Phantoms in the Brain: Probing the Mysteries of the Human Mind by V. S. Ramachandran, Sandra Blakeslee Page B
Authors: V. S. Ramachandran, Sandra Blakeslee
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chilblains in it every time the weather turns cold. Another woman described arthritic pain in her phantom joints. She'd had the problem before her arm was amputated but it has continued in the absence of real joints, with the pain being worse when it gets damp and cold just as it had in the real joints before amputation.
One of my medical school professors told me a story that he swore was true, the tale of another physician, an eminent cardiologist, who developed a pulsating cramp in his leg caused by Buerger's disease—a malady that produces constriction of arteries and intense, pulsing pain in the calf muscles.
Despite many attempts at treatment, nothing eased the pain. Out of sheer despair, the physician decided to have his leg amputated. He simply couldn't live with the pain any longer. He consulted a surgeon colleague and scheduled the operation, but to the surgeon's astonishment, he said he had a special request: "After you amputate my leg, could you please pickle it in a jar of formaldehyde and give it to me?" This was eccentric, to say the least, but the surgeon agreed, amputated the leg, put it in a jar of preservative and gave it to the physician, who then put it in his office and said, "Hah, at last, I can look at this leg and laugh at it and say, T
finally got rid of you!' "
But the leg had the last laugh. The pulsatile pains returned with a vengeance in the phantom leg. The good doctor stared at his floating limb in disbelief while it stared back at him, as if to mock all his efforts to rid himself of it.
There are many such stories in circulation, illustrating the astonishing specificity of pain memories and their tendency to surface when a limb is amputated. If this is the case, one can imagine being able to reduce the incidence of pain after amputation simply by injecting the limb with a local anesthetic before surgery. (This has been tried with some success.)
Pain is one of the most poorly understood of all sensory experiences. It is a source of great frustration to patient and physician alike and can emerge in many different guises. One especially enigmatic complaint frequently heard from patients is that every now and then the phantom hand becomes curled into a tight, white−knuckled fist, fingers digging into palm with all the fury of a prizefighter ready to deliver a knockout blow.
Robert Townsend is an intelligent, fifty−five−year−old engineer whose cancer caused him to lose his left arm six inches above the elbow. When I saw him seven months after the amputation, he was experiencing a vivid phantom limb that would often go into an involuntary clenching spasm. "It's like my nails are digging into my phantom hand," said Robert. "The pain is unbearable." Even if he concentrated all his attention on it, he could not open his invisible hand to relieve the spasm.
We wondered whether using the mirror box could help Robert eliminate his spasms. Like Philip, Robert looked into the box, positioned his good hand to superimpose its reflection over his phantom hand and, after making a fist with the normal hand, tried to unclench both hands simultaneously. The first time he did this, Robert exclaimed that he could
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feel the phantom fist open along with his good fist, simply as a result of the visual feedback. Better yet, the pain disappeared. The phantom then remained unclenched for several hours until a new spasm occurred spontaneously. Without the mirror, his phantom would throb in pain for forty minutes or more. Robert took the box home and tried the same trick each time that the clenching spasm recurred. If he did not use the box, he could not unclench his fist despite trying with all his might. If he used the mirror, the hand opened instantly.
We have tried this treatment in over a dozen patients and it works for half of them. They take the mirrored box home and whenever a spasm occurs, they put their good hand into the box and open it and the spasm is eliminated. But is it a cure? It's
One of my medical school professors told me a story that he swore was true, the tale of another physician, an eminent cardiologist, who developed a pulsating cramp in his leg caused by Buerger's disease—a malady that produces constriction of arteries and intense, pulsing pain in the calf muscles.
Despite many attempts at treatment, nothing eased the pain. Out of sheer despair, the physician decided to have his leg amputated. He simply couldn't live with the pain any longer. He consulted a surgeon colleague and scheduled the operation, but to the surgeon's astonishment, he said he had a special request: "After you amputate my leg, could you please pickle it in a jar of formaldehyde and give it to me?" This was eccentric, to say the least, but the surgeon agreed, amputated the leg, put it in a jar of preservative and gave it to the physician, who then put it in his office and said, "Hah, at last, I can look at this leg and laugh at it and say, T
finally got rid of you!' "
But the leg had the last laugh. The pulsatile pains returned with a vengeance in the phantom leg. The good doctor stared at his floating limb in disbelief while it stared back at him, as if to mock all his efforts to rid himself of it.
There are many such stories in circulation, illustrating the astonishing specificity of pain memories and their tendency to surface when a limb is amputated. If this is the case, one can imagine being able to reduce the incidence of pain after amputation simply by injecting the limb with a local anesthetic before surgery. (This has been tried with some success.)
Pain is one of the most poorly understood of all sensory experiences. It is a source of great frustration to patient and physician alike and can emerge in many different guises. One especially enigmatic complaint frequently heard from patients is that every now and then the phantom hand becomes curled into a tight, white−knuckled fist, fingers digging into palm with all the fury of a prizefighter ready to deliver a knockout blow.
Robert Townsend is an intelligent, fifty−five−year−old engineer whose cancer caused him to lose his left arm six inches above the elbow. When I saw him seven months after the amputation, he was experiencing a vivid phantom limb that would often go into an involuntary clenching spasm. "It's like my nails are digging into my phantom hand," said Robert. "The pain is unbearable." Even if he concentrated all his attention on it, he could not open his invisible hand to relieve the spasm.
We wondered whether using the mirror box could help Robert eliminate his spasms. Like Philip, Robert looked into the box, positioned his good hand to superimpose its reflection over his phantom hand and, after making a fist with the normal hand, tried to unclench both hands simultaneously. The first time he did this, Robert exclaimed that he could
42
feel the phantom fist open along with his good fist, simply as a result of the visual feedback. Better yet, the pain disappeared. The phantom then remained unclenched for several hours until a new spasm occurred spontaneously. Without the mirror, his phantom would throb in pain for forty minutes or more. Robert took the box home and tried the same trick each time that the clenching spasm recurred. If he did not use the box, he could not unclench his fist despite trying with all his might. If he used the mirror, the hand opened instantly.
We have tried this treatment in over a dozen patients and it works for half of them. They take the mirrored box home and whenever a spasm occurs, they put their good hand into the box and open it and the spasm is eliminated. But is it a cure? It's
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