I'm constantly amazed and impressed by the brain's capacity for change and healing -- especially as when I was a student, it was firmly believed that the idea of brain plasticity was a crank one!
In fact, the brain has an amazing capacity for adaptation and management of physical challenges, including pain management. A striking illustration of this is given by both the creation and subsequent removal of phantom limb pain, which is the subject of this week’s blog.
Effective management of pain has been a problem through the ages. Despite advancements in pain-modifying drugs and other medical treatments, pain is still a harsh reality for millions of people across the world. For many, hope lies in the possibility that the underlying condition will be successfully treated and so the cause of pain removed. How much of a greater problem then, when the pain is coming from a place that no longer exists? This is what often happens when part, or all, of a limb is removed.
People who have lost a limb through trauma or surgical amputation often feel tremendous pain coming from the place where the limb used to be. This is known as phantom limb pain. These patients frequently describe their phantom limb pain as being due to the clenching, spasmodic paralysis of the limb and generally believe that, if they could ‘move’ the phantom limb, the pain would go.
For many years, phantom limb pain was intractable as it tends to respond very poorly to painkillers. As with many conditions, treatment focussed mainly on pharmaceutical approaches. That is, until Vilayanur S Ramachandran noticed that this most commonly occurs in patients who experienced a painful injury or disease for a period prior to amputation. He postulated that, in these cases, the brain had learned that that the limb was both painful and paralysed. Then, when amputation occurred, the brain kept that body image and so the patient suffered from ‘learned paralysis’.
It occurred to him, that if the brain could somehow ‘see’ the phantom limb moving it would un-learn the paralysis and the pain would go. He tested this with a very simple technique and so invented the mirror box. This is simply a box with a mirror on the outside. The patient covered the amputated part of their limb with the box such that their healthy limb was reflected in the mirror. This made it look as if there were two whole limbs. Then, when they moved their healthy limb while looking at the mirror image, the brain is tricked in believing that it is seeing the other limb moving.
As Ramachandran predicted, this caused the pain to go away. Initially, on first use of a mirror box, the pain returns once the mirror box is removed. However, with regular practice, sure enough, the brain unlearns the paralysis and the pain disappears.
Mirror therapy is now widely used and has been extended to stroke patients afflicted by paralysis in one limb to aid rehabilitation. It is a perfect example of how the plasticity of the brain can be used to bring about profound changes in a person’s experience of pain and illustrates well why a focus on pharmaceutical approaches to pain relief may sometimes be taking us in the wrong direction.
Hypnotherapy can effectively enhance the brain’s ability to manage pain and can enable people for whom pain has become an overwhelming part of their lives regain some control. Of course, it is vital that a medical diagnosis has been obtained prior to using hypnotherapy to reduce or remove pain, in order to avoid masking any underlying and potentially serious conditions. Once that diagnosis has been made, hypnotherapy can then be used safely alongside medical treatment to help the client improve their quality of life.
To watch VS Ramachandran describe three amazing delusions: phantom limbs (and his discovery of mirror therapy); Capgras delusion and synaesthesia take a look at his TED lecture of 2007 by clicking here.
If you are interested in buying a portable mirror box they are available from Amazon and some other suppliers/