Dynamic reverberation. A unified mechanism for central and phantom pain.
Central and phantom pains remain unexplained by current pathophysiological hypotheses. Newer theories suggest that these may be the result of an altered processing inside a network of neurons extending throughout wide-spread areas of the brain, precluding neurosurgical treatment. On the basis of a literature review of cases with spontaneous resolution of the pain, it is argued that both central and phantom pain depend on a localized corticothalamic reverberatory loop, which is at the basis of the steady components of both. In this case, selective stereotactic lesions of the corona radiata deep to the frontoparietal sensorimotor strip may achieve a permanent cure. This theory refutes the neuromatrix hypothesis of phantom phenomena. It is speculated that electroconvulsive therapy might block the pathologic reverberation in both central and phantom pains.
Canavero
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Neurosurgical Clinic, Turin, Italy.
D000328:Adult; D000368:Aged; D002540:Cerebral Cortex / Q000503:physiopathology; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D010146:Pain / Q000503:physiopathology*; D059408:Pain Management; D010591:Phantom Limb / Q000503:physiopathology* / Q000628:therapy; D013788:Thalamus / Q000503:physiopathology