A Trip Through The Looking Glass to Eradicate Phantom Pain
July 16, 2014 2:55 PM   Subscribe

The Mirror Man Surgery and medication have been found to be only slightly or not at all effective when dealing with phantom pain... In 2008, Stephen ... had a particularly agonising bout of phantom pain. “I was not presentable for 72 hours,” he says. He was aware of mirror therapy from having looked online for treatments, and he decided to give it a try. He got into his truck and drove two-and-a-half hours to the nearest Home Depot to buy a mirror. He tried it right there in the parking lot, and in five minutes the pain was gone.

The article is mostly about his current work in helping other amputees resolve the pain they typically live with.

Interestingly, there was a movie made about his life. It is in German (thus the German title: Phantomschmerz). I managed to find a couple of clips:


Clip with English subtitles
posted by Michele in California (15 comments total) 22 users marked this as a favorite
This TED talk addressed this as well.. it was a good watch:

Vilayanur Ramachandran
posted by TravellingDen at 3:29 PM on July 16, 2014 [1 favorite]

They featured this technique in a recent episode of Black Box. Didn't know it was actually a thing. Cool!
posted by Thorzdad at 3:32 PM on July 16, 2014

It was also the B plot on an episode of House.
posted by benito.strauss at 3:57 PM on July 16, 2014 [5 favorites]

Phantom pain, experienced in missing limbs, tortures amputees and puzzles scientists.

It puzzles scientists in the sense that treating it can be difficult, but the basis for understanding why it exists has been known for over two decades. The article, of course, skirts around this, because the pull quote doesn't work without the "mystery" of phantom limb pain. The article is disingenuous because of it, even more so when they're selectively quoting people like Ramachandran who would probably be embarrassed by this article. It gets it half right in places, but throughout the article there is an assumption that some sort of sensory input is required for phantom limb pain, and that isn't the case, as I will explain below.

Any and all sensations you feel are products of your brain, experienced inside your brain, and they all require complex processing within your brain to become sensations. Sensations don't happen out in your body. Sensory input from the periphery can be considered data that may or may not be used by your brain to create the sensations your conscious self is presented with. The brain is not "interpreting" signals from your body as Descartes thought - it is creating them based on what the brain thinks you need to see, hear, smell, taste, or feel.

In the skin we have something called nociceptors. Historically they've been called "pain fibers" (and often still are) but are more accurately described as "threat detectors." Per what I just said above, you may or may not experience pain with or without nociception. Pain is a call to action to both defend and reduce motion in the area in pain (required for healing if there is tissue damage), and "call to action" in this case is very analogous to how thirst and hunger function. Pain does not imply tissue damage, and phantom limb pain is probably the best example of such, but for some reason society (and often medicine!) still wants to go with magic over science on this particular topic.

Phantom limb pain kind of goes in the same bucket as lack of pain right after severe trauma. In one case we have no nociception and a lot of pain; in the other case we have huge amounts of nociception and no pain. In the latter case I usually hear "adrenaline is amazing" or something similar. Again, no, the brain is making a command decision to not expose you to pain, the best theory being that your brain is assuming you are otherwise in danger and won't let you experience pain until your person is otherwise safe.

Go read this and even the referenced paper (pdf) instead of this article.
posted by MillMan at 3:58 PM on July 16, 2014 [41 favorites]

Wow. the Phantomshmerz link was filmed at my old worksite, the (now abandoned) NSA monitoring station at Teufelsberg.
posted by pjern at 4:49 PM on July 16, 2014 [1 favorite]

Very interesting stuff all around. And thank you MillMan for the additional infos! I had no idea about any of this and it's all pretty fascinating.
posted by Doleful Creature at 4:58 PM on July 16, 2014

On second read the article is interesting enough as a human interest story, but my criticism still stands. I get extremely worked up on this topic since I got into massage therapy and started to study this stuff in particular. Much of western and alternative medicine refuse to come into the modern era of pain science, and I massage a lot of people at work who are in a lot of pain who have been let down by shitty/indifferent doctors, physical therapists, chiropractors, and everyone else, and it makes my blood boil. The neuroscientists quoted in the article are all working from good theories as far as I know (and I'm absolutely not a neuroscientist so I can't really criticize them anyway) but like I said without a little bit of background on what pain is it's easy to misread what they're getting at.
posted by MillMan at 5:01 PM on July 16, 2014 [1 favorite]

Like you, the man profiled by the article is also helping people who are in pain and who have been let down by doctors and others professionals. And he did not write the article, so I think he bears no responsibility for how the article talked about the science behind pain. He is an amputee who got relief with mirror therapy and then decided to bring relief to others even less fortunate than himself.

I have not lost a limb but I have had a fair number of teeth extracted, many of them very infected at the time. The last tooth extraction left me with pain in a phantom tooth on and off for about a year or eighteen months. It was a minor annoyance compared to what the article describes but, for that and other reasons, I could relate to much of the story. I have endured quite a lot of pain in my life and I have a keen interest in things that simply work and are relatively simple to administer. I am okay with not necessarily knowing/understanding why it works. I am much more interested in the track record of success.
posted by Michele in California at 5:14 PM on July 16, 2014

the best theory being that your brain is assuming you are otherwise in danger and won't let you experience pain until your person is otherwise safe.

Is homonoculus-izing "the brain" like that really the best theory?

Also, I get that pain means "you are being injured - better do something" but it seems to me that my capacity to feel it is quite excessive. I know fully well that I kicked my toe against Thing last week, and, I guess, maybe broke it: it did not need to hurt that much.
posted by thelonius at 5:34 PM on July 16, 2014

What's wrong with homonoculusizing the brain?

We're made of it, ya know. A system that can generate one mind can also generate two.
posted by effugas at 5:36 PM on July 16, 2014 [1 favorite]

Well, for one thing, if the homonoculus can be understood directly in terms of what it wants and thinks, without some theory of ITS brain, then why do we need a brain theory to explain what we experience, in the first place?
posted by thelonius at 5:47 PM on July 16, 2014 [2 favorites]

It was also the B plot on an episode of House.

Did they try the medicine drug?
posted by EmpressCallipygos at 7:01 PM on July 16, 2014 [2 favorites]

Is homonoculus-izing "the brain" like that really the best theory?

In the lay sense, sure. I'm sure pain researchers like John Wall or Melzack (guy who wrote the paper I linked to) have something a little more technical sounding.

Michele - the guy profiled is doing good work. I'm irritated with the author.
posted by MillMan at 7:40 PM on July 16, 2014

Mirror therapy is also effective with phantom itches:

The Itch: Its mysterious power may be a clue to a new theory about brains and bodies.
Atul Gawande, The New Yorker (June 30, 2008)
posted by Auden at 4:07 AM on July 17, 2014

Auden: yeah, that's a decent article. Like this article it still struggles with giving the brain primacy over the tissues / peripheral nervous system, even as that's effectively the story it is trying to tell. It's more Cartesian baggage we're struggling to shake off.
posted by MillMan at 12:29 PM on July 17, 2014

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