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