Open AccessSelf‐Mutilation in Patients After Nerve Injury May Not Be Due to Deafferentation Pain: A Case Report
Author(s) -
Kachramanoglou Carolina,
Carlstedt Thomas,
Koltzenburg Martin,
Choi David
Publication year - 2011
Publication title -
pain medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.893
H-Index - 97
eISSN - 1526-4637
pISSN - 1526-2375
DOI - 10.1111/j.1526-4637.2011.01242.x
Subject(s) - autotomy , medicine , pathological , sensory loss , brachial plexus , nerve injury , chronic pain , denervation , surgery , anesthesia , anatomy , physical therapy , pathology
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. Conclusion. 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.