The World of Chronic Pain
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The World of
Chronic Pain

More than 125 million Amercians are suffering.

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These conditions can cause a world of pain.

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Up-to-date news on pain-related issues.

Phantom Pain

Phantom pain is much debated among doctors, but not among amputees. The pain in a missing limb can be so intense as to drive its victims crazy. Doctors theorize that in the cortex of the brain is a "little body" and that in the absense of a limb the brain actually intensifies the sensations of where that limb should be, trying to compensate for the missing limb, as if trying to find it.

Other doctors refuse to believe that phantom limb pain exists at all, saying (once again) "it's all in your head." As it turns out they may be right; it is in the brain "in the head" where the sensations originate.

Deborah Finnegan-Ling, a graduate student in neuroscience, is writing her dissertation on phantom limb pain. Finnegan-Ling should know a lot about this phenomenon because three years ago, after a farming accident, her left leg was amputated. She has experienced much pain from this phantom limb especially in her personal life. The area of the brain for the foot is adjacent to the area for genitalia. Because of this connection Finnegan-Lingís missing limb aches when she makes love."I consider myself tough," she says."But the pain is so acute that I'll cry."

Young Surfer Loses Arm in Shark Attack

Top amateur surfer Bethany Hamilton lost an arm in a shark attack November 3. The teenager was lying on her surfboard with her arm dangling off the board in the peaceful waters at Lihua, Hawaii when friends heard her screaming she had been attacked by a shark. Her life was saved by quick-thinking friends who rushed out to her, brought her to shore while her best friend's father applied a surfboard-leash tourniquet in the water to stop the bleeding. Without his quick thinking, she would have bled to death during the 25 minutes desperate trip to the beach.

The bite in the surfboard was 16 inches across and almost to the center of the board. This allowed Randy Honebrink, spokesman for the state Shark Task force to estimate the length of the shark to 12 to 15 feet in length.

The brave teenager managed to hold onto her surfboard somehow until the shark let go.

According to Dr. David Rovinsky at Wilcox Memorial Hospital, the shark ripped off Hamilton's arm just below the left shoulder, and that her top condition as a competitive athlete helped her survive the huge blood loss.

"She was alert and awake and talking and wasn't losing any blood, really because she had had a tourniquet applied around her shoulder," Rovinsky said.

Hamilton, of Princeville, was attacked a quarter-mile off Makua Beach near Haena, in an area know as The Tunnels. She had been surfing with her best friend, Alana Blanchard, 13, and Alana's father.

Her father, interviewed on "The Today Show" November 12, said Britany fully expects to return to surfing.

Before the attack, Bethany was expected to become a professional surfer.

She won the explorer women's division of the National Scholastic Surfing Association's Open and Explorer event on Kauai in August. Prior to that she beat older surfers to win the women's division at the Local Motion-Ezekiel Surf Into Summer contest at Ala Moana on Oahu.

When asked, her father said she was so far not reporting any phantom pain from her missing arm.

Already she is practicing her balance on a skateboard just waiting for the time the doctor gives the okay to get in the water and return to surfing!

Phantom Pain: How Does the Brain Feel?

Sometimes, when a limb is removed during an amputation, an individual will continue to have an internal sense of the lost limb. This phenomenon is known as phantom limb and accounts describing it date back to the 1800s. Similarly, many amputees are frequently aware of severe pain in the absent limb. Their pain is real and is often accompanied by other health problems, such as depression.

What causes this phenomenon? Scientists believe that following amputation, nerve cells "rewire" themselves and continue to receive messages, resulting in a remapping of the brain's circuitry. The brain's ability to restructure itself, to change and adapt following injury, is called plasticity.

Our understanding of phantom pain has improved tremendously in recent years. Investigators previously believed that brain cells affected by amputation simply died off. They attributed sensations of pain at the site of the amputation to irritation of nerves located near the limb stump.

Now, using imaging techniques such as positron emission tomography (PET) and magnetic resonance imaging (MRI), scientists can actually visualize increased activity in the brain's cortex when an individual feels phantom pain. When study participants move the stump of an amputated limb, neurons in the brain remain dynamic and excitable. Surprisingly, the brain's cells can be stimulated by other body parts, often those located closest to the missing limb.

Treatments for phantom pain may include analgesics, anticonvulsants, and other types of drugs; nerve blocks; electrical stimulation; psychological counseling, biofeedback, hypnosis, and acupuncture; and, in rare instances, surgery.

-- National Institute of Health