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Salud mental

versão impressa ISSN 0185-3325


ORTEGA-LEGASPI, J. Manuel. The nightmare of a painful phantom. Salud Ment [online]. 2007, vol.30, n.6, pp.49-52. ISSN 0185-3325.

Pain has a representation in the central nervous system within some of the most ancient structures developed over the phylogenetical history. Also, it is the most important symptom for which patients seek medical attention. However, there are pathologies in which pain stops being the alarm and becomes a medical issue, perhaps the most dramatic example of this would be the presence of pain in a part of the body that is no longer present, this is known as 'phantom limb pain'.

Over history, much attention has been given to pain understanding by well-known personalities and phantom limb itself was described first by Ambroise Paré in the 16th Century and later described by Silas Weir Mitchell in the 19th Century and thoroughly addressed by Livingston in the first half of the 20th Century.

The non-painful phantom limb phenomena are reported by almost all amputees and there is pain in 50 to 80%, no matter the nature of the amputation. We face a puzzling public health problem. The major cause of limb amputations comes from vascular and neuropathic complications provoked by diabetes, followed in frequency by trauma, all astonishingly prevalent in the general working population in productive ages. A worrying cause of trauma and the phantom limb in some developing countries is caused by anti-personnel mines leading people, a majority of civilians with a considerable amount of children, to a living hell accompanied by a painful phantom.

Phantom limb pain represents a challenge that involves a huge scope of study related to both public health and neuroscience. It is an entity that involves peripheral, central and psychological factors. Neuroscientific research has studied the system from the amputated peripheral nerve, where a neuroma develops, to the cerebral cortex in which there are changes in the somatosensory cortex after limb amputations, related to a decreased activation of the area that would represent the missing limb. Besides, this problem has caused the development of theories such as the 'neuromatrix' that is activated in the absence of peripheral sensory information. In this sense, the anterior cingulate cortex has been proposed as a key structure in the development of phantom nociception in animals.

After a huge amount of research, only 30% of patients benefits for a good number of interventions.

Phantom limb pain is a clear example that consciousness can indeed become ill and that the clinical frequency, importance and transcendence make research on the neuroscience of consciousness of vital importance.

The painful phantom represents a tool and challenge in the neuroscientific field, opens the door for the study on consciousness, supports the need for improved healthcare and allows us to think about war and its consequences in the development of society.

Palavras-chave : Phantom limb; pain; neuroscience; consciousness.

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