title: Self-mutilation in patients after nerve injury may not be due to deafferentation pain: a case report.
abstract: OBJECTIVE
  Animals with transected nerves may develop self-mutilating behavior (autotomy) directed at the denervated body part. Autotomy is often thought to be a response to deafferentation pain produced by pathological changes in the dorsal horn, and self-mutilation after dorsal rhizotomy has consequently been used as an outcome measure for the investigation of chronic pain in animal models. A less recognized hypothesis suggests that autotomy is simply an animal's efforts to remove the useless part. We report a case of self-mutilation of the thumb and fingers in a patient with loss of all sensory modalities in the arm after brachial plexus avulsion.
  
  
  CONCLUSIONS
  Asking the patient about the reasons for his self-mutilation provides insights into the cause of autotomy which cannot be established from animal studies. We suggest that autotomy may not be a result of chronic pain, and discuss the human experience and alternative underlying pathological processes.
authors.affiliation: Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK. c.kachramanoglou@ucl.ac.uk
authors.forename: Carolina
authors.initials: C
authors.lastname: Kachramanoglou
authors.forename: Thomas
authors.initials: T
authors.lastname: Carlstedt
authors.forename: Martin
authors.initials: M
authors.lastname: Koltzenburg
authors.forename: David
authors.initials: D
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000818:Animals; D002422:Causalgia / Q000503:physiopathology* / Q000523:psychology; D006801:Humans; D008297:Male; D010146:Pain; D012652:Self Mutilation / Q000209:etiology* / Q000503:physiopathology* / Q000523:psychology*; D020196:Trauma, Nervous System / Q000150:complications* / Q000523:psychology*