• Carolina Kachramanoglou, Thomas Carlstedt, Martin Koltzenburg, and David Choi.
• Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK. c.kachramanoglou@ucl.ac.uk
• Pain Med. 2011 Nov 1; 12 (11): 1644-8.

ObjectiveAnimals 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.ConclusionAsking 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.Wiley Periodicals, Inc.

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