Pain can originate from multiple places in the body as well as appear randomly throughout ones life. Pain is one of the most complained about symptom in patients but most patients can identify the location of their pain, some patients are not as lucky. Millions of amputees suffer isolated pain in "residual limb itself or as phantom pain in a limb that is no longer present" (Dumanian et. al 2019).
From previous research, one of the standard protocol treatments during the surgical removal of a limb is done by burying the cut nerve in a nearby muscle but it was found that patients that received this type of treatment had chronic pain. Dr. Dumanian and his team created a different protocol, targeted muscle reinnervation, that connects the nerve into a muscle segment and connected to another nerve to innervate the muscle segment. Many of the participants saw a decrease in phantom limb pain compared to those who received the standard treatment (Dumanian et. al 2019). This study suggested that by involving the motor neuron (by reconnecting it to the muscle) it allows the neuron to have a job and reduce the amount of pain felt by the patient.
This paper inspired me to further investigate and understand how those receiving the standard treatment may deal with their chronic pain since there were strict criteria for those able to receive the special protocol. Many amputees did not qualify for the targeted muscle reinnervation in Dumanian's trial due to many factors including those who had previously had undergone neuroma excision and burying before, as well as in the future if this technique is successful, it may be financially unrealistic.
Other studies have concluded similar conclusions regarding motor usage of the neuron may result in relief of chronic pain. It has been well hypothesized that when those experiencing phantom pain if they use a mirror and use the limb that is present to do movements it may "trick" the brain into thinking that the limb is there and releases pain. Similar to this line of thinking recent studies have found that virtual reality can ease phantom limb pain. Researchers at Aalborg University suggest that this technology can also "trick the aputee's brain into thinking that it is still in control of" the missing limb (Virtual reality eases phantom limb pain). The method of using virtual reality uses electrodes to send electrical impulses to create the illusion of sensation in the phantom limb. The patient then does numerous tasks through VR games and the participants claimed that their pain decreased as well as the amount of phantom limb attacks.
Although using VR and a mirror is extremely similar in methods this provides modern way to help relieve phantom pain. The method of using VR does relate to the Dumanian lab as it aims to "distract" the neuron. VR focuses on distracting the brain and tricking it into thinking that the limb is actually there where the Dumanian lab distracts the neuron itself by occupying it with other duties after the reconnection to a nearby muscle.
References:
Dumanian, G. A., Potter, B. K., Mioton, L. M., Ko, J. H., Cheesborough, J. E., Souza, J. M., Ertl, W. J., Tintle, S. M., Nanos, G. P., Valerio, I. L., Kuiken, T. A., Apkarian, A. V., Porter, K., & Jordan, S. W. (2019). Targeted muscle reinnervation treats neuroma and Phantom Pain in major limb amputees. Annals of Surgery, 270(2), 238–246. https://doi.org/10.1097/sla.0000000000003088
ScienceDaily. (2017, May 31). Virtual reality eases Phantom Limb pain. ScienceDaily. Retrieved December 13, 2021, from https://www.sciencedaily.com/releases/2017/05/170531102921.htm.
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