up-like pain, and peripheral input in generating and maintaining phantom limb pain are discussed.

Incidence of phantom limb phenomena after lower limb amputations in a Singapore tertiary hospital

“…According to some authors, cognitive-emotional sensitisation also contributes to the altered nociceptive processing seen in PLP patients. (48,49) In conclusion, our study reported the incidence of phantom limb phenomena in a predominantly Asian and multiracial population in Singapore. To the authors' knowledge, this is the first study that has published local epidemiological data on PLP in patients who underwent lower limb amputations.…”

Chronic Pain in People with Physically Disabling Conditions: A Review of the Application of Biopsychosocial Models

“…While pain catastrophizing has often been measured in questionnaires designed to measure coping strategies, it is best considered alongside other beliefs, and so will be reported on in this section. Pain catastrophizing has been found to be associated with pain intensity among people with chronic phantom limb pain post-amputation, multiple sclerosis and spinal cord injury (Hill, Niven, & Knussen, 1995;Osborne, Jensen, Ehde, Hanley, & Kraft, 2007;Turner, et al, 2002;Vase, et al, 2011;Wollaars, Post, van Asbeck, & Brand, 2007). In a study of people with phantom limb pain, pain catastrophizing was also shown to significantly contribute to wind-up-like pain when anxiety and depression were controlled for (Vase, et al, 2011) Pain catastrophizing has been found to be positively associated with pain-related disability among those with spinal cord injury, cerebral palsy, phantom limb pain, muscular dystrophy and multiple sclerosis (Borsbo, et al, 2009;Douglas, Wollin, & Windsor, 2008;Engel, et al, 2000;Hill, et al, 1995;Miro, et al, 2009;Molton, et al, 2009;Osborne, et al, 2007).…”

“…Pain catastrophizing has been found to be associated with pain intensity among people with chronic phantom limb pain post-amputation, multiple sclerosis and spinal cord injury (Hill, Niven, & Knussen, 1995;Osborne, Jensen, Ehde, Hanley, & Kraft, 2007;Turner, et al, 2002;Vase, et al, 2011;Wollaars, Post, van Asbeck, & Brand, 2007). In a study of people with phantom limb pain, pain catastrophizing was also shown to significantly contribute to wind-up-like pain when anxiety and depression were controlled for (Vase, et al, 2011) Pain catastrophizing has been found to be positively associated with pain-related disability among those with spinal cord injury, cerebral palsy, phantom limb pain, muscular dystrophy and multiple sclerosis (Borsbo, et al, 2009;Douglas, Wollin, & Windsor, 2008;Engel, et al, 2000;Hill, et al, 1995;Miro, et al, 2009;Molton, et al, 2009;Osborne, et al, 2007). Psychological functioning among people with spinal cord injury, multiple sclerosis, phantom limb pain, muscular dystrophy and cerebral palsy has been found to be negatively associated with pain catastrophizing (Douglas, et al, 2008;Engel, Jensen, & Schwartz, 2006;Engel, et al, 2000;Hanley, et al, 2004;Hill, et al, 1995;Miro, et al, 2009;Molton, et al, 2009;Osborne, et al, 2007;Smedema, Catalano, & Ebener, 2011;Ullrich, Jensen, Loeser, & Cardenas, 2007;Wollaars, et al, 2007).…”

“…It has been suggested that pain catastrophizing may, in fact, be a function of disturbed mood. This suggestion is brought into question by findings in both phantom limb pain and spinal cord injury related chronic pain which shows that pain catastrophizing is associated with pain intensity when mood is controlled for (Ullrich, et al, 2007;Vase, et al, 2011). Among the many studies of individuals with spinal cord injury pain, veterans with the condition appear to have higher levels of pain catastrophizing than non-veterans (Ullrich, Jensen, Loeser, Cardenas, & Weaver, 2008).…”

Pain catastrophizing and cortical responses in amputees with varying levels of phantom limb pain: a high-density EEG brain-mapping study

“…The mechanisms underlying phantom limb pain are not fully known (Flor et al 2006), but it has been shown that pain catastrophizing is related to phantom limb patients' spontaneous pain levels (Hill et al 1995;Jensen et al 2002;Whyte and Carroll 2004;Hanley et al 2004;Richardson et al 2007;Vase et al 2011). Pain catastrophizing has been broadly defined as ''the exaggerated orientation toward nociceptive stimuli,'' and it is characterized by a tendency to magnify the threat value of the stimulus, to feel helpless in the context of the stimulus and by a relative inability to inhibit pain-related thoughts in anticipation of, during or after a painful event (Rosenstiel and Keefe 1983;Sullivan et al 2001;Quartana et al 2009).…”