Theoretical foundations of Progressive Motor Training (PMT) for Phantom Limb Pain.

Phantom Limb Pain (PLP) remains highly prevalent despite decades of clinical and experimental interventions. While pharmacological and surgical approaches address acute or nociceptive components, chronic neuropathic PLP persists, and theoretical models often lack testable predictions. Here, I present the theoretical basis for Progressive Motor Training (PMT), a novel treatment derived from the Stochastic Entanglement hypothesis. This hypothesis proposes that PLP arises from maladaptive recruitment of underutilized somatosensory and motor circuits after amputation, rather than cortical reorganization or visual feedback deficits. PMT combines motor imagery and motor execution to maximize recruitment of the affected motor circuitry in a progressive, comprehensive, and adaptive manner. It is designed to overcome limitations of existing motor training therapies, such as Mirror Therapy and Phantom Motor Execution, by being applicable across amputation levels and clinical contexts, including early post-surgical stages where current technology-based interventions are impractical. Therefore, PMT can help to preserve phantom movement and hypothetically reduce PLP incidence when applied early. Overall, PMT offers a theoretically grounded, resource-efficient, and clinically flexible alternative for both treatment and prevention of PLP. Its efficacy alleviating PLP now requires systematic empirical evaluation.