Phantom Limbs

[Raphael Misson]

I've been fascinated by the concept of phantom limbs since I read V.S. Ramanchandran's explanation for how he believes they come about a year ago. (Those of you not interested in his theory can skip to the next paragraph; what follows is a bit technical. Basically Ramanchandran says that the notion of sensation in a non-existent body part comes from cross-wiring in the human brain. Our brain has a sort of map of sensations (called by psychologists the somatosensory homunculus) that explains which parts of the somatosensory cortex interpret which sensation inputs. Ramachandran's theory is that the sensation in the part next to that which has been removed sort of pirates (heh) the area that belonged to the thing removed. So if the forehead sensing area is by the finger sensing area on the brain "sensing map", the forehead takes over the area belonging to the finger when the finger is removed. The wiring in the brain is still the same, however, which results in a real sensation in the forehead producing a perceived feeling coming from the non-existent finger. The mind is a wondrous thing.)

I had heard the earliest reports of phantom limbs came from the Civil War, but, low and behold, Paré talks about it quite a bit in 1585.

"...the patiens pricked on that part would say they felt much paine there. But that feeling is oft deceiptfull, as that which proceeds rather from the strong apprehension of great paine which formerly reigned in the part, then from any facultie of feeling as yet remaining. A most cleare and manifest argument of this false and deceitful sense appeares after the amputation of the member; for a long while after they will complaine of the part which is cut away.

Verily it is a thing wondrous strange and prodigious, and which will scarse be credited, unless by such as have seene it with their eyes, and heard with their eares the patients who have many moneths after the cutting away of the Legge, grievously complained that they yet felt exceeding great paine of that Leg so cut off. Wherefore have a speciall care least this hinder your intended amputation; a thing pittifull, yet absolutely necessary for to preserve the life of the patient and all the rest of the body, by cutting away of that member which hath all the signes of a Sphacell and perfect mortification..." (Paré, p. 147)

"...the Patients imagine they have their members entire, and yet doe complaine thereof (which I imagine to come to passe, for that, the cut nerves retire themselves towards their originall, and thereby cause a paine like to convulsions; for as Galen writes in his book, De moru musuclorum, That contraction is the true and proper action of a nerve and muscle: and againe, extension is not so much an action as a motion: ) now wee must indeavor to give remedy to this symptome. Which may be done by annointing the spine of the backe and all the affected part with the following Liniment which is very powerfull against Convulsions, the Palsie, numnesse, and all cold affects of the nervous bodies." (Paré, p. 154)

So Paré not only recognizes it as happening, he offers a cure! (I haven't reprinted it here because it's quite long and all in Latin.)

[Barnaby Wilde]

It is very similar to how the pain of a heart attack often gives the sensation of pain in the left arm. During fetal development, the heart is formed high up in the chest cavity- nearly in the neck. As it descends, it captures an arm nerve and pulls it down with the heart. Now that nerve is somewhat connected to both the arm and the heart. Most of your life when you have pain along that nerve you have just injured your arm, so your brain learns, "pain in that nerve=pain in arm". Then, lo-and-behold you get heart pain which also travels along that nerve so your brain thinks that your arm in hurting.

If you want me to really get all "New Agey", I can talk about the human energy fields and how a physical limb removal still leaves the etheric limb intact. Stimuli to that field can still communicate to the brain as if the limb were still there..... but I won't go there.

[lady constance]

phantom pain---- is PRECISELY why now when a person needs an amputation of any kind, THEY DO A NERVE BLOCK-- they aim/attempt to completely make the person UNABLE to feel ANYTHING in the part of the body to be removed---- while awake and prior to surgery---- TO KEEP PHANTOM PAIN MINIMAL.... AND FOR MANY, they dont have phantom pain ever----

it felt no pain prior to removal....THUS NO PAIN after....

lady constance

[Raphael Misson]

From what I've read, no method of preventing sensation works every time. If it is indeed a function of the brain, no method would work every time. (Short of brain surgery...or trepaning.) Ramachandran has a really curious way of changing the pyschological perception of the missing limb using a sort of mirror box. It doesn't always work either, but the fact that it works at all suggests a definite brain and/or psychological component to the phantom limb phenomena.) Note also that Ramachandran is talking about sensation, not just pain.