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