Phantom Pain: A Critical Review of the Proposed Mechanisms

Deafferentation refers to any process that results in a loss of afferent input at the peripheral or central nervous system level. Phantom pain has been demonstrated to affect a significant number of people following a range of deafferentating conditions. These conditions include amputation, spinal cord injury, brachial plexus avulsion and even congenital aplasia and local anaesthesia. Despite the prevalence of phantom pain, little is known about its cause; indeed, it remains a contentious issue. This article discusses the major theories proposed and the evidence accumulated regarding each. A mixed mechanism is mooted, which combines pertinent elements from each theory, and the implications for occupational therapy are discussed.

Evaluation of safety and side effects in the process of anti-anxiety drug development *

SummaryAs with other drugs it is necessary to look for changes induced by anxiolytics on vital signs, laboratory parameters and adverse events. In return, in a more specific way for anxiolytics, we will look at side effects at the central nervous system level with psychological and physiological battery tests. We will also assess the safety of use of anxiolytics in certain specific conditions, such as overdose or withdrawal and in certain populations such as the elderly, neonates and children. The assessment of safety and side effects, whatever the drug type studied, must come early in the developing process of a drug (phases I, II and III).