Brain Stability & Phantom Limb Pain

 How does sensory input loss influence brain organisation?

Once a major input is lost to the brain, the missing hand area is thought to become “freed-up”. Our own research in amputees, however, shows that this is not the case. We are interested in understanding how malleable brain organisation is following input loss, using both experimental models (pharmacological nerve block) and longitudinal (pre and post amputation) studies in amputees. We use neuroimaging and brain stimulation to explore how persistent representation of the missing hand relates to phantom sensations, and phantom limb pain in particular.

Example papers: Kikkert et al., eLife, 2016; Makin & Bensmaia, TICS, 2017; Wesselink et al., eLife, 2019

What is the neural basis of phantom limb pain? 

Up to 80% of amputees report they suffer from phantom limb pain – pain perceived to arise from the ‘missing hand’. The neural underpinning of this fascinating phenomenon is still debated. We use neuroimaging, behavioural paradigms and electromyography  to characterise the physiological basis of phantom pain. We are particularly interested in the role of phantom hand motor control in predicting and modulating phantom limb pain. For example, we use a predictive coding framework to investigate whether phantom limb pain relates to sensorimotor prediction error.

Example papers: Makin et al., 2013, Nat. Comm.; Makin et al., 2015, Brain; Kikkert et al., 2017, Cortex

How can we relieve phantom limb pain?

Phantom limb pain poses a significant medical problem to many amputees. It also poses an unusual challenge to medical staff – how do you treat pain in a part of the body that no longer exists? We are applying discoveries made in our lab about the behavioural and brain correlates of phantom pain to investigate potential treatments for this condition. For example, we apply non-invasive brain stimulation coupled with behavioural therapy, to help characterise the neural process enabling pain relief.

Example paper: Kikkert et al., 2018, Annals of Neurology