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As a college freshman taking a neuroscience class, I was captivated by the idea of phantom limbs—pain or itching in body parts that are no longer there, say, after amputation. More than 20 years after that class, many questions about phantom limbs remain unanswered. But recent research has upended decades-old thinking that held problematic brain remapping was the likely cause of phantom pain. It seems that the body map in the brain is actually highly preserved.
This week, we'll dive into the latest science and the fascinating history on that topic, alongside deep dives into amputation and pain, exploring everything from biotech advances to patient experiences. I hope you enjoy!
Thoughts or reactions? Feel free to get in touch. Reaching out is as simple as replying to this message.
—Dina Fine Maron, 1440 Health & Medicine Section Editor |
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Phantom limbs 101
Phantom limbs are vivid, varied sensations that people may feel in body parts that are no longer present. Experienced by the majority of amputees, these errant feelings are subjective and may feel uncomfortable, itch, or cause pain. Though most commonly used to describe amputees' missing limbs, the term can also describe other missing body parts, including breasts after a mastectomy, missing teeth, and more.
First documented in the 16th century by a French clinician to describe the feeling that amputated limbs were still attached, the concept became more mainstream following a fictional story in The Atlantic written by a Civil War surgeon.
Researchers' understanding of why this phenomenon occurs is still evolving, with investigations spanning the brain and central nervous system and beyond into the peripheral nervous system. But one major way phantom pain is treated is with mirror box therapy, developed in the 1990s—essentially tricking the brain into thinking a still-attached limb is the missing one, and then moving the still-present limb in ways that may alleviate the uncomfortable or painful sensations. Virtual reality treatments that similarly trick the brain into thinking the missing limb is present and movable are also garnering increasing attention.
Explore everything else we've found on Phantom Limbs.
Also, check out ...
> The brain doesn't seem to massively rewire following amputation—a seismic shift from earlier beliefs that held brain remapping was causing phantom pain. (More)
> Readers thought the fictional Civil War vet George Dedlow, in 1866, was real—and sent donations. (More)
> Read that 1866 story in The Atlantic, which put phantom limbs on the map. (More)
> Nonamputees can be manipulated into thinking they have phantom limbs. (More) |
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Amputation, explained
Amputation is the removal of a limb or part of a limb—surgically cutting through flesh, bone, blood vessels, tendons, and nerves. This surgery is performed in extreme situations, such as when there's no blood flow to the area, there's a life-threatening infection that cannot be otherwise controlled, or a crush injury results in irreparable neurovascular and bone damage.
This drastic change can affect physical and mental health as it challenges mobility and independence. It can also lead to numerous complications, including chronic pain. The first known instance of an amputation occurred about 31,000 years ago, with fossil evidence suggesting a young adult survived and healed after having their lower left leg amputated.
Globally, traumas are the leading cause of amputation, primarily from incidents including falls, car accidents, and mechanical forces. But diabetes accounts for the majority of non-trauma-related lower-limb amputations, leading to about 160,000 amputations annually in the US—or roughly one limb amputation every 3.5 minutes. Prosthetic quality and access are making constant advances, due partly to 3D printing, cutting-edge bionic prosthetic research, and ongoing work with neural interfaces.
Explore everything else we've found on Amputation.
Also, check out ...
> Black patients are losing their limbs at triple the rate of other groups. (More)
> See what analysis of one man's amputated leg tells us about his otherwise invisible pain. (More)
> How bionic limbs are reshaping what it means to live as an amputee. (More)
> An experimental bionic knee has been directly integrated into the user's muscle and bone—not an external socket—which is a major advance. (More)
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A primer on pain
Pain is the body's warning signal that something is wrong and action must be taken—whether it's exiting a dangerous situation, resting an injury, or avoiding something that has caused damage before. Pain is subjective and can have many causes, including injuries, arthritis, fibromyalgia, and stress. It can also occur without a known, specific cause.
The body's equipped to respond quickly to acute pain: In response to stimuli such as heat and intense pressure, nerve endings called nociceptors detect those sensations and send electrical signals to the brain, which are interpreted as pain. Without pain signals, we're far more likely to get injured—or killed—as seen in individuals born with a rare congenital insensitivity to pain.
Almost a quarter of American adults suffer from chronic pain, with 8.5% of US adults reporting chronic pain that frequently limits life or work activities. Such pain can be difficult to treat and may be experienced more intensely at night when there are fewer distractions for the brain.
Cutting-edge research to alleviate pain includes virtual reality treatments, mindfulness-based cognitive therapy, psychedelic treatments, and Journavx, a recently FDA-approved, non-opioid pain reliever that aims to blunt pain by targeting a pain-signaling pathway in the peripheral nervous system.
Explore everything else we've found on Pain.
Also, check out ...
> Learn about the physical and emotional experience of pain. (More)
> The subjectivity of pain means that one person's kidney stones may feel like another's childbirth experience. (More)
> Why your favorite music can minimize physical pain. (More)
> Can we explain why we love to eat spicy food—even when it hurts? (More)
> How opioids work to dull pain. (More) |
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Medical Developments Spotlight |
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We love spending time learning about the latest medical breakthroughs and spotlighting research that piques our interest, may influence future research directions, or inform healthcare conversations. Here's what we found this week.
> A novel gene-editing approach used on early human embryos is looking even better than CRISPR
BioRxiv | Stepan Jerabek, Jimin Kim, et al. Base editing, a gene-editing approach that allows users to precisely chemically convert one DNA base into another—rather than just snipping DNA with CRISPR-Cas9—achieved unprecedented success in proof-of-concept work aimed at altering several specific genes in human embryos. Unlike some CRISPR work, this approach didn't lead to evidence of unintended damage to other DNA. Still, there were issues, including that some embryos retained the original versions of the genes, while others were altered, creating problems if they'd gone on to become fetuses. The hope is that this approach could one day be used for various medical applications, including future sickle cell treatments. The new research is published on a preprint server—meaning it has not yet been peer-reviewed. (Read | More on Base Editing)
> GLP-1s may reduce depression in mice by altering the microbiome
Fierce Biotech | Darren Incorvaia. Though findings about this peptide and depression have been mixed—with some work saying it may act as an antidepressant and other research linking it with worsened mental health and suicidal thoughts—a new rodent study has identified an intriguing, new pathway by which the drug could be promising for fighting depression, at least in mice. The work finds that the drug led to elevated levels of the bacterium Lactobacillus delbrueckii in the rodents' gut, and that those microbes produced a compound that combats depression symptoms. (Read)
> HIV persistence in the blood posttreatment explained by defective virus copies
Bioengineer | Staff. New research involving long-term analysis of blood samples from more than 50 people living with HIV suggests that a fraction of HIV patients who adhere to their medication regimens yet still exhibit detectable levels of the virus in their bloodstream are actually not typically infectious. It found that the detectable levels of the virus are mostly defective, noninfectious copies—not active, replication-competent HIV. (Read) |
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"Oh, my God! Oh, my God, doctor! This is unbelievable. It's mind-boggling! ... My left arm is plugged in again. It's as if I'm in the past." |
Philip Martinez's reaction after receiving mirror box therapy for his phantom limb pain, as recounted by his doctor, neurologist VS Ramachandran. |
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