May 15, 2016

"Igor Spetic, in Cleveland, suffered after his amputation from extreme, persistent pain, which he felt permanently emanating from the hand he no longer had."

"'It was unbearable, twenty-four seven, as though my hand were in a clamp,' he says. Since the last thing he vaguely recalls about his accident is his hand clutched in a vise as he reached out toward the mechanical press that crushed it, it seems that his mind had continued to feel that final moment, like a clanging bell that is the last thing remembered, and still heard on his hospital bed, by the victim of a train accident. His hand is so much there from the brain’s point of view that the brain may be creating the pain it thinks the hand ought to be feeling, the last tactile sensation it can recall. This kind of phantom pain in amputated limbs is a widely observed phenomenon, but for a long time it was thought to be a response to trauma of the 'cauterized' nerves in the residual limb. One of the things that Dustin Tyler’s project in Cleveland has helped confirm is that it is also a cognitive phenomenon, placed much 'higher up' in the system. After the sensors in Spetic’s arm were stimulated, his pain diminished, and then vanished. Reassured that the hand had moved on, that the trauma had passed and was no longer in need of response, the brain released it from the emergency state of feeling pain."

From "Feel Me/What the new science of touch says about ourselves," by Adam Gopnik.

14 comments:

Quaestor said...

I used to eat up that Oliver Sacks traumatic disassociation stuff with a spoon. Now I just think of Phantom Limb and chuckle.

jr565 said...

They should use this sort of treatment on people who are transgendered. Since it too is a cognitive phenomenon where the brain tricks the person into having distorted thoughts that may in fact be stored in memory as impressions that manifest as discomfort or depression over something that is not really a problem.

coupe said...

I was reading where trauma surgeons in Iraq would attach these electronic devices to the soldiers with severed limbs, and these helped immensely in recovery.

The doctor was told that these could not be used on airplanes, as they "could" interfere with the electronics (navigation, etc). He poo-pooed that and would not send a patient to Germany without the devices attached.

I don't know much about it, but remember the story when it came out. I have nerve damage in my left leg, and spots where it feels like my leg is asleep, and these will fire off at times giving me a sharp stabbing sensation. I told my doctor maybe we should cut it off, and she said maybe it would still do the same thing, even with the limb gone. Boy, that would be a sucker deal...

Lem said...

Star Trek IV: The Voyage Home...

"Once released, the whales (brought back to the future) respond to the probe's signal, causing the object to reverse its effects on Earth and return to the depths of space."

Curious George said...

There was an episode of House that dealt with this issue. He put the guys arm with a hand in a restraint, and then put a mirror up to it to trick the brain into thining it was the other hand. He unclenched his hand, no more pain. That Dr. House is a genius.

Michael K said...

Phantom limb pain is much worse if the amputation was preceded by severe pain as in ischemic pain. Traumatic amputation usually has phantom sensation but it is not painful.

Lem said...

House played a doctor that could not play house.

Bob said...

Look ye, carpenter, I dare say thou callest thyself a right good workmanlike workman, eh! Well, then, will it speak thoroughly well for thy work, if, when I come to mount this leg thou makest, I shall nevertheless feel another leg in the same identical place with it; that is, carpenter, my old lost leg; the flesh and blood one, I mean. Canst thou not drive that old Adam away?

Truly, Sir, I begin to understand somewhat now. Yes, I have heard something curious on that score, Sir; how that a dismasted man never entirely loses the feeling of his old spar, but it will be still pricking him at times. May I humbly ask if it be really so, Sir?

It is, man. Look, put thy live leg here in the place where mine once was; so, now, here is only one distinct leg to the eye, yet two to the soul. Where thou feelest tingling life; there, exactly there, there to a hair, do I. Is't a riddle?

I should humbly call it a poser, Sir.

Hist, then. How dost thou know that some entire, living, thinking thing may not be invisibly and uninterpenetratingly standing precisely where thou now standest; aye, and standing there in thy spite? In thy most solitary hours, then, dost thou not fear eavesdroppers? Hold, don't speak! And if I still feel the smart of my crushed leg, though it be now so long dissolved; then, why mayest not thou, carpenter, feel the fiery pains of hell for ever, and without a body? Hah!

John said...

Was he crushing gummy bears whenthe accident happened?

William said...

Does the reverse work? If the limb was feeling a pleasant sensation would it have an enduring, albeit phantom, memory of that pleasant sensation. If so, this could revolutionize the whole practice of transgender surgery.

Terry said...

Why was this man not encouraged to seek out euthanasia? He was suffering unbearable, incurable pain.

Ignorance is Bliss said...

Hannibal Lecter: Tell me, Senator: did you nurse Catherine yourself?
Senator Ruth Martin: What?
Hannibal Lecter: Did you breast-feed her?
Paul Krendler: Now wait a minute...
Senator Ruth Martin: Yes, I did.
Hannibal Lecter: Toughened your nipples, didn't it?
Paul Krendler: You son of a bitch!
Hannibal Lecter: Amputate a man's leg and he can still feel it tickling. Tell me, mum, when your little girl is on the slab, where will it tickle you?
Senator Ruth Martin: Take this... *thing* back to Baltimore!
Hannibal Lecter: Five foot ten, strongly built, about a hundred and eighty pounds; hair blonde, eyes pale blue. He'd be about thirty-five now. He said he lived in Philadelphia, but he may have lied. That's all I can remember, mum, but if I think of any more, I will let you know. Oh, and Senator, just one more thing: love your suit!

Carter Wood said...

One word: Ketamine.

Perioperative intravenous ketamine infusion for the prevention of persistent post-amputation pain: a randomized, controlled trial.
Hayes C1, Armstrong-Brown A, Burstal R.
Author information
Abstract
We hypothesized that perioperative ketamine administration would modify acute central sensitization following amputation and hence reduce the incidence and severity of persistent post-amputation pain (both phantom limb and stump pain). In a randomized, controlled trial, 45 patients undergoing above- or below-knee amputation received ketamine 0.5 mg x kg(-1) or placebo as a pre-induction bolus followed by an intravenous infusion of ketamine 0.5 mg x kg(-1) x h(-1) or normal saline for 72 hours postoperatively. Both groups received standardized general anaesthesia followed by patient-controlled intravenous morphine. The surface area of allodynia over the stump was mapped at days 3 and 6. Postamputation pain was assessed at days 3 and 6 and at 6 months postoperatively. We found no significant difference between groups in the surface area of stump allodynia or in morphine consumption. There was an unexplained, but significant, increase in the incidence of stump pain in the ketamine group at day 3. At six-month review, the incidence of phantom pain was 47% in the ketamine group and 71% in the control group. This did not reach statistical significance (P=0.28) as the power of the study was based on the search for a large treatment effect. The incidence of stump pain at six months was 47% in the ketamine group and 35% in the control group (P=0.72). There were no significant between-group differences in pain severity throughout the study period. Ketamine at the dose administered did not significantly reduce acute central sensitization or the incidence and severity of post-amputation pain.
PMID: 15264726 [PubMed - indexed for MEDLINE]

Carter Wood said...

Two words: Ketamine Sun.

By The Fall.