title: Phantom limb pain and bodily awareness: current concepts and future directions.
abstract: OBJECTIVE
  Phantom pain is a frequent consequence of amputation or deafferentation. There are many possible contributing mechanisms, including stump-related pathology, spinal and cortical changes. Phantom limb pain is notoriously difficult to treat. Continued consideration of the factors associated with phantom pain and its treatment is of utmost importance, not only to advance the scientific knowledge about the experience of the body and neuropathic pain, but also fundamentally to promote efficacious pain management.
  
  
  RESULTS
  This review first discusses the mechanisms associated with phantom pain and summarizes the current treatments. The mechanisms underlying phantom pain primarily relate to peripheral/spinal dysfunction, and supraspinal and central plasticity in sensorimotor body representations. The most promising methods for managing phantom pain address the maladaptive changes at multiple levels of the neuraxis, for example, complementing pharmacological administration with physical, psychological or behavioural intervention. These supplementary techniques are even efficacious in isolation, perhaps by replacing the absent afferent signals from the amputated limb, thereby restoring disrupted bodily representations.
  
  
  CONCLUSIONS
  Ultimately, for optimal patient outcomes, treatments should be both symptom and mechanism targeted.
authors.affiliation: Experimental Neuropsychology Research Unit, Monash University, Clayton, Victoria, Australia. melita.giummarra@monash.edu
authors.forename: Melita J
authors.initials: MJ
authors.lastname: Giummarra
authors.forename: G Lorimer
authors.initials: GL
authors.lastname: Moseley
mesh_terms: D000672:Amputation Stumps / Q000503:physiopathology; D001364:Awareness / Q000502:physiology*; D004599:Electric Stimulation Therapy; D006801:Humans; D009068:Movement; D010146:Pain / Q000503:physiopathology; D059408:Pain Management; D017933:Peripheral Nervous System / Q000503:physiopathology; D010591:Phantom Limb / Q000188:drug therapy / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D026741:Physical Therapy Modalities; D019736:Prostheses and Implants; D011613:Psychotherapy