Induced sensorimotor brain plasticity controls pain in phantom limb patients

The cause of pain in a phantom limb after partial or complete deafferentation is an important problem. A popular but increasingly controversial theory is that it results from maladaptive reorganization of the sensorimotor cortex, suggesting that experimental induction of further reorganization should affect the pain, especially if it results in functional restoration. Here we use a brain-machine interface (BMI) based on real-time magnetoencephalography signals to reconstruct affected hand movements with a robotic hand. BMI training induces significant plasticity in the sensorimotor cortex, manifested as improved discriminability of movement information and enhanced prosthetic control. Contrary to our expectation that functional restoration would reduce pain, the BMI training with the phantom hand intensifies the pain. In contrast, BMI training designed to dissociate the prosthetic and phantom hands actually reduces pain. These results reveal a functional relevance between sensorimotor cortical plasticity and pain, and may provide a novel treatment with BMI neurofeedback.This research was conducted under the ‘Development of BMI Technologies for Clinical Application’ of SRPBS by MEXT and AMED. This research was also supported in part by JST PRESTO; JSPS KAKENHI JP24700419, JP26560467, JP22700435, JP26242088, JP26282165, JP15H05710 and JP15H05920; Brain/MINDS and SICP from AMED; ImPACT; Ministry of Health, Labor, and Welfare (18261201); and the Japan Foundation of Aging and Health