March 1, 2022 • 46 mins
Phantom pain is when you sense pain from a lost limb. We don't entirely know how why, but we have some ideas. Listen in to find out.
Learn more about your ad-choices at https://www.iheartpodcastnetwork.com
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Stuff you should know, a production of I
Heart Radio. Hey, welcome to the podcast. I'm Josh, and
there's Chuck and there's Jerry over there, and this is
stuff you should know straight ahead. Both barrels blazon science, strange, unusual,
(00:25):
fascinating type stuff you should know. That's right, and uh,
both of us fresh from vacation. M hmm. I just
got to say. We took the first family trip to
Disney World and it was great. The oh that was
the first ever. Wow, I'll bet that was something special.
It was I haven't been in thirty five years myself,
(00:48):
and the same with Emily, and uh, it's remarkable how
much of the Magic Kingdom is exactly the same. But
then I realized that Disney h cultists diehards and appropriate.
They don't want anything different, so that that all made sense.
But it was great. My daughter was you know, you
never notice how you get down there. But I had
(01:09):
a feeling, because she's not a very fearful kid, that
she would ride stuff, and she rode everything that she
was big enough to ride, and then pride on the
things that she wasn't big enough to ride because she
couldn't ride. Yeah, like she did Space Mountain twice, she
did Tower of Terror. She she wanted to do the
Aerosmith ride at Hollywood Studios that she was bummed out about. Um,
(01:30):
which have you written that one so many times? Did
you realize you probably realized this the little video they
showed at the beginning of Smith in the Studio, that's
Ken Marino as the as the engineer. Oh no, I
thought you were going to talk about Ileana Douglas. I
had no idea. It was Kim Marino from that one
show from the eighties. Oh well, please, I mean he
(01:53):
was from this he was a co founder of the State.
But he's he's one of my comedy heroes. Oh that's
not who I'm thinking of. Then, yeah, Ki Marinos from
the State and you know, wet, hot American summer and
party down and he had he had literally no lines. Thought, oh,
there's Kim Marino's gonna do something funny. But he was.
I guess it was after the State and before he
(02:14):
had done a ton of other stuff, so he was
just bunching buttons. I thought it was very funny. But anyway,
we had a makes even funnier that he didn't have
a like any kind of maybe I kept waiting for it. Uh.
It was a lot of fun, though. Uh if we
went back, we would do it a little different. We
went to Universal Studios and tried to park hot but
(02:35):
it's too much to do in one day. And uh
we we did all the Harry Potter stuff but didn't
get to ride some of the big rides who wanted
to ride. Well, that's cool. I'm glad you guys had
a good time. It was wonderful and refreshing, and uh boy,
I think we both needed a little respite. We definitely did,
me and you. We went to Hawaii for tenth anniversary
or yeah, it was the first time we've traveled in
(03:00):
two and a half three years something like that first trip. Uh, yes,
it was something else, but it was great. See, I
went travel crazy after I got COVID for a while,
so I had gotten some trips in. You're like, I
only have a few days to spread this far and wide.
I better get out there. No. After I got it, Oh,
gotcha got you? After I recovered you know what I mean,
(03:21):
I know I'm with you. No, I I stayed inside
and scared, but this is so it was. It was
something like I was like I don't know how this
is gonna go, but it went really well. But we're back.
We're here to do a job, and this is You're right,
this is very old school stuff. You should know kind
of topic. I'm shocked that we hadn't covered it yet. Uh.
I think the reason that you're shocked is because we
(03:44):
actually have. We did. We did uh amputations. I know
we talked about it there because we talked about the
mirror box before plenty and then possibly talked about it
in limb reattachment I'm not sure, but definitely in amputations
we did. All right, Well, this finishes up the sweet enfolding.
I agree. So what's phantom pain? Well, so, um, shout
(04:07):
out to Olivia first of all for helping us out
with this. I realized that we didn't. We didn't acknowledge
that she helped us with the chow Chillibus kidnapping articles.
So sorry for that one too, So I want to
let that pass. But um, so this she she does
a good job like basically getting across like what phantom
pain isn't that we actually don't really know what it is,
(04:30):
but you can describe it as anyone who's had an
amputation about of those people um suffer some sort of
pain sensation, and it's a whole range of pain. As
we'll see. The problem is it's in that limb that's
not there anymore. It's not in the residual limb what
people colloquially called the stump. Yes, you can have pain
(04:52):
there too, that's called residual limb pain. This is phantom
limb pain where let's say you had your foot cut off.
You feel like they're is a nail being driven into
the bottom of your foot. The problem is your foot
is not there anymore, so you can't pull the nail out.
And hence we get to the meat of what the
big problem is with phantom pain. That's right. Uh, it
(05:12):
can it's you know, usually think of hands and feet
and arms and legs and stuff like that. But it
can be after amassectomy, it can be removal of testicles.
I know that's not exactly a limb. It depends on
how big it is. Oh boy, I did set it
up with that inflection of my voice, right of course. Uh.
(05:38):
There's also sort of a side affliction called uh, phantom
limb sensation simsation sensation, which is it's not exactly pain,
but it's like, you know, I feel like my foot
is moving that's not there. Or my hand feels hot
even though I no longer have that hand, or maybe
(05:59):
uh pressure or something like that, but it's not. Or
it may feel like swollen, or like when you're asleep,
I feel like my arm is stuck behind my back
and it's causing me great discomfort even though you don't
have that arm. That kind of thing. Yeah, and so
for a long time people have said, like, well, clearly
it's these people are nuts, it's in their head. I
(06:19):
thought it was as recent as seven that they finally said, no,
that's not the case. And we'll talk about some of
the historical view of it, but the upshot of it
is now we understand that people who experience phantom limb
pain are in fact experiencing pain in the same way
that you or I would experience pain in that same limb.
(06:41):
Like it's just as real to them as it is
to us. And it means that the brain's gone haywire.
And there's all sorts of ways it can manifest itself.
There's shooting spain, shooting pain, stabbing pain, it could be
cramping pain, pins and needles, which is bad enough, but
pain from pins and needles, which should be awful, and
it's you aunt, possibly scratch that sounds about as bad
(07:03):
as it can get. A crushing, pain, throbbing, basically, any
variety of pain that you could have experienced in that
um in that limb before it was amputated, you're capable
of experiencing it after it was amputated too. Yeah, and
Livia makes a good point here. And as you'll see
in the history part, there have long been philosophers and
(07:24):
and people like to think it scientists even that are
just fascinated with this curious syndrome. And it's you know,
it makes sense that people would be fascinated with it
like that. But it is a real problem. Um. It is.
It can cause people to not sleep, It can cause
people to not have the job that they want. It
can lead to suicidal thoughts. Like it is a real
(07:45):
affliction and not something that should be just treated as
a as an interesting curiosity, right, But it also is
an interesting curiosity. It's the tring that we need to
understand to help people with. But it's fascinating and the
reason why philosophers are so so you know, nuts for
it is because it proves that, like our subjective experience
(08:07):
of reality is not necessarily fully in line with reality.
It shows that we're capable of experiencing the unreal. Wow,
that was dramatic. I thought so too. Uh So, let's
you want to dive into the history a little bit, Yes,
and let's talk first, Chuck. I think at the beginning
(08:28):
about Ambrose Pare. Oh. Yeah, he was a French surgeon
in the mid sixteenth century. And this is one of
those kind of rare cases where someone from hundreds of
years ago describe something and had a handle on something
in in a pretty solid way. Like looking back, he
really was pretty close and a lot of the things
(08:50):
that he thought about phantom limpain and he was the
first dude to describe it, which is pretty remarkable. Yeah.
I mean we're talking the middle of the sixteenth century.
Like you said, that's that's crazy. That's a time when
people didn't really think that that the people working in
science for scientists, Like science kind of came later, according
to some people. And it's like, um, if we had
(09:13):
just kind of built on paradise understanding of it, who
knows how much further along we would be in in
you know, treating and dealing with that kind of stuff.
But um, it's, like you said, he had a really
good handle on it. He's he was the first to differentiate.
Remember how I said, there's like residual residual limb pain
and then there's phantom limb pain. He was the first
(09:33):
one to say those are two separate things. It's not
the same thing. Uh. He said that there's different factors
that can um set it off, like the weather, change
in the weather. Um. And then that there's different things
that could treat it, like sometimes massage around the residual
limb helps to what else. Uh. He also made the distinction.
You know we described the phantom limb sensations. He described
(09:56):
the difference there between the pain and the sensation. Oh yeah, Uh,
that's a big one. He also said, so he said
two things. He said that um either that his guests
for what was causing it was that either there was
some problem with the nerves in the residual limb um.
I think he said that he thought they were retreating
(10:16):
possibly or withdrawing, which makes sense in a weird way. Um.
Or he thought that it was that it originated in
the brain, not through some sort of psychosis, but through
some sort of you know, foul up in the brain,
like a glitch in the brain. And still today, as
we'll see when we're talking about this, our understanding, a
(10:37):
pan of limp pain basically boils down to those two,
those two general concepts. Yeah, it's pretty amazing and um,
we're not. Well, we'll get to that. I want to
save that. I don't want to spoil it. I mentioned
philosophers being sort of um delighted by this idea. Descartes
was one of them. In the kind of early to
mid sixteen hundreds, he talked a lot about Fannalm mimes.
(11:00):
He he was one of the people that was really
blown away by what he called non resemblance, which is
what you were talking about, your subjective experience not aligning
with reality. And he also thinks or thought it had
to do with severed nerves, so he was sort of
on the right track as well. And then the Scottish guy,
uh William Porterfield in seventeen fifty nine. He was a
(11:23):
physician that lost a foot and he had an actual physicians,
first person autobiographical take on it all and talked about
his toes, heel and ankle spelled with a sea which
is fantastic, Um, like experiencing pain and itching several years after.
I don't think we said it can start up to
(11:45):
like as in as short as like a week afterward,
and it can go on, you know, sometimes it comes
and goes. Sometimes it's persistent, sometimes it goes away entirely.
Sometimes it lasts forever. So um, it can really be
all over the all over the map. But his description
was at least a few years afterward, right, So um,
(12:06):
that was seventeen fifty nine, And that was almost exactly
two hundred years after Perry first identified phantom limb sensation
or fantom in pain. Um, And it just kind of
got lost from there. And it wasn't until the American
Civil War when a surgeon named Silas Weir Mitchell, who
I know, we've talked about. His name seems very familiar, um,
(12:30):
who took part in the removal of thirty thousand limbs,
not himself personally, but he was like among the battlefield
surgeons who took that total number during the American Civil War.
Thanks to advances in certain kinds of bullets and projectiles
that could really do some so much damage that when
they hit like a bone in a lagorant arm, like
you just were going to lose that arm or leg
(12:51):
to save your life. Um. He he had like all
this firsthand experience with these people who had just lost
a limb, and we're complained meaning about pain in the limbs.
So this this idea phantom limp pain kind of came
back to the four at a time when surgeons were
starting to talk to each other more and science was
starting to be practiced in a more methodical way, so
(13:13):
that the discovery of one person could be understood and
learned and built on by other people a lot more
easily than it was in the sixteenth century. Right. But
he took a kind of weird approach initially, uh and
that he wrote a fictional account, basically a fictional short
story called the Case of George Deadlow, and he talked
(13:34):
about a Civil War veteran who experienced fanom pain and
legs and arms that he had lost in the war.
And it ultimately led to a seance where he's communicating
with these limbs and then walks around the room on
these invisible limbs, and a lot of people thought this
was real and started sending donations in and wanted to
visit with this person and six years afterwards he was like,
(13:56):
maybe I should write, uh, something real and not fiction piece.
And he went on to do that, I think to
greater effect. Yeah, because he finally after six years he
stopped face palming, Like, Okay, it sounds like people a day,
doesn't it. Can't you see people a day sending in
donations to the guy who lost his legs but were
(14:17):
was able to walk around on invisible residual limbs and
a seance Facebook told him so so um so silence
where Mitchell finally creates what what you could kind of
point to is like the first um modern scientific paper
on phantom limb pain, and he estimated as high as
(14:39):
eighties six out of ninety of his um amputee patients
experience phantom limb pain. Not just phantom limb sensation, but
phantom limb pain. Um and uh that that is a
really high number. It's higher than average. But like I
said before, I mean in the neighborhood of a d
I think I've seen as high as eighty five of
people who of an amputated limb will experience pain to
(15:02):
some degree in that in that that phantom limb right,
And I think most people experienced sensation, right, I believe
that's correct. Yes, My understanding is more of the phantom
pain stuff. Though. Is phantom sensation more prevalent? Yeah, I
mean for sure. Okay, al right, well that makes sense too.
(15:24):
And that's just merciful, that's right. Uh. And for a
lot of years there was you know, up until like
the mid twentieth century, there were a lot of psychological
um or they were attributing this at least a psychological causes.
Earlier on, it was you know, doctors would say, oh,
you know, people who experienced this have one quote was
(15:45):
an unsatisfactory personality. Or they said they may be obsessive
people obsessed with things being wrong. They may be anxious people,
they may be overly dramatic. I know. But although up
until nineteen p but were arguing, doctors were arguing at
the Mayo Clinic that, uh, phantom limb pain sufferers, if
(16:07):
it was persistent, reflected a pre existing difficulty and adapting
to problems. Uh, and may be influenced by just knowing
that it exists, like well, yeah, I've read about this,
I'm I'm feeling that pain too. So if you if
you suffer pain, phantom limb pain. You are neurotic, easily suggestible.
Possibly you're you consider yourself a failure now that you've
(16:29):
lost a limb, and you're worried about disappointing your father
or mother who might be like overly concerned with sports
triumphs or beauty or something like that. And like I said,
I dug up a reference that said it was seven
when they finally did a meta analysis of all of
the literature and said, everyone, these people are not crazy.
(16:50):
Like for years they used to compare. It wasn't even
a comparison. It was like um, it was a tangential
um syndrome where if you experience phantom pain it was
tantamount to having psychosis. Like that's how they were treated.
And so for years and years people just knew, like
you didn't complain about your fanom pain or else, they
were going to give you electro convulsive therapy, maybe even
(17:13):
a lobotomy. It doesn't I didn't turn that up, but
I guarantee someone got a lobotomy for phantom limp pain
sometime in the ninet thirties or forties. That would not surprise.
I would put a lot of money on that they
would lobotomize, uh, domestic housewives for not wanting to do
dishes exactly. So you know, somebody with fanom limp pain
(17:34):
got that treatment. Uh. Should we take a break? Yeah,
all right, that was chuck full of information. Yeah, so
we can only go down from here. You know, let's
keep chucking it up. Chuck. All right, we'll be right
back to chuck it, chocking it. Let's chock it some more.
(18:13):
Hold its mouth open um. This is really interesting. Livia
dug up a couple of first person descriptions of phantom
uh pain syndrome. Is it a syndrome? Uh, I don't
know why I'm calling it that because of alien hand syndrome. Probably. Yeah,
The thing is, I don't I think it is a
(18:33):
syndrome because the syndrome is usually a cluster of seemingly
unrelated symptoms. So probably not. Look at you, smarty pants.
I can't remember what that was from. I think in
our albinism episode, I learned what difference between a syndrome
and a non syndrome. Yeah, okay, so it's recent. Don't
don't be too impressed. She dug up a couple of
Norwegian academics and one page and this is just to
(18:57):
let you know what what some of these people go through.
One of the patient described a phantom arm being stuck straightforward,
just sticking straight out from the shoulder, and basically every
time he walked through a door would go through sideways.
And you know, this is you hear something like this,
and it's this is a It's not like shooting, stabbing,
(19:19):
pain and pins and needles, but it's something that you
have to explain to everybody. It's something that you're living
with that uh, that people would see as abnormal, so
it causes psychological impacts, you know. Yeah, I mean if
you saw somebody with only one arm just turn and
go gingerly kind of sideways through a doorway for no reason,
(19:40):
yes it would it would be a little odd, you know.
But the idea of your arm never being down, I
mean that kind of goes back to what we were saying,
the difference between being fascinated with and the difference between
having to live with it. You know, like, just think
about what it feels like they have your arm up,
like just for a minute, or to imagine always feeling that.
And then the guy you mentioned, he was also in
(20:01):
that Norwegian paper you mentioned before, where um, there was
a patient who couldn't sleep on his back because he
felt like his arm was twisted behind him at all times.
And yeah, that sucks to not be able to sleep
on your back. That's like the money sleep right there.
But imagine feeling like your arms twisted behind your back
every waking moment and that you can't do anything about it.
(20:25):
That would drive you nuts. It's as simple as that. Yeah,
So those are like on this sort of lighter psychological side.
On the other end of the spectrum, another man who
I think lost both legs um was woken up periodically
thinking that the nail of one toe was growing into
(20:47):
the next toe. Uh. And another ampute said they felt
like the skin on their arm was ripped off, salt
was being poured on it, and it was thrust into
a fire. Right. And then other people report to Chuck,
this seems like something that would be easy to overlook,
that you know, having you know, consistent pain in this
phantom limb. Remind them that they have a phantom limb,
(21:09):
that they have like an an amputation, and that just
makes the whole thing that much more. Already distressing event
is consistently distressing, over and over again because it's just
a reminder of it, you know, right, especially if you're
trying to rehabilitate and move on with your with the
new normal, you know exactly. So, UM, we kind of
(21:31):
reached finally, like where we're at with our understanding of
phantom limb pain. And that's basically where we were in
the sixteenth century if everyone had listened to Ambrose Parey,
and that is that. Um, despite a lot a lot
of people getting amputations every year in the US alone,
(21:53):
I think there's something like a hundred and eighty five
thousand amputations every year, the vast majority of them due
to complications from vascular disease including diabetes. UM having a
whole bunch of troops come back from Iraq and Afghanistan
with amputations needing treatment and rehabilitation, and eight percent of
(22:14):
these people suffering phantom limp pain. We still don't know
what causes fami limp pain, what the basis of it is.
And that's despite thinking we did for a little while
there right like in the late nineties, early two thousands,
and we talked about it, and I think our amputation episode,
we thought we had a handle on it. And that's
since been challenged and possibly debunked. Yeah, and you know,
(22:37):
like we said with Parae, Uh, Michael Parree is that
his name you're thinking of? Michael Buble? I was thinking
of Eddie and the Cruisers. Maybe that's how I was
thinking you were talking about when you mentioned can Marino.
Oh man, they should remake that with Kid Marina. What
a funny movie that would be. Who is the guy
(22:58):
I am thinking of? I want to say it's like
a he was like a kind of like a dark
night kind of figure who would like help people and
maybe the fifties. Arthur Fonzarelli. No, No, I'll try to remember.
I'm gonna I'm gonna pro portion off like seven percent
(23:19):
of my brain just to be working on this this
problem while the other is focused on this episode. Okay.
You know what, It's funny that I said, Arthur Fonzarelli
because our friend of the show, Paula Tompkins and uh
sort of colleague pal in real life for us, he
mentions Arthur fonds Relli more than any other human I've
(23:40):
ever known in my life. Yeah. Yeah, in his in
his show Freedom and then conversationally on his other show
Stay at Hopkins with his wife Janie. He just he
it's a great comedic effect. He brings up Fonzi a lot.
It's pretty great. Well yeah, I mean, if you if
you want to get an easy laugh just bringing up
fond Yeah, he times it out. Well, this is really
(24:00):
well done, Like you just did it yourself. I feel
like I channeled up Paul of Tompkinson, so I can
tell you what the show is now if you want
to know. It has nothing to do with the fifties
dark night thing. I'm still not sure what that show is.
It's a show. I promise it's called Growing Pains. The
guy I'm thinking of is Ken Wall in the show
(24:21):
Wise Guy. Sure, he kind of looks like Ken Marino too.
If you put him next to each other, you'd be like,
don't be ridiculous. But if you see one at a
party and then went to another party down the street
and saw the other, you'd be like, gosh, you guys
look a lot alike. I remember Kinting Wall. I don't
know what happened to that guy. Maybe everyone figured out
(24:42):
he was a bad actor. Was he a bad actor?
I mean, come on, Wise Guy has a seven point
eight out of ten on I AMDB, really high these days.
Well that says it all. Yeah. Uh so I think
where I was headed before I got sidetracked was uh,
like you said, with Parade, they are still sort of
looking at two schools of thought, and you know, it
(25:03):
could be a who knows, it could be a combination
of both, but uh, you know, central nervous system stuff
and then um, you know, brain mapping and literal nerve
issues like you know, it could have. You know, the
first thing you're gonna do is put you into the
Wonder machine and see what lights up when you feel
(25:24):
that type of pain. And they have found that it
does show activity in parts of the brain connected to
the nerves of that missing limb. So that's a good
place to start. Uh. It could be thickening of the
severed nerve endings, um like after the operation, uh, making
things a little more sensitive. But there's still a lot
of debate on this, you know. Yeah, and that last
(25:44):
one is called the neuroma theory, and that is how
that was a leading um explanation for and it still
could be right. But there when they when they amputate
your limb, um, they're also amputating a lot of other
stuff than just like your leg there's a lot of
stuff that's still remains that is no longer intact, and
that includes nerve endings. Those nerve endings have lost their
(26:06):
attachment points, their end points, but they're still capable of
transmitting electricity through your your peripheral and into your central
nervous system. And so they actually seek connections and will
sometimes connect with each other and cause all sorts of
haywire stuff. And they are like, well, maybe that's what
phantom limb pain comes from, and it's entirely possible. It is. Well,
(26:30):
here's something that I had no idea. I knew a
little bit about this, but when I read this, I
was pretty uh dumb struck. H If you had like
a bad knee and then you had to have an
amputation from like the thigh down, you're more likely to
have phantom limb pain because you had that bad knee before. Right, Yeah, yeah,
(26:51):
that's a risk factor. I don't know if it's still
considered that, but it was for a long time that
if you had pain in your your limb, and we're
talking like in the hours leading up to your amputation,
even yeah, that that that your brain remembers that and
that yes, um, that's kind of evident, like your brain
never got a chance to work out that it was
(27:13):
no longer in pain, is just continuing on UM. And
there's they they've done studies of UM people who where
they give a local anesthetic to like just to your
leg and they really numb it and then they move it.
And then they bring you out of anesthesia and they say,
what what what direction is your leg moving in? And
(27:35):
almost consistently across the board, people report the way that
it was before it was moved when it was under anesthesia.
Does that make sense? So like you remember this kind
of stuff, and that actually kind of leads to another
theory of UM what causes fantom limb pains called appropriate
reception theory. So so appropriate exception is just your awareness
(27:59):
of where your limbs and extremities are in space. I've
seen it explained as like how you can close your
eyes and touch your nose. That's all appropriate exception. And
this this whole idea behind appropriate reception having to do
with phantom limp pain is that we do this because
we're able to like touch our nose with our eyes closed,
not just because we know where are our limbs are
(28:21):
in space, Because our brain is constantly keeping track of
it and has basically a general map of our body
at any given point. So if we lose a part
of that body, that brain map doesn't necessarily catch up
with it. So the brain map is still expecting signals
and is basically creating signals UM based on its expectations.
(28:43):
And that's the appropriate reception theory of of phantom limb pain.
It's interesting because it's almost as if some of these
theories point to the brain being less able, I guess,
less neuroplastic than they thought, right, yes, yeah, and well
that's the thing. So so the neuroplasticity. That's the leading,
(29:05):
most dominant accepted explanation for phantom limp pain, which is
that you're the part of your brain that was dedicated
to sensation and movement of your arm that has now
been amputated. It's being restructured, rewired, reconnected, and so you're
getting all sorts of weird cross talk and it's creating
(29:26):
the sensation of pain in a limb that's not there anymore.
That makes sense, and it's been accepted since I think
the nineties, UM, but it's been challenged recently by findings
that that show your brain's actually doesn't seem to be
restructuring itself at all. Yeah, there's a famous Ted talk
a researcher from cal San Diego named vs uh Rama
(29:50):
Shandron who he argues about neuroplasticity, and he's the one
that uses the mirror box, which is what you mentioned
at the beginning, which is the idea, and this is
I think in the nineties, where there's the box and
if you're a unilateral amputee, you would put your let's
say you've lost your right arm, you put your left
(30:10):
arm into one side of the box and the residual
limb and the other side of the box. You would
see your reflection as if you still had both those arms.
And the idea is that your brain sees this and
so it can it can map this out. But I
think they've done um studies and meta analyzes that have
found that if it does work, it's very short term.
(30:35):
It's not like the brain completely remaps long term. So
it's more like a salve than a cure. That's what
the studies have shown. But that's kind of surprising because
it was it was touted early on, is like a
like this is gonna cure it, and it makes sense
from a neuroplastic way, like you're you're allowing your brain
like do you remember I was just talking about how
(30:57):
it's possible that your your brain isn't caught up to
the idea that that limb is not there any longer um,
and so you're you think your limbs in a different
position the last position it was in, or it's in
the pain that you thought it was in. If you
could trick your brain with the mirror box to see
that thing and make your hand wiggle, or make your
brain think your hand is wiggling and be like, okay, good,
(31:17):
I'm not actually experiencing a pain. I can stop that
signal and you can go on with your married life.
It makes sense, and a lot of people accepted it
for a long time, but like you said, the follow
up studies and analyses have shown like doesn't really have
that long term effect like you would think. And then
on top of that, some of those m r I
studies that you mentioned a few minutes ago have actually
(31:40):
shown like, no, actually that region that was in control
of your left arm that's now been amputated, that region
of the brain is still fully capable of causing your
arm to function in whatever. There hasn't been like some
great reconnection where other like your tongue sensation has taken
over that part of your brain to become a super
tasting tongue. That's just not panned out in the in
(32:03):
the reviews, in the follow up studies. So we're back
to basically square one. We don't know what causes phantom
limb pain. All right. I think we should take another
break and we'll talk some about treatment when we come back,
including what I think we will If I can speak
for you, I think you'll agree some of the most
fascinating headway they're making, which is working with prosthetic limbs
(32:29):
to be more realistic, is also having effect on phantom
limp pain. All right, So we talked a little bit,
(32:56):
and hold on, hold on, I'm sorry, I'm sorry what happened.
As want to give an update here. You can probably
understand why I confused Ken Wall as the um lead
of a like a kind of a mid fifties like
Dark Night kind of helping people out, because Ken Wall
was the lead in the nineteen seventy nine grease or
(33:16):
flick the Wanderers. Okay, I knew he was in a
greaser movie. That's I think that's what I was confusing.
His hair looks good in a duck tail. I think
I had confused the Wanderers with the Um the eighties
TV show Crime Story as well. I think I conflated
all those. I don't know what that is. It was
a cool one. It was like, I think a mob
(33:37):
Vegas mob show. It was like a cop drama. What
was was Wanders like an Outsider's rip off. No, it's
a little more true. Outsiders was weird and avant garde
or um? I'm sorry, did you say outsiders or um?
What am I thinking of? What's the weirdness? The weird
one Warriors, That's what I'm thinking. Oh, oh, I'm thinking
(34:00):
of pony Boy. I think the Outsiders came after the
Wanderers and was probably something of an homage to that. No,
it was a book from way back. Okay, fine, we're
never going to get to I'm losing my stuff. It's
all kin Wall's fault. I think it's all Ca Marino's fault. Um.
(34:22):
All right, So what we were talking about before, and
we'll talk a little bit about some of the treatments,
But for my money, Some of the most fascinating work
going on right now is research that is trying to
help people use prosthetic limbs more effectively. One one, there's
a couple of different things they're doing. Well, there's a
lot of different things, but a couple of them are
targeted muscle reinnervation and targeted sensory reinnervation, which is either
(34:48):
using leftover motor nerves or leftover sensory nerves from that
amputated limb connecting those two muscles that lost their function.
And all of this in service of you know that
all the work they've done with prosthetic limbs to make
them smarter and like like, hey, you can you grab
a coffee cup in a different way that you would
(35:09):
grab a pillow, and you may be able to know
when something's hot or cold. Like the advances that they're
making is unbelievable. And some of these advances are helping
with basically telling the brain, now you've got a real
limb there again, and so you don't have that venom
limb pain. Yeah, I found this, um this one mention
of how apparently there's people who have prosthetics are faced
(35:33):
with this terrible choice where um, the prosthetic feels way
heavier than their limb ever did, even though the prosthetic
probably weighs less than their limb did. For some reason,
because it's foreign, it's not really part of their body
to their brain, it's very taxing to wear it or
carry it around or use it, and it can be
so taxing that it can it can increase their risk
(35:56):
of cardiovascular disease, of heart attack, of all sorts of
stuff like that, just by like over exerting themselves. And
then the other thing they could do is just not
use the prosthetic at all and lead an increasingly unhealthy
sedentary lifestyle. So these new prosthetics are are kind of
getting around that by recreating, as far as the brain
(36:17):
is concerned, a limb very closely. In the way that
you do that is like you said, UM, give it
senses that it used to have, like give it sensory
information from this limb. And what they're doing is information
from the from say like a prosthetic foot, just the
fact that it's receiving pressure from the ground. It will
send an electrical signal up through its cables to a
(36:41):
terminal where it's connected to the actual like like um
nerves and then muscle tissue also in your leg, and
it will send that on up to your peripheral nervous
system and into your central nervous system and your brain experiences.
This is so awesome, the sense that it's a pressure
from the bottom of your foot when you put that
that prosthetic foot on the ground. That's the level that
(37:04):
we're at at this point, which is amazing. Yeah, I mean,
I remember many years ago, it may have been one
of those episodes you mentioned where we talked about and this.
This was probably at least ten years ago, so I
imagine the strides since since then or even more that
you know, they've gotten to the point where you can think,
you know, grab coffee cup, and that prosthetic hand will
(37:27):
grab coffee cup. And the more lifelike that feedback is,
the more it seems like at least that it's going
to help alleviate phantom limb pain exactly, because that seems
to be one of the bases that they're figuring out
about phantom limb pain, is that these nerves um, whether
it's muscle tissue, nerves connected formally connected to muscle tissue
(37:48):
or axons, or some some type of nerve impulse carrying
material a nerve. I guess if you're not a total
weirdo and say things normally. Um, they they still want
to carry these impulses, so they're still accepting like impulses,
but they're just not cut out for the task any longer.
And what they're figuring out is like, hey, surgeons, if
(38:09):
you leave some muscle tissue attached, will come back and
attach the sensory cables from a prosthetic to that muscle tissue,
and we're going to be back in business. And the
brain is gonna think like, hey, I've got this. I
got my foot back, I got my leg back, I
got my arm back. To the braining, it's all the same.
It's still getting some sort of sensory information. It might
be kind of primitive compared to what you had before,
(38:32):
but from what I'm seeing, it's it's not necessarily we're
getting more and more advanced by the by the year.
Well yeah, and it's that muscle tissue that allows the
body to sense things like applied force or a sensation
of stretching, you know something. And not only are they
saying to surgeons like maybe we should rethink the way
(38:53):
we're doing amputations, but they're saying, we can go back
in and and attach muscle to the end of those
nerves for um amputations that happened years ago. And so
if you give these nerves something to do productive, they're
gonna stop looking for something to do. Basically that's actually
very unproductive and like causing phantom pain. And so that's
(39:14):
like you said that they think that that is not
they think like they're they're seeing quite clearly that that
helps alleviate and maybe cure as phantom pain. Just giving
these nerves a productive job yet again because they just
want to work so bad, but they got caught in half. Yeah,
it's remarkable, um on the less remarkable side treatment wise,
(39:35):
and this is I think just residual, you know. I mean,
that's a very forward weight, way, forward thinking way to
do things. I think with phantom limpain, which is this
prosthetic stuff that they're working on, the old school treatments
are literally like giving people pain drugs and giving people opioids, uh,
(39:55):
you know, muscle relaxers, beta blockers, stuff like that. And
I'm not poopooing medica asian if it helps people out,
but it does seem like a bit of an antiquated
thing to do is just to throw pain meds somebody's way, right. Um.
So there are other like non pharmaceutical techniques to one
of them is kind of like a low five version
(40:16):
of what you would get with a really advanced prosthetic. UM.
It's called TENS. It's been around since at least the eighties.
Um My mom was a hospital administrator later in her career,
and I remember we had pads of paper laying around
our house that had like pictures of TENS units on them. Yeah,
I guess the TENS unit supplier gave us some free
(40:37):
pads of paper. Um. So that's transcutaneous electrical nerves stimulation
and it's basically giving those nerves something to talk about
without them having to make it up themselves. But it's
just stimulating them with electricity, and they think that that
What happens is you're kind of overwhelming that pain signal
(40:57):
with a more robust elector cool signal that just turns
off that pain signal and it actually helps really really well,
tends helps a lot of people. UM, with back pain.
You you have you seen those like little um electrode
things that you can put on your lower back and
there's like a little looks like a beeper attached to it.
That's attends unit and almost doing is sending electrical input
(41:18):
pulses through your skin to your nerves and basically saying,
shut up, pain signals. Here's here's something, here's something bigger.
It's the Bonnie rate treatment. Yeah, let's give them something
to talk about. Or what was that ad? Move over something?
Now there's something leaner, Move over bacon, I think so.
(41:38):
But what was the product? It was sizzline, wasn't it. Yeah,
that's what was sezzelin. It was not good. I'll tell
you that. I don't even know what that was. Remember
stake ums You you like stake Ums, Well, it's the
it's the you know, it's the budget version of a
(42:00):
Philly cheese steak. Yes, and that's how I always ate
it too. But even still it's like, this is terrible
it Yeah I did it? Did? I like stak hms
for many years? Having said that, that was you know,
forty years ago. Um, And now you know, if you
make a homemade cheese steak, slice that ribbi, fold it
(42:22):
up and roll it up and slice it really thin.
Is that right? That's what you using some good Rubbi. Yeah,
flatting it out, pound it out, really thin, man, you
have come so far. You have arrived because I'm pounding Ribbi. No,
because you left stake Ms in the roof. You went
from steak ms to ribby. What else that? I think
there's a few more treatments. There's biofeedback, of course. Uh.
(42:45):
There are very simple things like just propping up the
residual limb, repositioning it, you know, being distracted. They say,
lifestyle changes like you know, yoga, meditation, music, stuff like
that you can can help, um, probably better than throwing
opioids at the problem. Yeah, and again I mean just
doing stuff like moving the limb, um, massaging it, um,
(43:09):
just just giving it some sort of other like very
real stimulation tends to help. But I mean, if you
feel like you can't sleep because your arms twisted behind
your back and it's like that constantly, especially if it
starts hurting like you get a Charlie horse like that,
nobody's going to blame you if you ask for opioid
to know like, that's that's that's the reason why this
(43:31):
is not just interesting that we it's an imperative that
we we understand it and learned to cure it fully agreed.
So that's it for phantom limb pain and phantom limb sensation. Everybody. Uh,
if you thought that was pretty neat, there's a lot
of interesting stuff to read about that, uh. Phenomenon. Not
syndrome though, we don't think Uh. And since I said
(43:53):
not syndrome, that means it's time for listener mail. I'm
gonna call all this just sort of an enlightening email
from a from a listener. Hey guys, longtime listener. My
first email to you was when you were working for
Discovery Channel. In the episode on albinism, you mentioned that
(44:15):
it's the barest minimum of parenting to explain to children
the scientific reasons behind why we have some variety in
the expressions of what it means to be human. And yes,
that is important. It's also important to teach children that
society creates is ms about these expressions, which served a
privilege or marginalized certain groups of people. My researches around
(44:35):
race and racism, so I'll use that as an example. Yes,
it is important to teach children what science says about
how variety manifests in the human body. Likewise, children need
to learn that racism exists, and that racism is a
social construct that is not biological. Just the former without
the ladder fails to prepare children to react appropriately when
(44:55):
they are faced with racism, and the same goes for
any ism. As I wrote almost a decade ago, still
use your podcast with my grad students. H. And that
is from Judd Judson laughter. He him his from ut
in Knoxville. Yeah, go Valls right up the road. My
(45:17):
I guess niece in law maybe Okay, I think nice
in law in law potentially just got into UM University
of Tennessee and she it's like her her dream, like
she wants to go study the body farm. Chuck, doesn't
that just see your heart? I love that. So congratulations
and thanks professor Laughter. Awesome name. That is a really
(45:41):
important thing to point out, and thank you for sharing
that with everybody. If you want to be like Professor
Laughter and share your awesome name and or awesome point,
you can email us It's stuff podcast at iHeart radio
dot com. Stuff you Should Know is a production of
iHeart Radio. For more podcasts my heart Radio, visit the
(46:02):
I heart Radio app, Apple Podcasts, or wherever you listen
to your favorite shows. H
Welcome to Stuff you should know, a production of I
Heart Radio. Hey, welcome to the podcast. I'm Josh, and
there's Chuck and there's Jerry over there, and this is
stuff you should know straight ahead. Both barrels blazon science, strange, unusual,
(00:25):
fascinating type stuff you should know. That's right, and uh,
both of us fresh from vacation. M hmm. I just
got to say. We took the first family trip to
Disney World and it was great. The oh that was
the first ever. Wow, I'll bet that was something special.
It was I haven't been in thirty five years myself,
(00:48):
and the same with Emily, and uh, it's remarkable how
much of the Magic Kingdom is exactly the same. But
then I realized that Disney h cultists diehards and appropriate.
They don't want anything different, so that that all made sense.
But it was great. My daughter was you know, you
never notice how you get down there. But I had
(01:09):
a feeling, because she's not a very fearful kid, that
she would ride stuff, and she rode everything that she
was big enough to ride, and then pride on the
things that she wasn't big enough to ride because she
couldn't ride. Yeah, like she did Space Mountain twice, she
did Tower of Terror. She she wanted to do the
Aerosmith ride at Hollywood Studios that she was bummed out about. Um,
(01:30):
which have you written that one so many times? Did
you realize you probably realized this the little video they
showed at the beginning of Smith in the Studio, that's
Ken Marino as the as the engineer. Oh no, I
thought you were going to talk about Ileana Douglas. I
had no idea. It was Kim Marino from that one
show from the eighties. Oh well, please, I mean he
(01:53):
was from this he was a co founder of the State.
But he's he's one of my comedy heroes. Oh that's
not who I'm thinking of. Then, yeah, Ki Marinos from
the State and you know, wet, hot American summer and
party down and he had he had literally no lines. Thought, oh,
there's Kim Marino's gonna do something funny. But he was.
I guess it was after the State and before he
(02:14):
had done a ton of other stuff, so he was
just bunching buttons. I thought it was very funny. But anyway,
we had a makes even funnier that he didn't have
a like any kind of maybe I kept waiting for it. Uh.
It was a lot of fun, though. Uh if we
went back, we would do it a little different. We
went to Universal Studios and tried to park hot but
(02:35):
it's too much to do in one day. And uh
we we did all the Harry Potter stuff but didn't
get to ride some of the big rides who wanted
to ride. Well, that's cool. I'm glad you guys had
a good time. It was wonderful and refreshing, and uh boy,
I think we both needed a little respite. We definitely did,
me and you. We went to Hawaii for tenth anniversary
or yeah, it was the first time we've traveled in
(03:00):
two and a half three years something like that first trip. Uh, yes,
it was something else, but it was great. See, I
went travel crazy after I got COVID for a while,
so I had gotten some trips in. You're like, I
only have a few days to spread this far and wide.
I better get out there. No. After I got it, Oh,
gotcha got you? After I recovered you know what I mean,
(03:21):
I know I'm with you. No, I I stayed inside
and scared, but this is so it was. It was
something like I was like I don't know how this
is gonna go, but it went really well. But we're back.
We're here to do a job, and this is You're right,
this is very old school stuff. You should know kind
of topic. I'm shocked that we hadn't covered it yet. Uh.
I think the reason that you're shocked is because we
(03:44):
actually have. We did. We did uh amputations. I know
we talked about it there because we talked about the
mirror box before plenty and then possibly talked about it
in limb reattachment I'm not sure, but definitely in amputations
we did. All right, Well, this finishes up the sweet enfolding.
I agree. So what's phantom pain? Well, so, um, shout
(04:07):
out to Olivia first of all for helping us out
with this. I realized that we didn't. We didn't acknowledge
that she helped us with the chow Chillibus kidnapping articles.
So sorry for that one too, So I want to
let that pass. But um, so this she she does
a good job like basically getting across like what phantom
pain isn't that we actually don't really know what it is,
(04:30):
but you can describe it as anyone who's had an
amputation about of those people um suffer some sort of
pain sensation, and it's a whole range of pain. As
we'll see. The problem is it's in that limb that's
not there anymore. It's not in the residual limb what
people colloquially called the stump. Yes, you can have pain
(04:52):
there too, that's called residual limb pain. This is phantom
limb pain where let's say you had your foot cut off.
You feel like they're is a nail being driven into
the bottom of your foot. The problem is your foot
is not there anymore, so you can't pull the nail out.
And hence we get to the meat of what the
big problem is with phantom pain. That's right. Uh, it
(05:12):
can it's you know, usually think of hands and feet
and arms and legs and stuff like that. But it
can be after amassectomy, it can be removal of testicles.
I know that's not exactly a limb. It depends on
how big it is. Oh boy, I did set it
up with that inflection of my voice, right of course. Uh.
(05:38):
There's also sort of a side affliction called uh, phantom
limb sensation simsation sensation, which is it's not exactly pain,
but it's like, you know, I feel like my foot
is moving that's not there. Or my hand feels hot
even though I no longer have that hand, or maybe
(05:59):
uh pressure or something like that, but it's not. Or
it may feel like swollen, or like when you're asleep,
I feel like my arm is stuck behind my back
and it's causing me great discomfort even though you don't
have that arm. That kind of thing. Yeah, and so
for a long time people have said, like, well, clearly
it's these people are nuts, it's in their head. I
(06:19):
thought it was as recent as seven that they finally said, no,
that's not the case. And we'll talk about some of
the historical view of it, but the upshot of it
is now we understand that people who experience phantom limb
pain are in fact experiencing pain in the same way
that you or I would experience pain in that same limb.
(06:41):
Like it's just as real to them as it is
to us. And it means that the brain's gone haywire.
And there's all sorts of ways it can manifest itself.
There's shooting spain, shooting pain, stabbing pain, it could be
cramping pain, pins and needles, which is bad enough, but
pain from pins and needles, which should be awful, and
it's you aunt, possibly scratch that sounds about as bad
(07:03):
as it can get. A crushing, pain, throbbing, basically, any
variety of pain that you could have experienced in that
um in that limb before it was amputated, you're capable
of experiencing it after it was amputated too. Yeah, and
Livia makes a good point here. And as you'll see
in the history part, there have long been philosophers and
(07:24):
and people like to think it scientists even that are
just fascinated with this curious syndrome. And it's you know,
it makes sense that people would be fascinated with it
like that. But it is a real problem. Um. It is.
It can cause people to not sleep, It can cause
people to not have the job that they want. It
can lead to suicidal thoughts. Like it is a real
(07:45):
affliction and not something that should be just treated as
a as an interesting curiosity, right, But it also is
an interesting curiosity. It's the tring that we need to
understand to help people with. But it's fascinating and the
reason why philosophers are so so you know, nuts for
it is because it proves that, like our subjective experience
(08:07):
of reality is not necessarily fully in line with reality.
It shows that we're capable of experiencing the unreal. Wow,
that was dramatic. I thought so too. Uh So, let's
you want to dive into the history a little bit, Yes,
and let's talk first, Chuck. I think at the beginning
(08:28):
about Ambrose Pare. Oh. Yeah, he was a French surgeon
in the mid sixteenth century. And this is one of
those kind of rare cases where someone from hundreds of
years ago describe something and had a handle on something
in in a pretty solid way. Like looking back, he
really was pretty close and a lot of the things
(08:50):
that he thought about phantom limpain and he was the
first dude to describe it, which is pretty remarkable. Yeah.
I mean we're talking the middle of the sixteenth century.
Like you said, that's that's crazy. That's a time when
people didn't really think that that the people working in
science for scientists, Like science kind of came later, according
to some people. And it's like, um, if we had
(09:13):
just kind of built on paradise understanding of it, who
knows how much further along we would be in in
you know, treating and dealing with that kind of stuff.
But um, it's, like you said, he had a really
good handle on it. He's he was the first to differentiate.
Remember how I said, there's like residual residual limb pain
and then there's phantom limb pain. He was the first
(09:33):
one to say those are two separate things. It's not
the same thing. Uh. He said that there's different factors
that can um set it off, like the weather, change
in the weather. Um. And then that there's different things
that could treat it, like sometimes massage around the residual
limb helps to what else. Uh. He also made the distinction.
You know we described the phantom limb sensations. He described
(09:56):
the difference there between the pain and the sensation. Oh yeah, Uh,
that's a big one. He also said, so he said
two things. He said that um either that his guests
for what was causing it was that either there was
some problem with the nerves in the residual limb um.
I think he said that he thought they were retreating
(10:16):
possibly or withdrawing, which makes sense in a weird way. Um.
Or he thought that it was that it originated in
the brain, not through some sort of psychosis, but through
some sort of you know, foul up in the brain,
like a glitch in the brain. And still today, as
we'll see when we're talking about this, our understanding, a
(10:37):
pan of limp pain basically boils down to those two,
those two general concepts. Yeah, it's pretty amazing and um,
we're not. Well, we'll get to that. I want to
save that. I don't want to spoil it. I mentioned
philosophers being sort of um delighted by this idea. Descartes
was one of them. In the kind of early to
mid sixteen hundreds, he talked a lot about Fannalm mimes.
(11:00):
He he was one of the people that was really
blown away by what he called non resemblance, which is
what you were talking about, your subjective experience not aligning
with reality. And he also thinks or thought it had
to do with severed nerves, so he was sort of
on the right track as well. And then the Scottish guy,
uh William Porterfield in seventeen fifty nine. He was a
(11:23):
physician that lost a foot and he had an actual physicians,
first person autobiographical take on it all and talked about
his toes, heel and ankle spelled with a sea which
is fantastic, Um, like experiencing pain and itching several years after.
I don't think we said it can start up to
(11:45):
like as in as short as like a week afterward,
and it can go on, you know, sometimes it comes
and goes. Sometimes it's persistent, sometimes it goes away entirely.
Sometimes it lasts forever. So um, it can really be
all over the all over the map. But his description
was at least a few years afterward, right, So um,
(12:06):
that was seventeen fifty nine, And that was almost exactly
two hundred years after Perry first identified phantom limb sensation
or fantom in pain. Um, And it just kind of
got lost from there. And it wasn't until the American
Civil War when a surgeon named Silas Weir Mitchell, who
I know, we've talked about. His name seems very familiar, um,
(12:30):
who took part in the removal of thirty thousand limbs,
not himself personally, but he was like among the battlefield
surgeons who took that total number during the American Civil War.
Thanks to advances in certain kinds of bullets and projectiles
that could really do some so much damage that when
they hit like a bone in a lagorant arm, like
you just were going to lose that arm or leg
(12:51):
to save your life. Um. He he had like all
this firsthand experience with these people who had just lost
a limb, and we're complained meaning about pain in the limbs.
So this this idea phantom limp pain kind of came
back to the four at a time when surgeons were
starting to talk to each other more and science was
starting to be practiced in a more methodical way, so
(13:13):
that the discovery of one person could be understood and
learned and built on by other people a lot more
easily than it was in the sixteenth century. Right. But
he took a kind of weird approach initially, uh and
that he wrote a fictional account, basically a fictional short
story called the Case of George Deadlow, and he talked
(13:34):
about a Civil War veteran who experienced fanom pain and
legs and arms that he had lost in the war.
And it ultimately led to a seance where he's communicating
with these limbs and then walks around the room on
these invisible limbs, and a lot of people thought this
was real and started sending donations in and wanted to
visit with this person and six years afterwards he was like,
(13:56):
maybe I should write, uh, something real and not fiction piece.
And he went on to do that, I think to
greater effect. Yeah, because he finally after six years he
stopped face palming, Like, Okay, it sounds like people a day,
doesn't it. Can't you see people a day sending in
donations to the guy who lost his legs but were
(14:17):
was able to walk around on invisible residual limbs and
a seance Facebook told him so so um so silence
where Mitchell finally creates what what you could kind of
point to is like the first um modern scientific paper
on phantom limb pain, and he estimated as high as
(14:39):
eighties six out of ninety of his um amputee patients
experience phantom limb pain. Not just phantom limb sensation, but
phantom limb pain. Um and uh that that is a
really high number. It's higher than average. But like I
said before, I mean in the neighborhood of a d
I think I've seen as high as eighty five of
people who of an amputated limb will experience pain to
(15:02):
some degree in that in that that phantom limb right,
And I think most people experienced sensation, right, I believe
that's correct. Yes, My understanding is more of the phantom
pain stuff. Though. Is phantom sensation more prevalent? Yeah, I
mean for sure. Okay, al right, well that makes sense too.
(15:24):
And that's just merciful, that's right. Uh. And for a
lot of years there was you know, up until like
the mid twentieth century, there were a lot of psychological
um or they were attributing this at least a psychological causes.
Earlier on, it was you know, doctors would say, oh,
you know, people who experienced this have one quote was
(15:45):
an unsatisfactory personality. Or they said they may be obsessive
people obsessed with things being wrong. They may be anxious people,
they may be overly dramatic. I know. But although up
until nineteen p but were arguing, doctors were arguing at
the Mayo Clinic that, uh, phantom limb pain sufferers, if
(16:07):
it was persistent, reflected a pre existing difficulty and adapting
to problems. Uh, and may be influenced by just knowing
that it exists, like well, yeah, I've read about this,
I'm I'm feeling that pain too. So if you if
you suffer pain, phantom limb pain. You are neurotic, easily suggestible.
Possibly you're you consider yourself a failure now that you've
(16:29):
lost a limb, and you're worried about disappointing your father
or mother who might be like overly concerned with sports
triumphs or beauty or something like that. And like I said,
I dug up a reference that said it was seven
when they finally did a meta analysis of all of
the literature and said, everyone, these people are not crazy.
(16:50):
Like for years they used to compare. It wasn't even
a comparison. It was like um, it was a tangential
um syndrome where if you experience phantom pain it was
tantamount to having psychosis. Like that's how they were treated.
And so for years and years people just knew, like
you didn't complain about your fanom pain or else, they
were going to give you electro convulsive therapy, maybe even
(17:13):
a lobotomy. It doesn't I didn't turn that up, but
I guarantee someone got a lobotomy for phantom limp pain
sometime in the ninet thirties or forties. That would not surprise.
I would put a lot of money on that they
would lobotomize, uh, domestic housewives for not wanting to do
dishes exactly. So you know, somebody with fanom limp pain
(17:34):
got that treatment. Uh. Should we take a break? Yeah,
all right, that was chuck full of information. Yeah, so
we can only go down from here. You know, let's
keep chucking it up. Chuck. All right, we'll be right
back to chuck it, chocking it. Let's chock it some more.
(18:13):
Hold its mouth open um. This is really interesting. Livia
dug up a couple of first person descriptions of phantom
uh pain syndrome. Is it a syndrome? Uh, I don't
know why I'm calling it that because of alien hand syndrome. Probably. Yeah,
The thing is, I don't I think it is a
(18:33):
syndrome because the syndrome is usually a cluster of seemingly
unrelated symptoms. So probably not. Look at you, smarty pants.
I can't remember what that was from. I think in
our albinism episode, I learned what difference between a syndrome
and a non syndrome. Yeah, okay, so it's recent. Don't
don't be too impressed. She dug up a couple of
Norwegian academics and one page and this is just to
(18:57):
let you know what what some of these people go through.
One of the patient described a phantom arm being stuck straightforward,
just sticking straight out from the shoulder, and basically every
time he walked through a door would go through sideways.
And you know, this is you hear something like this,
and it's this is a It's not like shooting, stabbing,
(19:19):
pain and pins and needles, but it's something that you
have to explain to everybody. It's something that you're living
with that uh, that people would see as abnormal, so
it causes psychological impacts, you know. Yeah, I mean if
you saw somebody with only one arm just turn and
go gingerly kind of sideways through a doorway for no reason,
(19:40):
yes it would it would be a little odd, you know.
But the idea of your arm never being down, I
mean that kind of goes back to what we were saying,
the difference between being fascinated with and the difference between
having to live with it. You know, like, just think
about what it feels like they have your arm up,
like just for a minute, or to imagine always feeling that.
And then the guy you mentioned, he was also in
(20:01):
that Norwegian paper you mentioned before, where um, there was
a patient who couldn't sleep on his back because he
felt like his arm was twisted behind him at all times.
And yeah, that sucks to not be able to sleep
on your back. That's like the money sleep right there.
But imagine feeling like your arms twisted behind your back
every waking moment and that you can't do anything about it.
(20:25):
That would drive you nuts. It's as simple as that. Yeah,
So those are like on this sort of lighter psychological side.
On the other end of the spectrum, another man who
I think lost both legs um was woken up periodically
thinking that the nail of one toe was growing into
(20:47):
the next toe. Uh. And another ampute said they felt
like the skin on their arm was ripped off, salt
was being poured on it, and it was thrust into
a fire. Right. And then other people report to Chuck,
this seems like something that would be easy to overlook,
that you know, having you know, consistent pain in this
phantom limb. Remind them that they have a phantom limb,
(21:09):
that they have like an an amputation, and that just
makes the whole thing that much more. Already distressing event
is consistently distressing, over and over again because it's just
a reminder of it, you know, right, especially if you're
trying to rehabilitate and move on with your with the
new normal, you know exactly. So, UM, we kind of
(21:31):
reached finally, like where we're at with our understanding of
phantom limb pain. And that's basically where we were in
the sixteenth century if everyone had listened to Ambrose Parey,
and that is that. Um, despite a lot a lot
of people getting amputations every year in the US alone,
(21:53):
I think there's something like a hundred and eighty five
thousand amputations every year, the vast majority of them due
to complications from vascular disease including diabetes. UM having a
whole bunch of troops come back from Iraq and Afghanistan
with amputations needing treatment and rehabilitation, and eight percent of
(22:14):
these people suffering phantom limp pain. We still don't know
what causes fami limp pain, what the basis of it is.
And that's despite thinking we did for a little while
there right like in the late nineties, early two thousands,
and we talked about it, and I think our amputation episode,
we thought we had a handle on it. And that's
since been challenged and possibly debunked. Yeah, and you know,
(22:37):
like we said with Parae, Uh, Michael Parree is that
his name you're thinking of? Michael Buble? I was thinking
of Eddie and the Cruisers. Maybe that's how I was
thinking you were talking about when you mentioned can Marino.
Oh man, they should remake that with Kid Marina. What
a funny movie that would be. Who is the guy
(22:58):
I am thinking of? I want to say it's like
a he was like a kind of like a dark
night kind of figure who would like help people and
maybe the fifties. Arthur Fonzarelli. No, No, I'll try to remember.
I'm gonna I'm gonna pro portion off like seven percent
(23:19):
of my brain just to be working on this this
problem while the other is focused on this episode. Okay.
You know what, It's funny that I said, Arthur Fonzarelli
because our friend of the show, Paula Tompkins and uh
sort of colleague pal in real life for us, he
mentions Arthur fonds Relli more than any other human I've
(23:40):
ever known in my life. Yeah. Yeah, in his in
his show Freedom and then conversationally on his other show
Stay at Hopkins with his wife Janie. He just he
it's a great comedic effect. He brings up Fonzi a lot.
It's pretty great. Well yeah, I mean, if you if
you want to get an easy laugh just bringing up
fond Yeah, he times it out. Well, this is really
(24:00):
well done, Like you just did it yourself. I feel
like I channeled up Paul of Tompkinson, so I can
tell you what the show is now if you want
to know. It has nothing to do with the fifties
dark night thing. I'm still not sure what that show is.
It's a show. I promise it's called Growing Pains. The
guy I'm thinking of is Ken Wall in the show
(24:21):
Wise Guy. Sure, he kind of looks like Ken Marino too.
If you put him next to each other, you'd be like,
don't be ridiculous. But if you see one at a
party and then went to another party down the street
and saw the other, you'd be like, gosh, you guys
look a lot alike. I remember Kinting Wall. I don't
know what happened to that guy. Maybe everyone figured out
(24:42):
he was a bad actor. Was he a bad actor?
I mean, come on, Wise Guy has a seven point
eight out of ten on I AMDB, really high these days.
Well that says it all. Yeah. Uh so I think
where I was headed before I got sidetracked was uh,
like you said, with Parade, they are still sort of
looking at two schools of thought, and you know, it
(25:03):
could be a who knows, it could be a combination
of both, but uh, you know, central nervous system stuff
and then um, you know, brain mapping and literal nerve
issues like you know, it could have. You know, the
first thing you're gonna do is put you into the
Wonder machine and see what lights up when you feel
(25:24):
that type of pain. And they have found that it
does show activity in parts of the brain connected to
the nerves of that missing limb. So that's a good
place to start. Uh. It could be thickening of the
severed nerve endings, um like after the operation, uh, making
things a little more sensitive. But there's still a lot
of debate on this, you know. Yeah, and that last
(25:44):
one is called the neuroma theory, and that is how
that was a leading um explanation for and it still
could be right. But there when they when they amputate
your limb, um, they're also amputating a lot of other
stuff than just like your leg there's a lot of
stuff that's still remains that is no longer intact, and
that includes nerve endings. Those nerve endings have lost their
(26:06):
attachment points, their end points, but they're still capable of
transmitting electricity through your your peripheral and into your central
nervous system. And so they actually seek connections and will
sometimes connect with each other and cause all sorts of
haywire stuff. And they are like, well, maybe that's what
phantom limb pain comes from, and it's entirely possible. It is. Well,
(26:30):
here's something that I had no idea. I knew a
little bit about this, but when I read this, I
was pretty uh dumb struck. H If you had like
a bad knee and then you had to have an
amputation from like the thigh down, you're more likely to
have phantom limb pain because you had that bad knee before. Right, Yeah, yeah,
(26:51):
that's a risk factor. I don't know if it's still
considered that, but it was for a long time that
if you had pain in your your limb, and we're
talking like in the hours leading up to your amputation,
even yeah, that that that your brain remembers that and
that yes, um, that's kind of evident, like your brain
never got a chance to work out that it was
(27:13):
no longer in pain, is just continuing on UM. And
there's they they've done studies of UM people who where
they give a local anesthetic to like just to your
leg and they really numb it and then they move it.
And then they bring you out of anesthesia and they say,
what what what direction is your leg moving in? And
(27:35):
almost consistently across the board, people report the way that
it was before it was moved when it was under anesthesia.
Does that make sense? So like you remember this kind
of stuff, and that actually kind of leads to another
theory of UM what causes fantom limb pains called appropriate
reception theory. So so appropriate exception is just your awareness
(27:59):
of where your limbs and extremities are in space. I've
seen it explained as like how you can close your
eyes and touch your nose. That's all appropriate exception. And
this this whole idea behind appropriate reception having to do
with phantom limp pain is that we do this because
we're able to like touch our nose with our eyes closed,
not just because we know where are our limbs are
(28:21):
in space, Because our brain is constantly keeping track of
it and has basically a general map of our body
at any given point. So if we lose a part
of that body, that brain map doesn't necessarily catch up
with it. So the brain map is still expecting signals
and is basically creating signals UM based on its expectations.
(28:43):
And that's the appropriate reception theory of of phantom limb pain.
It's interesting because it's almost as if some of these
theories point to the brain being less able, I guess,
less neuroplastic than they thought, right, yes, yeah, and well
that's the thing. So so the neuroplasticity. That's the leading,
(29:05):
most dominant accepted explanation for phantom limp pain, which is
that you're the part of your brain that was dedicated
to sensation and movement of your arm that has now
been amputated. It's being restructured, rewired, reconnected, and so you're
getting all sorts of weird cross talk and it's creating
(29:26):
the sensation of pain in a limb that's not there anymore.
That makes sense, and it's been accepted since I think
the nineties, UM, but it's been challenged recently by findings
that that show your brain's actually doesn't seem to be
restructuring itself at all. Yeah, there's a famous Ted talk
a researcher from cal San Diego named vs uh Rama
(29:50):
Shandron who he argues about neuroplasticity, and he's the one
that uses the mirror box, which is what you mentioned
at the beginning, which is the idea, and this is
I think in the nineties, where there's the box and
if you're a unilateral amputee, you would put your let's
say you've lost your right arm, you put your left
(30:10):
arm into one side of the box and the residual
limb and the other side of the box. You would
see your reflection as if you still had both those arms.
And the idea is that your brain sees this and
so it can it can map this out. But I
think they've done um studies and meta analyzes that have
found that if it does work, it's very short term.
(30:35):
It's not like the brain completely remaps long term. So
it's more like a salve than a cure. That's what
the studies have shown. But that's kind of surprising because
it was it was touted early on, is like a
like this is gonna cure it, and it makes sense
from a neuroplastic way, like you're you're allowing your brain
like do you remember I was just talking about how
(30:57):
it's possible that your your brain isn't caught up to
the idea that that limb is not there any longer um,
and so you're you think your limbs in a different
position the last position it was in, or it's in
the pain that you thought it was in. If you
could trick your brain with the mirror box to see
that thing and make your hand wiggle, or make your
brain think your hand is wiggling and be like, okay, good,
(31:17):
I'm not actually experiencing a pain. I can stop that
signal and you can go on with your married life.
It makes sense, and a lot of people accepted it
for a long time, but like you said, the follow
up studies and analyses have shown like doesn't really have
that long term effect like you would think. And then
on top of that, some of those m r I
studies that you mentioned a few minutes ago have actually
(31:40):
shown like, no, actually that region that was in control
of your left arm that's now been amputated, that region
of the brain is still fully capable of causing your
arm to function in whatever. There hasn't been like some
great reconnection where other like your tongue sensation has taken
over that part of your brain to become a super
tasting tongue. That's just not panned out in the in
(32:03):
the reviews, in the follow up studies. So we're back
to basically square one. We don't know what causes phantom
limb pain. All right. I think we should take another
break and we'll talk some about treatment when we come back,
including what I think we will If I can speak
for you, I think you'll agree some of the most
fascinating headway they're making, which is working with prosthetic limbs
(32:29):
to be more realistic, is also having effect on phantom
limp pain. All right, So we talked a little bit,
(32:56):
and hold on, hold on, I'm sorry, I'm sorry what happened.
As want to give an update here. You can probably
understand why I confused Ken Wall as the um lead
of a like a kind of a mid fifties like
Dark Night kind of helping people out, because Ken Wall
was the lead in the nineteen seventy nine grease or
(33:16):
flick the Wanderers. Okay, I knew he was in a
greaser movie. That's I think that's what I was confusing.
His hair looks good in a duck tail. I think
I had confused the Wanderers with the Um the eighties
TV show Crime Story as well. I think I conflated
all those. I don't know what that is. It was
a cool one. It was like, I think a mob
(33:37):
Vegas mob show. It was like a cop drama. What
was was Wanders like an Outsider's rip off. No, it's
a little more true. Outsiders was weird and avant garde
or um? I'm sorry, did you say outsiders or um?
What am I thinking of? What's the weirdness? The weird
one Warriors, That's what I'm thinking. Oh, oh, I'm thinking
(34:00):
of pony Boy. I think the Outsiders came after the
Wanderers and was probably something of an homage to that. No,
it was a book from way back. Okay, fine, we're
never going to get to I'm losing my stuff. It's
all kin Wall's fault. I think it's all Ca Marino's fault. Um.
(34:22):
All right, So what we were talking about before, and
we'll talk a little bit about some of the treatments,
But for my money, Some of the most fascinating work
going on right now is research that is trying to
help people use prosthetic limbs more effectively. One one, there's
a couple of different things they're doing. Well, there's a
lot of different things, but a couple of them are
targeted muscle reinnervation and targeted sensory reinnervation, which is either
(34:48):
using leftover motor nerves or leftover sensory nerves from that
amputated limb connecting those two muscles that lost their function.
And all of this in service of you know that
all the work they've done with prosthetic limbs to make
them smarter and like like, hey, you can you grab
a coffee cup in a different way that you would
(35:09):
grab a pillow, and you may be able to know
when something's hot or cold. Like the advances that they're
making is unbelievable. And some of these advances are helping
with basically telling the brain, now you've got a real
limb there again, and so you don't have that venom
limb pain. Yeah, I found this, um this one mention
of how apparently there's people who have prosthetics are faced
(35:33):
with this terrible choice where um, the prosthetic feels way
heavier than their limb ever did, even though the prosthetic
probably weighs less than their limb did. For some reason,
because it's foreign, it's not really part of their body
to their brain, it's very taxing to wear it or
carry it around or use it, and it can be
so taxing that it can it can increase their risk
(35:56):
of cardiovascular disease, of heart attack, of all sorts of
stuff like that, just by like over exerting themselves. And
then the other thing they could do is just not
use the prosthetic at all and lead an increasingly unhealthy
sedentary lifestyle. So these new prosthetics are are kind of
getting around that by recreating, as far as the brain
(36:17):
is concerned, a limb very closely. In the way that
you do that is like you said, UM, give it
senses that it used to have, like give it sensory
information from this limb. And what they're doing is information
from the from say like a prosthetic foot, just the
fact that it's receiving pressure from the ground. It will
send an electrical signal up through its cables to a
(36:41):
terminal where it's connected to the actual like like um
nerves and then muscle tissue also in your leg, and
it will send that on up to your peripheral nervous
system and into your central nervous system and your brain experiences.
This is so awesome, the sense that it's a pressure
from the bottom of your foot when you put that
that prosthetic foot on the ground. That's the level that
(37:04):
we're at at this point, which is amazing. Yeah, I mean,
I remember many years ago, it may have been one
of those episodes you mentioned where we talked about and this.
This was probably at least ten years ago, so I
imagine the strides since since then or even more that
you know, they've gotten to the point where you can think,
you know, grab coffee cup, and that prosthetic hand will
(37:27):
grab coffee cup. And the more lifelike that feedback is,
the more it seems like at least that it's going
to help alleviate phantom limb pain exactly, because that seems
to be one of the bases that they're figuring out
about phantom limb pain, is that these nerves um, whether
it's muscle tissue, nerves connected formally connected to muscle tissue
(37:48):
or axons, or some some type of nerve impulse carrying
material a nerve. I guess if you're not a total
weirdo and say things normally. Um, they they still want
to carry these impulses, so they're still accepting like impulses,
but they're just not cut out for the task any longer.
And what they're figuring out is like, hey, surgeons, if
(38:09):
you leave some muscle tissue attached, will come back and
attach the sensory cables from a prosthetic to that muscle tissue,
and we're going to be back in business. And the
brain is gonna think like, hey, I've got this. I
got my foot back, I got my leg back, I
got my arm back. To the braining, it's all the same.
It's still getting some sort of sensory information. It might
be kind of primitive compared to what you had before,
(38:32):
but from what I'm seeing, it's it's not necessarily we're
getting more and more advanced by the by the year.
Well yeah, and it's that muscle tissue that allows the
body to sense things like applied force or a sensation
of stretching, you know something. And not only are they
saying to surgeons like maybe we should rethink the way
(38:53):
we're doing amputations, but they're saying, we can go back
in and and attach muscle to the end of those
nerves for um amputations that happened years ago. And so
if you give these nerves something to do productive, they're
gonna stop looking for something to do. Basically that's actually
very unproductive and like causing phantom pain. And so that's
(39:14):
like you said that they think that that is not
they think like they're they're seeing quite clearly that that
helps alleviate and maybe cure as phantom pain. Just giving
these nerves a productive job yet again because they just
want to work so bad, but they got caught in half. Yeah,
it's remarkable, um on the less remarkable side treatment wise,
(39:35):
and this is I think just residual, you know. I mean,
that's a very forward weight, way, forward thinking way to
do things. I think with phantom limpain, which is this
prosthetic stuff that they're working on, the old school treatments
are literally like giving people pain drugs and giving people opioids, uh,
(39:55):
you know, muscle relaxers, beta blockers, stuff like that. And
I'm not poopooing medica asian if it helps people out,
but it does seem like a bit of an antiquated
thing to do is just to throw pain meds somebody's way, right. Um.
So there are other like non pharmaceutical techniques to one
of them is kind of like a low five version
(40:16):
of what you would get with a really advanced prosthetic. UM.
It's called TENS. It's been around since at least the eighties.
Um My mom was a hospital administrator later in her career,
and I remember we had pads of paper laying around
our house that had like pictures of TENS units on them. Yeah,
I guess the TENS unit supplier gave us some free
(40:37):
pads of paper. Um. So that's transcutaneous electrical nerves stimulation
and it's basically giving those nerves something to talk about
without them having to make it up themselves. But it's
just stimulating them with electricity, and they think that that
What happens is you're kind of overwhelming that pain signal
(40:57):
with a more robust elector cool signal that just turns
off that pain signal and it actually helps really really well,
tends helps a lot of people. UM, with back pain.
You you have you seen those like little um electrode
things that you can put on your lower back and
there's like a little looks like a beeper attached to it.
That's attends unit and almost doing is sending electrical input
(41:18):
pulses through your skin to your nerves and basically saying,
shut up, pain signals. Here's here's something, here's something bigger.
It's the Bonnie rate treatment. Yeah, let's give them something
to talk about. Or what was that ad? Move over something?
Now there's something leaner, Move over bacon, I think so.
(41:38):
But what was the product? It was sizzline, wasn't it. Yeah,
that's what was sezzelin. It was not good. I'll tell
you that. I don't even know what that was. Remember
stake ums You you like stake Ums, Well, it's the
it's the you know, it's the budget version of a
(42:00):
Philly cheese steak. Yes, and that's how I always ate
it too. But even still it's like, this is terrible
it Yeah I did it? Did? I like stak hms
for many years? Having said that, that was you know,
forty years ago. Um, And now you know, if you
make a homemade cheese steak, slice that ribbi, fold it
(42:22):
up and roll it up and slice it really thin.
Is that right? That's what you using some good Rubbi. Yeah,
flatting it out, pound it out, really thin, man, you
have come so far. You have arrived because I'm pounding Ribbi. No,
because you left stake Ms in the roof. You went
from steak ms to ribby. What else that? I think
there's a few more treatments. There's biofeedback, of course. Uh.
(42:45):
There are very simple things like just propping up the
residual limb, repositioning it, you know, being distracted. They say,
lifestyle changes like you know, yoga, meditation, music, stuff like
that you can can help, um, probably better than throwing
opioids at the problem. Yeah, and again I mean just
doing stuff like moving the limb, um, massaging it, um,
(43:09):
just just giving it some sort of other like very
real stimulation tends to help. But I mean, if you
feel like you can't sleep because your arms twisted behind
your back and it's like that constantly, especially if it
starts hurting like you get a Charlie horse like that,
nobody's going to blame you if you ask for opioid
to know like, that's that's that's the reason why this
(43:31):
is not just interesting that we it's an imperative that
we we understand it and learned to cure it fully agreed.
So that's it for phantom limb pain and phantom limb sensation. Everybody. Uh,
if you thought that was pretty neat, there's a lot
of interesting stuff to read about that, uh. Phenomenon. Not
syndrome though, we don't think Uh. And since I said
(43:53):
not syndrome, that means it's time for listener mail. I'm
gonna call all this just sort of an enlightening email
from a from a listener. Hey guys, longtime listener. My
first email to you was when you were working for
Discovery Channel. In the episode on albinism, you mentioned that
(44:15):
it's the barest minimum of parenting to explain to children
the scientific reasons behind why we have some variety in
the expressions of what it means to be human. And yes,
that is important. It's also important to teach children that
society creates is ms about these expressions, which served a
privilege or marginalized certain groups of people. My researches around
(44:35):
race and racism, so I'll use that as an example. Yes,
it is important to teach children what science says about
how variety manifests in the human body. Likewise, children need
to learn that racism exists, and that racism is a
social construct that is not biological. Just the former without
the ladder fails to prepare children to react appropriately when
(44:55):
they are faced with racism, and the same goes for
any ism. As I wrote almost a decade ago, still
use your podcast with my grad students. H. And that
is from Judd Judson laughter. He him his from ut
in Knoxville. Yeah, go Valls right up the road. My
(45:17):
I guess niece in law maybe Okay, I think nice
in law in law potentially just got into UM University
of Tennessee and she it's like her her dream, like
she wants to go study the body farm. Chuck, doesn't
that just see your heart? I love that. So congratulations
and thanks professor Laughter. Awesome name. That is a really
(45:41):
important thing to point out, and thank you for sharing
that with everybody. If you want to be like Professor
Laughter and share your awesome name and or awesome point,
you can email us It's stuff podcast at iHeart radio
dot com. Stuff you Should Know is a production of
iHeart Radio. For more podcasts my heart Radio, visit the
(46:02):
I heart Radio app, Apple Podcasts, or wherever you listen
to your favorite shows. H
Stuff You Should Know News
Hosts And Creators
Josh Clark
Chuck Bryant
Show Links
Order Our BookRSSStoreSYSK ArmyAboutPopular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations.
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Nikki Glaser Podcast
Every week comedian and infamous roaster Nikki Glaser provides a fun, fast-paced, and brutally honest look into current pop-culture and her own personal life.