WEBVTT - What's the deal with phantom pain? 0:00:01.480 --> 0:00:04.280 Welcome to Stuff you should know, a production of I 0:00:04.360 --> 0:00:13.240 Heart Radio. Hey, welcome to the podcast. I'm Josh, and 0:00:13.280 --> 0:00:16.560 there's Chuck and there's Jerry over there, and this is 0:00:16.600 --> 0:00:25.400 stuff you should know straight ahead. Both barrels blazon science, strange, unusual, 0:00:25.520 --> 0:00:29.840 fascinating type stuff you should know. That's right, and uh, 0:00:30.280 --> 0:00:34.120 both of us fresh from vacation. M hmm. I just 0:00:34.159 --> 0:00:36.360 got to say. We took the first family trip to 0:00:36.360 --> 0:00:41.080 Disney World and it was great. The oh that was 0:00:41.159 --> 0:00:44.080 the first ever. Wow, I'll bet that was something special. 0:00:44.520 --> 0:00:48.240 It was I haven't been in thirty five years myself, 0:00:48.320 --> 0:00:51.040 and the same with Emily, and uh, it's remarkable how 0:00:51.080 --> 0:00:54.000 much of the Magic Kingdom is exactly the same. But 0:00:54.520 --> 0:01:01.320 then I realized that Disney h cultists diehards and appropriate. 0:01:02.160 --> 0:01:04.800 They don't want anything different, so that that all made sense. 0:01:05.720 --> 0:01:07.920 But it was great. My daughter was you know, you 0:01:07.959 --> 0:01:09.440 never notice how you get down there. But I had 0:01:09.480 --> 0:01:12.160 a feeling, because she's not a very fearful kid, that 0:01:12.200 --> 0:01:15.679 she would ride stuff, and she rode everything that she 0:01:15.800 --> 0:01:17.640 was big enough to ride, and then pride on the 0:01:17.640 --> 0:01:19.600 things that she wasn't big enough to ride because she 0:01:19.600 --> 0:01:23.000 couldn't ride. Yeah, like she did Space Mountain twice, she 0:01:23.040 --> 0:01:25.080 did Tower of Terror. She she wanted to do the 0:01:25.080 --> 0:01:29.840 Aerosmith ride at Hollywood Studios that she was bummed out about. Um, 0:01:30.800 --> 0:01:34.640 which have you written that one so many times? Did 0:01:34.680 --> 0:01:37.840 you realize you probably realized this the little video they 0:01:37.840 --> 0:01:40.320 showed at the beginning of Smith in the Studio, that's 0:01:40.440 --> 0:01:45.000 Ken Marino as the as the engineer. Oh no, I 0:01:45.000 --> 0:01:47.200 thought you were going to talk about Ileana Douglas. I 0:01:47.240 --> 0:01:49.800 had no idea. It was Kim Marino from that one 0:01:49.800 --> 0:01:53.320 show from the eighties. Oh well, please, I mean he 0:01:53.360 --> 0:01:55.160 was from this he was a co founder of the State. 0:01:55.240 --> 0:01:58.080 But he's he's one of my comedy heroes. Oh that's 0:01:58.120 --> 0:02:00.800 not who I'm thinking of. Then, yeah, Ki Marinos from 0:02:00.840 --> 0:02:03.000 the State and you know, wet, hot American summer and 0:02:03.680 --> 0:02:07.800 party down and he had he had literally no lines. Thought, oh, 0:02:07.800 --> 0:02:10.560 there's Kim Marino's gonna do something funny. But he was. 0:02:10.680 --> 0:02:13.959 I guess it was after the State and before he 0:02:14.000 --> 0:02:15.679 had done a ton of other stuff, so he was 0:02:15.760 --> 0:02:19.440 just bunching buttons. I thought it was very funny. But anyway, 0:02:19.480 --> 0:02:21.600 we had a makes even funnier that he didn't have 0:02:21.720 --> 0:02:26.120 a like any kind of maybe I kept waiting for it. Uh. 0:02:27.040 --> 0:02:29.800 It was a lot of fun, though. Uh if we 0:02:29.840 --> 0:02:32.200 went back, we would do it a little different. We 0:02:32.240 --> 0:02:35.000 went to Universal Studios and tried to park hot but 0:02:35.040 --> 0:02:38.440 it's too much to do in one day. And uh 0:02:38.560 --> 0:02:40.280 we we did all the Harry Potter stuff but didn't 0:02:40.280 --> 0:02:41.679 get to ride some of the big rides who wanted 0:02:41.680 --> 0:02:43.920 to ride. Well, that's cool. I'm glad you guys had 0:02:43.960 --> 0:02:48.800 a good time. It was wonderful and refreshing, and uh boy, 0:02:49.080 --> 0:02:51.880 I think we both needed a little respite. We definitely did, 0:02:51.960 --> 0:02:54.639 me and you. We went to Hawaii for tenth anniversary 0:02:54.760 --> 0:02:58.520 or yeah, it was the first time we've traveled in 0:03:00.600 --> 0:03:04.880 two and a half three years something like that first trip. Uh, yes, 0:03:05.680 --> 0:03:07.959 it was something else, but it was great. See, I 0:03:08.000 --> 0:03:10.320 went travel crazy after I got COVID for a while, 0:03:10.360 --> 0:03:12.920 so I had gotten some trips in. You're like, I 0:03:13.000 --> 0:03:15.440 only have a few days to spread this far and wide. 0:03:15.440 --> 0:03:19.400 I better get out there. No. After I got it, Oh, 0:03:19.480 --> 0:03:21.760 gotcha got you? After I recovered you know what I mean, 0:03:21.880 --> 0:03:24.000 I know I'm with you. No, I I stayed inside 0:03:24.040 --> 0:03:26.240 and scared, but this is so it was. It was 0:03:26.280 --> 0:03:27.760 something like I was like I don't know how this 0:03:27.800 --> 0:03:30.720 is gonna go, but it went really well. But we're back. 0:03:31.440 --> 0:03:33.840 We're here to do a job, and this is You're right, 0:03:33.919 --> 0:03:37.080 this is very old school stuff. You should know kind 0:03:37.080 --> 0:03:41.559 of topic. I'm shocked that we hadn't covered it yet. Uh. 0:03:41.720 --> 0:03:44.280 I think the reason that you're shocked is because we 0:03:44.280 --> 0:03:49.280 actually have. We did. We did uh amputations. I know 0:03:49.320 --> 0:03:50.920 we talked about it there because we talked about the 0:03:50.920 --> 0:03:55.600 mirror box before plenty and then possibly talked about it 0:03:55.640 --> 0:03:59.320 in limb reattachment I'm not sure, but definitely in amputations 0:03:59.360 --> 0:04:02.400 we did. All right, Well, this finishes up the sweet enfolding. 0:04:02.640 --> 0:04:07.800 I agree. So what's phantom pain? Well, so, um, shout 0:04:07.840 --> 0:04:09.680 out to Olivia first of all for helping us out 0:04:09.720 --> 0:04:12.120 with this. I realized that we didn't. We didn't acknowledge 0:04:12.120 --> 0:04:15.040 that she helped us with the chow Chillibus kidnapping articles. 0:04:15.120 --> 0:04:18.080 So sorry for that one too, So I want to 0:04:18.160 --> 0:04:24.840 let that pass. But um, so this she she does 0:04:24.880 --> 0:04:27.200 a good job like basically getting across like what phantom 0:04:27.240 --> 0:04:30.320 pain isn't that we actually don't really know what it is, 0:04:30.360 --> 0:04:32.880 but you can describe it as anyone who's had an 0:04:32.920 --> 0:04:38.600 amputation about of those people um suffer some sort of 0:04:38.680 --> 0:04:41.440 pain sensation, and it's a whole range of pain. As 0:04:41.480 --> 0:04:45.440 we'll see. The problem is it's in that limb that's 0:04:45.440 --> 0:04:48.560 not there anymore. It's not in the residual limb what 0:04:48.960 --> 0:04:52.080 people colloquially called the stump. Yes, you can have pain 0:04:52.120 --> 0:04:55.920 there too, that's called residual limb pain. This is phantom 0:04:56.040 --> 0:04:58.400 limb pain where let's say you had your foot cut off. 0:04:58.760 --> 0:05:01.560 You feel like they're is a nail being driven into 0:05:01.560 --> 0:05:03.840 the bottom of your foot. The problem is your foot 0:05:03.880 --> 0:05:05.960 is not there anymore, so you can't pull the nail out. 0:05:06.320 --> 0:05:08.240 And hence we get to the meat of what the 0:05:08.279 --> 0:05:12.159 big problem is with phantom pain. That's right. Uh, it 0:05:12.200 --> 0:05:15.359 can it's you know, usually think of hands and feet 0:05:15.360 --> 0:05:17.760 and arms and legs and stuff like that. But it 0:05:17.800 --> 0:05:22.600 can be after amassectomy, it can be removal of testicles. 0:05:23.640 --> 0:05:27.400 I know that's not exactly a limb. It depends on 0:05:27.400 --> 0:05:31.120 how big it is. Oh boy, I did set it 0:05:31.200 --> 0:05:38.400 up with that inflection of my voice, right of course. Uh. 0:05:38.839 --> 0:05:43.560 There's also sort of a side affliction called uh, phantom 0:05:43.600 --> 0:05:49.640 limb sensation simsation sensation, which is it's not exactly pain, 0:05:49.720 --> 0:05:52.920 but it's like, you know, I feel like my foot 0:05:53.040 --> 0:05:56.400 is moving that's not there. Or my hand feels hot 0:05:56.760 --> 0:05:59.200 even though I no longer have that hand, or maybe 0:05:59.800 --> 0:06:02.800 uh pressure or something like that, but it's not. Or 0:06:02.839 --> 0:06:06.040 it may feel like swollen, or like when you're asleep, 0:06:06.080 --> 0:06:08.200 I feel like my arm is stuck behind my back 0:06:08.640 --> 0:06:10.920 and it's causing me great discomfort even though you don't 0:06:10.960 --> 0:06:14.440 have that arm. That kind of thing. Yeah, and so 0:06:14.520 --> 0:06:17.159 for a long time people have said, like, well, clearly 0:06:17.200 --> 0:06:19.800 it's these people are nuts, it's in their head. I 0:06:19.839 --> 0:06:23.000 thought it was as recent as seven that they finally said, no, 0:06:23.120 --> 0:06:24.800 that's not the case. And we'll talk about some of 0:06:24.839 --> 0:06:28.560 the historical view of it, but the upshot of it 0:06:28.600 --> 0:06:32.479 is now we understand that people who experience phantom limb 0:06:32.600 --> 0:06:37.839 pain are in fact experiencing pain in the same way 0:06:37.880 --> 0:06:40.960 that you or I would experience pain in that same limb. 0:06:41.000 --> 0:06:43.479 Like it's just as real to them as it is 0:06:43.520 --> 0:06:46.560 to us. And it means that the brain's gone haywire. 0:06:47.040 --> 0:06:49.400 And there's all sorts of ways it can manifest itself. 0:06:49.440 --> 0:06:52.960 There's shooting spain, shooting pain, stabbing pain, it could be 0:06:53.000 --> 0:06:56.560 cramping pain, pins and needles, which is bad enough, but 0:06:56.720 --> 0:06:59.279 pain from pins and needles, which should be awful, and 0:06:59.440 --> 0:07:03.120 it's you aunt, possibly scratch that sounds about as bad 0:07:03.120 --> 0:07:06.920 as it can get. A crushing, pain, throbbing, basically, any 0:07:07.040 --> 0:07:10.800 variety of pain that you could have experienced in that 0:07:11.400 --> 0:07:14.680 um in that limb before it was amputated, you're capable 0:07:14.720 --> 0:07:18.920 of experiencing it after it was amputated too. Yeah, and 0:07:19.000 --> 0:07:21.240 Livia makes a good point here. And as you'll see 0:07:21.240 --> 0:07:24.760 in the history part, there have long been philosophers and 0:07:24.760 --> 0:07:27.520 and people like to think it scientists even that are 0:07:27.600 --> 0:07:31.240 just fascinated with this curious syndrome. And it's you know, 0:07:32.080 --> 0:07:34.320 it makes sense that people would be fascinated with it 0:07:34.400 --> 0:07:37.880 like that. But it is a real problem. Um. It is. 0:07:38.400 --> 0:07:40.920 It can cause people to not sleep, It can cause 0:07:40.920 --> 0:07:43.280 people to not have the job that they want. It 0:07:43.320 --> 0:07:45.520 can lead to suicidal thoughts. Like it is a real 0:07:45.560 --> 0:07:48.680 affliction and not something that should be just treated as 0:07:48.720 --> 0:07:53.040 a as an interesting curiosity, right, But it also is 0:07:53.080 --> 0:07:55.360 an interesting curiosity. It's the tring that we need to 0:07:55.440 --> 0:07:58.880 understand to help people with. But it's fascinating and the 0:07:58.920 --> 0:08:02.480 reason why philosophers are so so you know, nuts for 0:08:02.560 --> 0:08:07.240 it is because it proves that, like our subjective experience 0:08:07.280 --> 0:08:11.480 of reality is not necessarily fully in line with reality. 0:08:11.600 --> 0:08:17.280 It shows that we're capable of experiencing the unreal. Wow, 0:08:17.720 --> 0:08:22.120 that was dramatic. I thought so too. Uh So, let's 0:08:22.200 --> 0:08:24.320 you want to dive into the history a little bit, Yes, 0:08:24.800 --> 0:08:28.000 and let's talk first, Chuck. I think at the beginning 0:08:28.040 --> 0:08:32.240 about Ambrose Pare. Oh. Yeah, he was a French surgeon 0:08:32.480 --> 0:08:35.920 in the mid sixteenth century. And this is one of 0:08:35.920 --> 0:08:39.559 those kind of rare cases where someone from hundreds of 0:08:39.640 --> 0:08:43.680 years ago describe something and had a handle on something 0:08:44.520 --> 0:08:47.800 in in a pretty solid way. Like looking back, he 0:08:48.000 --> 0:08:50.920 really was pretty close and a lot of the things 0:08:50.920 --> 0:08:53.880 that he thought about phantom limpain and he was the 0:08:53.920 --> 0:08:56.560 first dude to describe it, which is pretty remarkable. Yeah. 0:08:56.600 --> 0:08:59.040 I mean we're talking the middle of the sixteenth century. 0:08:59.080 --> 0:09:01.920 Like you said, that's that's crazy. That's a time when 0:09:01.920 --> 0:09:06.120 people didn't really think that that the people working in 0:09:06.160 --> 0:09:10.000 science for scientists, Like science kind of came later, according 0:09:10.040 --> 0:09:13.520 to some people. And it's like, um, if we had 0:09:13.559 --> 0:09:17.160 just kind of built on paradise understanding of it, who 0:09:17.200 --> 0:09:19.520 knows how much further along we would be in in 0:09:20.040 --> 0:09:22.440 you know, treating and dealing with that kind of stuff. 0:09:22.440 --> 0:09:24.720 But um, it's, like you said, he had a really 0:09:24.720 --> 0:09:28.400 good handle on it. He's he was the first to differentiate. 0:09:28.440 --> 0:09:31.640 Remember how I said, there's like residual residual limb pain 0:09:32.000 --> 0:09:33.680 and then there's phantom limb pain. He was the first 0:09:33.679 --> 0:09:35.600 one to say those are two separate things. It's not 0:09:35.679 --> 0:09:39.199 the same thing. Uh. He said that there's different factors 0:09:39.200 --> 0:09:42.079 that can um set it off, like the weather, change 0:09:42.080 --> 0:09:45.120 in the weather. Um. And then that there's different things 0:09:45.120 --> 0:09:48.120 that could treat it, like sometimes massage around the residual 0:09:48.200 --> 0:09:52.600 limb helps to what else. Uh. He also made the distinction. 0:09:52.600 --> 0:09:56.480 You know we described the phantom limb sensations. He described 0:09:56.480 --> 0:10:00.520 the difference there between the pain and the sensation. Oh yeah, Uh, 0:10:00.520 --> 0:10:03.160 that's a big one. He also said, so he said 0:10:03.200 --> 0:10:07.360 two things. He said that um either that his guests 0:10:07.640 --> 0:10:09.640 for what was causing it was that either there was 0:10:09.720 --> 0:10:13.920 some problem with the nerves in the residual limb um. 0:10:13.960 --> 0:10:16.359 I think he said that he thought they were retreating 0:10:16.520 --> 0:10:21.120 possibly or withdrawing, which makes sense in a weird way. Um. 0:10:21.360 --> 0:10:24.600 Or he thought that it was that it originated in 0:10:24.640 --> 0:10:27.840 the brain, not through some sort of psychosis, but through 0:10:27.920 --> 0:10:31.520 some sort of you know, foul up in the brain, 0:10:31.600 --> 0:10:35.120 like a glitch in the brain. And still today, as 0:10:35.160 --> 0:10:37.280 we'll see when we're talking about this, our understanding, a 0:10:37.320 --> 0:10:40.000 pan of limp pain basically boils down to those two, 0:10:40.240 --> 0:10:44.599 those two general concepts. Yeah, it's pretty amazing and um, 0:10:44.800 --> 0:10:46.559 we're not. Well, we'll get to that. I want to 0:10:46.600 --> 0:10:49.559 save that. I don't want to spoil it. I mentioned 0:10:49.559 --> 0:10:54.480 philosophers being sort of um delighted by this idea. Descartes 0:10:54.559 --> 0:10:57.080 was one of them. In the kind of early to 0:10:57.120 --> 0:11:00.720 mid sixteen hundreds, he talked a lot about Fannalm mimes. 0:11:00.760 --> 0:11:03.400 He he was one of the people that was really 0:11:03.400 --> 0:11:06.160 blown away by what he called non resemblance, which is 0:11:06.200 --> 0:11:09.880 what you were talking about, your subjective experience not aligning 0:11:09.880 --> 0:11:14.120 with reality. And he also thinks or thought it had 0:11:14.160 --> 0:11:15.800 to do with severed nerves, so he was sort of 0:11:15.800 --> 0:11:19.760 on the right track as well. And then the Scottish guy, 0:11:20.000 --> 0:11:23.800 uh William Porterfield in seventeen fifty nine. He was a 0:11:23.840 --> 0:11:29.800 physician that lost a foot and he had an actual physicians, 0:11:30.040 --> 0:11:34.120 first person autobiographical take on it all and talked about 0:11:34.280 --> 0:11:37.520 his toes, heel and ankle spelled with a sea which 0:11:37.559 --> 0:11:43.120 is fantastic, Um, like experiencing pain and itching several years after. 0:11:43.280 --> 0:11:45.440 I don't think we said it can start up to 0:11:45.760 --> 0:11:47.800 like as in as short as like a week afterward, 0:11:48.440 --> 0:11:51.200 and it can go on, you know, sometimes it comes 0:11:51.200 --> 0:11:54.680 and goes. Sometimes it's persistent, sometimes it goes away entirely. 0:11:54.760 --> 0:11:58.480 Sometimes it lasts forever. So um, it can really be 0:11:58.520 --> 0:12:01.920 all over the all over the map. But his description 0:12:02.040 --> 0:12:06.679 was at least a few years afterward, right, So um, 0:12:06.800 --> 0:12:12.080 that was seventeen fifty nine, And that was almost exactly 0:12:12.080 --> 0:12:16.600 two hundred years after Perry first identified phantom limb sensation 0:12:16.679 --> 0:12:19.360 or fantom in pain. Um, And it just kind of 0:12:19.400 --> 0:12:22.640 got lost from there. And it wasn't until the American 0:12:22.679 --> 0:12:26.120 Civil War when a surgeon named Silas Weir Mitchell, who 0:12:26.160 --> 0:12:29.600 I know, we've talked about. His name seems very familiar, um, 0:12:30.000 --> 0:12:33.920 who took part in the removal of thirty thousand limbs, 0:12:33.960 --> 0:12:36.839 not himself personally, but he was like among the battlefield 0:12:36.880 --> 0:12:40.400 surgeons who took that total number during the American Civil War. 0:12:40.840 --> 0:12:44.599 Thanks to advances in certain kinds of bullets and projectiles 0:12:44.600 --> 0:12:47.360 that could really do some so much damage that when 0:12:47.360 --> 0:12:49.760 they hit like a bone in a lagorant arm, like 0:12:49.800 --> 0:12:51.839 you just were going to lose that arm or leg 0:12:51.920 --> 0:12:55.440 to save your life. Um. He he had like all 0:12:55.440 --> 0:12:58.920 this firsthand experience with these people who had just lost 0:12:59.000 --> 0:13:01.440 a limb, and we're complained meaning about pain in the limbs. 0:13:01.480 --> 0:13:04.560 So this this idea phantom limp pain kind of came 0:13:04.600 --> 0:13:08.400 back to the four at a time when surgeons were 0:13:08.440 --> 0:13:10.520 starting to talk to each other more and science was 0:13:10.559 --> 0:13:13.120 starting to be practiced in a more methodical way, so 0:13:13.160 --> 0:13:16.160 that the discovery of one person could be understood and 0:13:16.240 --> 0:13:18.319 learned and built on by other people a lot more 0:13:18.360 --> 0:13:22.080 easily than it was in the sixteenth century. Right. But 0:13:22.120 --> 0:13:25.840 he took a kind of weird approach initially, uh and 0:13:25.920 --> 0:13:30.640 that he wrote a fictional account, basically a fictional short 0:13:30.679 --> 0:13:34.120 story called the Case of George Deadlow, and he talked 0:13:34.120 --> 0:13:37.760 about a Civil War veteran who experienced fanom pain and 0:13:38.000 --> 0:13:40.560 legs and arms that he had lost in the war. 0:13:41.320 --> 0:13:44.400 And it ultimately led to a seance where he's communicating 0:13:44.400 --> 0:13:47.040 with these limbs and then walks around the room on 0:13:47.080 --> 0:13:49.760 these invisible limbs, and a lot of people thought this 0:13:49.840 --> 0:13:52.880 was real and started sending donations in and wanted to 0:13:52.960 --> 0:13:56.680 visit with this person and six years afterwards he was like, 0:13:56.760 --> 0:14:00.760 maybe I should write, uh, something real and not fiction piece. 0:14:01.400 --> 0:14:03.240 And he went on to do that, I think to 0:14:03.679 --> 0:14:07.559 greater effect. Yeah, because he finally after six years he 0:14:07.600 --> 0:14:12.680 stopped face palming, Like, Okay, it sounds like people a day, 0:14:12.720 --> 0:14:14.840 doesn't it. Can't you see people a day sending in 0:14:14.920 --> 0:14:17.360 donations to the guy who lost his legs but were 0:14:17.840 --> 0:14:20.960 was able to walk around on invisible residual limbs and 0:14:21.000 --> 0:14:27.240 a seance Facebook told him so so um so silence 0:14:27.280 --> 0:14:30.920 where Mitchell finally creates what what you could kind of 0:14:30.960 --> 0:14:35.840 point to is like the first um modern scientific paper 0:14:35.920 --> 0:14:39.640 on phantom limb pain, and he estimated as high as 0:14:39.680 --> 0:14:43.200 eighties six out of ninety of his um amputee patients 0:14:44.080 --> 0:14:47.400 experience phantom limb pain. Not just phantom limb sensation, but 0:14:47.440 --> 0:14:52.040 phantom limb pain. Um and uh that that is a 0:14:52.080 --> 0:14:54.440 really high number. It's higher than average. But like I 0:14:54.480 --> 0:14:56.920 said before, I mean in the neighborhood of a d 0:14:57.040 --> 0:14:59.280 I think I've seen as high as eighty five of 0:14:59.280 --> 0:15:02.720 people who of an amputated limb will experience pain to 0:15:02.800 --> 0:15:07.440 some degree in that in that that phantom limb right, 0:15:07.560 --> 0:15:12.320 And I think most people experienced sensation, right, I believe 0:15:12.400 --> 0:15:16.280 that's correct. Yes, My understanding is more of the phantom 0:15:16.320 --> 0:15:21.160 pain stuff. Though. Is phantom sensation more prevalent? Yeah, I 0:15:21.200 --> 0:15:24.280 mean for sure. Okay, al right, well that makes sense too. 0:15:24.320 --> 0:15:27.200 And that's just merciful, that's right. Uh. And for a 0:15:27.240 --> 0:15:30.280 lot of years there was you know, up until like 0:15:30.320 --> 0:15:34.040 the mid twentieth century, there were a lot of psychological 0:15:34.480 --> 0:15:38.440 um or they were attributing this at least a psychological causes. 0:15:38.720 --> 0:15:42.280 Earlier on, it was you know, doctors would say, oh, 0:15:42.320 --> 0:15:45.400 you know, people who experienced this have one quote was 0:15:45.440 --> 0:15:49.960 an unsatisfactory personality. Or they said they may be obsessive 0:15:49.960 --> 0:15:53.320 people obsessed with things being wrong. They may be anxious people, 0:15:53.360 --> 0:15:57.760 they may be overly dramatic. I know. But although up 0:15:57.800 --> 0:16:02.400 until nineteen p but were arguing, doctors were arguing at 0:16:02.400 --> 0:16:07.680 the Mayo Clinic that, uh, phantom limb pain sufferers, if 0:16:07.960 --> 0:16:11.600 it was persistent, reflected a pre existing difficulty and adapting 0:16:11.600 --> 0:16:15.560 to problems. Uh, and may be influenced by just knowing 0:16:15.640 --> 0:16:18.160 that it exists, like well, yeah, I've read about this, 0:16:18.240 --> 0:16:20.800 I'm I'm feeling that pain too. So if you if 0:16:20.800 --> 0:16:25.880 you suffer pain, phantom limb pain. You are neurotic, easily suggestible. 0:16:26.200 --> 0:16:29.800 Possibly you're you consider yourself a failure now that you've 0:16:29.840 --> 0:16:32.400 lost a limb, and you're worried about disappointing your father 0:16:32.880 --> 0:16:36.200 or mother who might be like overly concerned with sports 0:16:36.240 --> 0:16:40.520 triumphs or beauty or something like that. And like I said, 0:16:40.560 --> 0:16:44.120 I dug up a reference that said it was seven 0:16:44.160 --> 0:16:47.360 when they finally did a meta analysis of all of 0:16:47.360 --> 0:16:50.520 the literature and said, everyone, these people are not crazy. 0:16:50.760 --> 0:16:53.680 Like for years they used to compare. It wasn't even 0:16:53.680 --> 0:16:56.600 a comparison. It was like um, it was a tangential 0:16:57.320 --> 0:17:01.480 um syndrome where if you experience phantom pain it was 0:17:01.560 --> 0:17:05.359 tantamount to having psychosis. Like that's how they were treated. 0:17:05.760 --> 0:17:08.000 And so for years and years people just knew, like 0:17:08.080 --> 0:17:10.119 you didn't complain about your fanom pain or else, they 0:17:10.160 --> 0:17:13.200 were going to give you electro convulsive therapy, maybe even 0:17:13.200 --> 0:17:15.600 a lobotomy. It doesn't I didn't turn that up, but 0:17:15.720 --> 0:17:19.720 I guarantee someone got a lobotomy for phantom limp pain 0:17:19.920 --> 0:17:24.000 sometime in the ninet thirties or forties. That would not surprise. 0:17:24.080 --> 0:17:26.159 I would put a lot of money on that they 0:17:26.160 --> 0:17:30.919 would lobotomize, uh, domestic housewives for not wanting to do 0:17:31.000 --> 0:17:34.320 dishes exactly. So you know, somebody with fanom limp pain 0:17:34.440 --> 0:17:39.000 got that treatment. Uh. Should we take a break? Yeah, 0:17:39.560 --> 0:17:42.679 all right, that was chuck full of information. Yeah, so 0:17:42.720 --> 0:17:45.200 we can only go down from here. You know, let's 0:17:45.280 --> 0:17:48.040 keep chucking it up. Chuck. All right, we'll be right 0:17:48.040 --> 0:18:12.600 back to chuck it, chocking it. Let's chock it some more. 0:18:13.320 --> 0:18:18.159 Hold its mouth open um. This is really interesting. Livia 0:18:18.400 --> 0:18:22.200 dug up a couple of first person descriptions of phantom 0:18:22.560 --> 0:18:28.560 uh pain syndrome. Is it a syndrome? Uh, I don't 0:18:28.560 --> 0:18:31.480 know why I'm calling it that because of alien hand syndrome. Probably. Yeah, 0:18:31.600 --> 0:18:33.760 The thing is, I don't I think it is a 0:18:33.800 --> 0:18:36.800 syndrome because the syndrome is usually a cluster of seemingly 0:18:36.880 --> 0:18:41.080 unrelated symptoms. So probably not. Look at you, smarty pants. 0:18:41.200 --> 0:18:42.800 I can't remember what that was from. I think in 0:18:42.840 --> 0:18:46.480 our albinism episode, I learned what difference between a syndrome 0:18:46.520 --> 0:18:49.040 and a non syndrome. Yeah, okay, so it's recent. Don't 0:18:49.080 --> 0:18:52.439 don't be too impressed. She dug up a couple of 0:18:52.520 --> 0:18:57.159 Norwegian academics and one page and this is just to 0:18:57.280 --> 0:18:59.440 let you know what what some of these people go through. 0:19:00.119 --> 0:19:04.359 One of the patient described a phantom arm being stuck straightforward, 0:19:05.040 --> 0:19:08.200 just sticking straight out from the shoulder, and basically every 0:19:08.240 --> 0:19:11.840 time he walked through a door would go through sideways. 0:19:12.720 --> 0:19:15.280 And you know, this is you hear something like this, 0:19:15.359 --> 0:19:19.320 and it's this is a It's not like shooting, stabbing, 0:19:19.320 --> 0:19:22.600 pain and pins and needles, but it's something that you 0:19:22.640 --> 0:19:24.840 have to explain to everybody. It's something that you're living 0:19:24.880 --> 0:19:29.639 with that uh, that people would see as abnormal, so 0:19:29.720 --> 0:19:32.840 it causes psychological impacts, you know. Yeah, I mean if 0:19:32.880 --> 0:19:37.320 you saw somebody with only one arm just turn and 0:19:37.359 --> 0:19:40.840 go gingerly kind of sideways through a doorway for no reason, 0:19:40.920 --> 0:19:42.879 yes it would it would be a little odd, you know. 0:19:43.400 --> 0:19:47.280 But the idea of your arm never being down, I 0:19:47.280 --> 0:19:49.080 mean that kind of goes back to what we were saying, 0:19:49.080 --> 0:19:51.800 the difference between being fascinated with and the difference between 0:19:51.800 --> 0:19:53.960 having to live with it. You know, like, just think 0:19:53.960 --> 0:19:55.760 about what it feels like they have your arm up, 0:19:55.960 --> 0:19:58.840 like just for a minute, or to imagine always feeling that. 0:19:59.240 --> 0:20:01.679 And then the guy you mentioned, he was also in 0:20:01.680 --> 0:20:05.800 that Norwegian paper you mentioned before, where um, there was 0:20:05.840 --> 0:20:08.040 a patient who couldn't sleep on his back because he 0:20:08.119 --> 0:20:11.600 felt like his arm was twisted behind him at all times. 0:20:12.160 --> 0:20:14.080 And yeah, that sucks to not be able to sleep 0:20:14.119 --> 0:20:16.200 on your back. That's like the money sleep right there. 0:20:16.920 --> 0:20:20.920 But imagine feeling like your arms twisted behind your back 0:20:21.320 --> 0:20:25.320 every waking moment and that you can't do anything about it. 0:20:25.960 --> 0:20:29.880 That would drive you nuts. It's as simple as that. Yeah, 0:20:29.880 --> 0:20:33.520 So those are like on this sort of lighter psychological side. 0:20:33.560 --> 0:20:37.000 On the other end of the spectrum, another man who 0:20:37.560 --> 0:20:43.760 I think lost both legs um was woken up periodically 0:20:44.160 --> 0:20:47.040 thinking that the nail of one toe was growing into 0:20:47.119 --> 0:20:50.920 the next toe. Uh. And another ampute said they felt 0:20:50.960 --> 0:20:54.240 like the skin on their arm was ripped off, salt 0:20:54.320 --> 0:20:56.480 was being poured on it, and it was thrust into 0:20:56.560 --> 0:20:59.800 a fire. Right. And then other people report to Chuck, 0:20:59.880 --> 0:21:02.200 this seems like something that would be easy to overlook, 0:21:02.240 --> 0:21:05.639 that you know, having you know, consistent pain in this 0:21:05.720 --> 0:21:09.280 phantom limb. Remind them that they have a phantom limb, 0:21:09.280 --> 0:21:12.199 that they have like an an amputation, and that just 0:21:12.280 --> 0:21:15.919 makes the whole thing that much more. Already distressing event 0:21:16.400 --> 0:21:19.960 is consistently distressing, over and over again because it's just 0:21:20.000 --> 0:21:23.040 a reminder of it, you know, right, especially if you're 0:21:23.080 --> 0:21:26.040 trying to rehabilitate and move on with your with the 0:21:26.080 --> 0:21:31.159 new normal, you know exactly. So, UM, we kind of 0:21:31.359 --> 0:21:35.439 reached finally, like where we're at with our understanding of 0:21:35.840 --> 0:21:40.199 phantom limb pain. And that's basically where we were in 0:21:40.200 --> 0:21:43.639 the sixteenth century if everyone had listened to Ambrose Parey, 0:21:44.440 --> 0:21:48.680 and that is that. Um, despite a lot a lot 0:21:48.760 --> 0:21:53.000 of people getting amputations every year in the US alone, 0:21:53.760 --> 0:21:56.440 I think there's something like a hundred and eighty five 0:21:56.520 --> 0:21:59.840 thousand amputations every year, the vast majority of them due 0:21:59.880 --> 0:22:06.359 to complications from vascular disease including diabetes. UM having a 0:22:06.440 --> 0:22:09.320 whole bunch of troops come back from Iraq and Afghanistan 0:22:10.040 --> 0:22:14.560 with amputations needing treatment and rehabilitation, and eight percent of 0:22:14.600 --> 0:22:18.680 these people suffering phantom limp pain. We still don't know 0:22:19.359 --> 0:22:22.280 what causes fami limp pain, what the basis of it is. 0:22:22.480 --> 0:22:25.160 And that's despite thinking we did for a little while 0:22:25.200 --> 0:22:27.680 there right like in the late nineties, early two thousands, 0:22:28.200 --> 0:22:30.600 and we talked about it, and I think our amputation episode, 0:22:30.760 --> 0:22:32.600 we thought we had a handle on it. And that's 0:22:32.640 --> 0:22:36.959 since been challenged and possibly debunked. Yeah, and you know, 0:22:37.040 --> 0:22:40.960 like we said with Parae, Uh, Michael Parree is that 0:22:41.040 --> 0:22:44.840 his name you're thinking of? Michael Buble? I was thinking 0:22:44.880 --> 0:22:47.600 of Eddie and the Cruisers. Maybe that's how I was 0:22:47.640 --> 0:22:49.800 thinking you were talking about when you mentioned can Marino. 0:22:53.000 --> 0:22:55.359 Oh man, they should remake that with Kid Marina. What 0:22:55.400 --> 0:22:57.960 a funny movie that would be. Who is the guy 0:22:58.040 --> 0:23:00.199 I am thinking of? I want to say it's like 0:23:00.280 --> 0:23:03.240 a he was like a kind of like a dark 0:23:03.400 --> 0:23:06.000 night kind of figure who would like help people and 0:23:06.080 --> 0:23:16.160 maybe the fifties. Arthur Fonzarelli. No, No, I'll try to remember. 0:23:16.240 --> 0:23:19.320 I'm gonna I'm gonna pro portion off like seven percent 0:23:19.359 --> 0:23:21.639 of my brain just to be working on this this 0:23:21.720 --> 0:23:25.240 problem while the other is focused on this episode. Okay. 0:23:25.680 --> 0:23:27.959 You know what, It's funny that I said, Arthur Fonzarelli 0:23:28.080 --> 0:23:32.560 because our friend of the show, Paula Tompkins and uh 0:23:32.880 --> 0:23:35.880 sort of colleague pal in real life for us, he 0:23:35.920 --> 0:23:40.040 mentions Arthur fonds Relli more than any other human I've 0:23:40.040 --> 0:23:44.040