Treatment of phantom pain in the phantom limb (arm or leg)

 In the series «House MD» in the series «Tyrant» is unusually bright scene — House cures neighbor from virtually incurable disease — phantom pain — an ailment that affects 80-90 percent of amputees.

This scene was struck not only because it was scary and joyful at the same time, but also because of this miracle is a very real experience — experimental, still not quite sensible, but still quite effective.

Since in Russian almost no intelligible articles on this subject, I was to have a small digest, mainly based on the article in the «New Yorker.» I am quite certain that she has served as a source for stories with a neighbor — the article came out in the spring, this magazine is very well known and read, so that the connection is obvious to me.

Vilayamur Ramachandran, a doctor of Indian origin, is currently working in one of the University of California. He explores the many phenomena, including phantom pain, apotemnofiliyu (a rare disorder in which patients experience an uncontrollable desire to amputate an arm or leg), the effects of stroke, and more. Since we are interested in phantom pain, I will tell you it is about them.

About phantom pain (ie feeling pain, tension in the amputated limb) wrote long ago. Typically, patients complain of terrible tension that can not be discharged — for example, feels like a fist compressed so that the nails digging into his palm. For some, the pain is so unbearable that people commit suicide. For nearly a century, doctors believed that the cause of phantom pain is inflammation of the nerve endings (neuroma), the remaining stump in the hands or feet. Some patsenty addressed at second amputation, more and more injured limb shortening. When that did not work, they tried to block the nerves in the spine, and even neutralize segments thalamus (the base of the brain that processes pain signals). Nothing worked.

Ramadcharan claims that phantom sensation is generated in the interaction of sensory and motor areas of the cerebral cortex, as well as «body map», which is located in the right section of the cortex, just above the right ear. A major objective of this section is to create a solid body image derived from touching («I touch the cup with your fingers»), visual cues («I see that as my hand touched the cup») and the signals from the muscles, ligaments and muscles ( «I feel like my hand reaches for the cup»). Despite the fact that people with amputees do not receive these signals, Ramadcharan believes that memories of them and stored in the brain and the nervous system. In examining case histories of people with phantom pains, he noticed that many of the amputation to the corresponding part of the body was immobilized (disease, plaster, bandage). As a result, a vicious circle — in response to continuous impulses that come from the brain to the limbs, the body receives visual and tactile proof that the arm or leg can not move. After the amputation, the patient's brain, a new «map of the body,» which «is written» feeling of paralysis or pain in the amputated limb is. According to Ramachandran, all you need to do — is to «trick» the brain, showing him that the arm or leg is still in place and it can move.

His first patient was a young man who once got into an accident, leaving his left arm paralyzed. Within a year, he walked with a sling, and then agreed to amputation. Since then, it had the feeling as if numb hand, in an uncomfortable position. Ramachandran has established a regular mirror, so that it is aligned vertically and perpendicular to the body of a young man. He asked to put his good hand on the same side of the mirror, and the stump — on the other. The patient looked at the reflection of his good hand — so that he had the illusion that the hand — in fact, a continuation of his amputated limb. Ramachandran then asked the man to move his hands simultaneously — up and down, keeping his eyes on the mirror. «Oh, God! — Exclaimed the patient, — Oh, God, doctor, this can not be! „For the first time in ten years, the patient felt that his phantom arm“ move „and the pain finally subsided. The patient was subjected to during the month of mirror therapy for 10 minutes a day and gradually his phantom arm was gone, and with it disappeared and phantom pain. “For the first time — later wrote Ramachandran — we can talk about the successful amputation of a phantom limb.»

Ramachandran conducted experiment for eight patients and all but one of the unclenched fist, the muscles on the phantom dealt hands. Subsequently, the experiment was repeated by an independent group of researchers in England, because the technique of «mirror therapy» evoked skepticism and hostility of doctors. Of 18 people suffering from phantom pains, six were mirror therapy, and the other — the other methods (closed mirror and visualization). As a result, in the control group, only three patients was somewhat better, while in all other pain increased. Six patients receiving mirror therapy, the pain was gone for good.

Now back to the «House.» According to the veteran, he suffers phantom pains for many years — and, as in real patients, it hurts feelings compressed to cramp fist. House, as expected, radically acts — attacks him, binds and forces thrust his hands in a box.

This is the same «mirror box» that came up with Ramachandran, it is widely used mirror therapy. Veteran put your hand, sees a stump in place the whole hand. «And now — let go, unclench his fist» — says House.

And the pain, stress, tormented man many years away. According to studies, the effect of mirror therapy can be immediate, but it is recommended to repeat these sessions several times, the pain disappeared completely. Ramachandran himself says that in his practice-third of patients completely free of pain. However, he warns that if the amputation occurred ten or more years ago, the treatment may not work.

And yet, my opinion — I do not think so fast relief is possible when the person is so scared and shocked as bonded patient House.

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