The mechanisms underlying chronic postamputation pain have not been completely clarified, but both peripheral and central mechanisms are likely to play a role. Nerve section is associated with clear changes in the periphery, which represents an obvious origin for pain. It is clear, however, that the phantom limb with its complex perceptual qualities is ultimately integrated in the brain. An extensive experimental and clinical literature documents that nerve injury induces a number of morphological, physiological, and chemical changes in both the peripheral and central nervous system (for review, see Flor et al.61). These changes will be described briefly in the following. An understanding of the underlying mechanisms is likely to lead to new and rational-founded types of treatment.

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