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."


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.


Visualizing Phantom Pain


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


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