The Frontal Cortex

Phantom limb syndrome has always been intertwined with war. It was first discovered by Silas Weir Mitchell after the Battle of Gettysburg, when the hospitals of Philadelphia were overwhelmed by soldiers with amputated limbs. Many of these soldiers said that they still felt their missing arms and legs, even though they were clearly gone. As Weir Mitchell put it, the soldiers were afflicted with "sensory ghosts".*

After the Civil War, Weir Mitchell's clinical observations fell into obscurity. Because phantom limbs had no material explanation, medical science continued to ignore the phenomenon. However, the syndrome was eventually rediscovered by the neurologist J. Babinski, after he spent time with the maimed soldiers of WW I.

Now we have another war, and phantom limbs are again in the news. This time, though, the news is good:

On the morning of July 2, 2006, Sgt. Nick Paupore was driving the lead Humvee in a convoy near Kirkuk, in northern Iraq, when a roadside bomb blew off his right leg above the knee.

Within 48 hours, he was at Walter Reed Army Medical Center in Washington, where he has spent the past 18 months recovering. Soon after arriving, Paupore began to feel excruciating pain - in his missing leg.

"It felt like someone was shocking me, like someone was putting an electrode on the back of my ankle," says Paupore, 32.

He tried several painkillers, including methadone, but the pain didn't let up. Then a Navy neurologist, Dr. Jack W. Tsao, asked him to try a new approach that requires patients to move the intact limb while watching the action in a mirror.

Not surprisingly, Paupore was skeptical, and said no thanks.

He's not skeptical now.

Tsao eventually persuaded Paupore to try the therapy. After several weeks the shocks had almost disappeared.

"As soon as I started the treatment, I noticed a remarkable change," says Paupore, who has stopped taking painkillers. "I could see really big improvement, really fast."

The mirror treatment was pioneered by V.S. Ramachandran, although Walter Reed Army Medical Center is the first hospital to actually conduct a trial study of the treatment. The results so far are encouraging:

The soldiers were divided into three groups of six: One group received mirror treatment; another underwent treatment using a covered mirror, while the third didn't use a mirror, but visualized moving the amputated limb.

Those who used an uncovered mirror had significant pain relief. Few in the other groups got relief, and some actually got worse. When the covered-mirror and visualization patients tried the mirror, almost all improved.

Tsao has published his results in the New England Journal of Medicine.

*I discuss the discovery of sensory ghosts in my book, and talk about how Herman Melville was actually the first person to really describe the phenomenon in detail.

Thanks for the tip Steve!