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The Experience Of Phantom Limbs Essay

1846 words - 8 pages

A phantom is a persistent image or memory of a body part, generally a limb, for a period of time after its loss that can last months, even years. Silas Weir Mitchell studied this phenomenon during the Civil War. For amputees, phantom limbs are essential to regaining use of limbs following prosthetic procedures, without this sensation the recovery and reanimation of limbs can be disastrous. Positional phantoms, a type of phantom that leads to proprioceptive illusions and ever changing distorted images, can bring about acute onset tabes that leads to the feeling of being on “a ship in heavy seas” (68). The jury is still out on whether or not phantoms can be termed good or bad, but it seems they allow those with prosthetics to keep the limb alive, active and well; a necessary part to recovery. Pain may accompany phantoms; generally these are dull or ‘ordinary’ types of pain, but they can be sharp and excruciating in some cases. Having a phantom can lead to severe sensory diabetic neuropathy, like it did for the sailor in the story. However, the experience of a pathological disorder can cure phantoms.
There are still questions as to exactly which pathways are involved with the experience of phantom limbs. Originally it was believed the peripheral nervous system was involved, but this theory including the concept of neuromas (nerves in stumps that fire the sensations of pain up the spinal cord to the brain) has since been widely disregarded. The central theory suggests that phantom limb pain is a result of central sensitization, or excessive activity in the spinal cord. This occurs as a result of the spinal cord losing the afferent input from the missing limb. The neurons in the dorsal horn thus get irritated and increase their excitability. This neuronal excitability, coupled with the reduced inhibitory effects, results in a self-perpetuating loop that sends noxious signals up the spinothalamic tract to the cortex where the proprioceptive sensation of phantom limbs would be felt. Still, this theory has also been called into question by the fact that patients with upper body spinal cord injuries still report pain and sensation in the lower legs. Another theory revolves around the somatosensory cortex and the body map associated within this area of the brain. Studies have shown that cortical representation of the body can be remapped and reorganized; if part of the cortex is unused then the surrounding areas take over that space. For instance if the hand is amputated, the represented area for the hand in the somatosensory cortex is no longer in use. Since the face area is located directly next to the hand in the cortex, the face gets remapped onto the area of the missing hand. Phantom limb pain seems to be correlated to the amount of cortical reorganization. So the more remapping of the cortex that occurs, the more pain the patient will feel in the phantom limb. This correlation could be related to an enduring nociceptive pathway from some pain in...

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