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December 24, 1997

Phantom Pain

Author Affiliations

Washington, DC

JAMA. 1997;278(24):2194-2195. doi:10.1001/jama.1997.03550240086048

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Pain is arguably the most common symptom that causes patients to seek medical attention. Localization of pain and associated signs, including heat, swelling, redness, and loss of function, usually establish the diagnosis and treatment. Alternatively, pain may be referred to contiguous or remote sites. Coronary disease presents with pain in the chest, shoulder, arm, or jaw. Ureteral obstruction is announced by pain in the groin or testicle.

What, then, can be said about pain that originates in organs or extremities that have been surgically or traumatically removed and no longer exist? That is the subject of Phantom Pain. Beginning with the premise that phantom pain need not be psychogenic, Sherman and associates search a wilderness of causes. Treading a serpentine path from the periphery of the nervous system to the most superficial layers of the cerebral cortex, they speculate about pathogenetic mechanisms: possibly neuroma formation, neuropathy, neurohumoral or autonomic imbalance