Stuff You Should Know - What's the deal with phantom pain?

Episode Date: March 1, 2022

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.  Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

Hey, I'm Lance Bass, host of the new iHeart podcast Frosted Tips with Lance Bass. Do you ever think to yourself, what advice would Lance Bass and my favorite boy bands give me in this situation? If you do, you've come to the right place because I'm here to help. And a different hot sexy teen crush boy bander each week to guide you through life. Tell everybody, yeah, everybody about my new podcast and make sure to listen so we'll never, ever have to say bye, bye, bye. Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple podcast, or wherever you listen to podcasts. I'm Munga Chauticular and it turns out astrology is way more widespread than any of us want to

believe. You can find in Major League Baseball, International Banks, K-pop groups, even the White House. But just when I thought I had a handle on this subject, something completely unbelievable happened to me and my whole view on astrology changed. Whether you're a skeptic or a believer, give me a few minutes because I think your ideas are about to change too. Listen to Skyline Drive on the iHeart radio app, Apple podcast, or wherever you get your podcasts. Welcome to Stuff You Should Know, a production of iHeart Radio. Hey and 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, Blazins,

Sciencey, Strange, Unusual, Fascinating Type Stuff You Should Know. That's right. And both of us, fresh from vacation, I just got to say, we took the first family trip to Disney World and it was great. Oh, that was the first ever, huh? Wow, I'll bet that was something special. It was. I haven't been in 35 years. Wow. Myself and the same with Emily and it's remarkable how much of the Magic Kingdom is exactly the same. Oh, sure. But then I realized that Disney cultists, diehards. I think cultists is appropriate. They don't want anything different. So that all made sense. But it was great. My daughter was, you know, you never know till 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 cried 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 wanted to do the Aerosmith ride at Hollywood Studios. That's something that she was bummed out about. Which, have you ridden that one? Many times. Did you realize? You probably realized this. The little video they showed at the beginning of Aerosmith in the studio. That's Ken Marino as the engineer. Oh, no. I thought you were going to talk about Ileana Douglas. I had no idea it was Ken Marino from that one show from the 80s. Oh, well, please. I mean, he was a co-founder of the state, but he's one of my comedy heroes. Oh, that's not who I'm thinking

up then. Yeah, Ken Marino's from the state and, you know, wet hot American summer and party down. He had literally no lines. I thought, oh, there's Ken Marino. He's going to 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 bunch of buttons. I thought it was very funny. But anyway, we had a great time. That makes it even funnier that he didn't have like any kind of talk. Maybe. I kept waiting for it. It was a lot of fun, though. 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 we did all the Harry Potter stuff, but didn't get to ride some of the big rides we wanted to ride. Well, that's

cool. I'm glad you guys had a good time. It was wonderful and refreshing. Yeah. Boy, I think we both needed a little respite. We definitely did. Me and Yumi went to Hawaii for our 10th anniversary, our 10th wedding anniversary. Yeah. It was the first time we've traveled in about two and a half, three years, something like that. First trip, huh? 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, gotcha. After I recovered. You know what I mean. I know. I'm with you. No, I stayed inside and scared, but this is so it was something like,

I was like, I don't know how this is going to 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. I think the reason that you're shocked is because we actually have. No. We did. We did amputations. I know we talked about it in there because we talked about the mirror box before plenty. Yeah. Yeah. 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 suite in full then. I agree. So, what's fan and pain? Well, so 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 chilla bus kidnapping article. So, sorry for that one too. So, I want to let that pass. Hey, Libby is all over RC and though, and she's doing great. She really is. So, this, she does a good job like basically getting across like what fan to pain is and that we actually don't really know what it is. But you can describe it as anyone who's had an amputation about 80% of those people 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 call 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 there is a nail being driven into the bottom of your foot. The problem is your foot's 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. 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 a mastectomy. It can be removal of testicles. I know this is 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. I just wanted to take the bait. Of course. There's also sort of a side affliction called

phantom limb sensation, 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 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 saw it was as recent as 1987 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 would be awful. And itch, you can't possibly scratch. Oh boy. 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 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 people like to think it in 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. 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 something 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. 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 Paré. Oh yeah. He was a French surgeon in the mid 16th century. And this is one of those kind of rare cases where someone from hundreds of years ago described something and had a handle on something in a pretty solid way. Like looking back, he really was pretty close in a lot of the things

that he thought about phantom limb pain. And he was the first dude to describe it, which is pretty remarkable. Yeah. I mean, we're talking the middle of the 16th century. Like you said, that's crazy. That's a time when people didn't really think that the people working in science were scientists. Like science kind of came later, according to some people. And it's like, if we had just kind of built on Paré's understanding of it, who knows how much further along we would be in treating and dealing with that kind of stuff. But it's like you said, he had a really good handle on it. He was the first to differentiate. Remember how I said there's like 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. He said that there's different factors that can set it off, like the weather, change in the weather. And then there's different things that could treat it, like sometimes massage around the residual limb helps too. What else? He also made the distinction. We described the phantom limb sensations. He described the difference there between the pain and the sensation. Oh, yeah. That's a big one. He also said, so he said two things. He said that his guess for what was causing it was that either there was some problem with the nerves in the residual limb. I think he said that he thought they were retreating possibly or withdrawing, which makes sense in a weird way. Or he thought that it originated in the brain,

not through some sort of psychosis, but through some sort of 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 of phantom limb pain basically boils down to those two general concepts. Yeah, it's pretty amazing. And 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 delighted by this idea. Descartes was one of them in the kind of early to mid 1600s. He talked a lot about phantom limbs. 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 William Porterfield in 1759, he was a physician that lost a foot. And he had an actual physician's first person autobiographical take on it all and talked about his toes, heel and ankle spelled with a C, which is fantastic. Like experiencing pain and itching several years after, I don't think we said it can start up to like in the shortest 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 it can really be all over the map. But his description was at least a few years afterward.

Right. So that was 1759. And that was almost exactly 200 years after Paray first identified phantom limb sensation or phantom limb pain. 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, who took part in the removal of 30,000 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 leg or an arm, like you just were going to lose that arm relating to save your life. He had like all

this firsthand experience with these people who had just lost a limb and were complaining about pain in the limb. So this idea of phantom limb pain kind of came back to the fore 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 16th century. Right, but he took a kind of weird approach initially in 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 phantom pain in 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 afterward he was like, maybe I should write something real, a non-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. That's how long it took. It sounds like people today, doesn't it? Can't you see people today sending in donations to the guy who lost his legs but was able to walk around on invisible residual limbs and a seance? Yeah, Facebook told them so.

So Silas Weird Mitchell finally creates what you could point to as the first modern scientific paper on phantom limb pain and he estimated as high as 86 out of 90 of his amputee patients experienced phantom limb pain. Not just phantom limb sensation, but phantom limb pain and that is a really high number. It's higher than average, but like I said before, I mean, in the neighborhood of 80, I think I've seen as high as 85% of people who have an amputated limb will experience pain to some degree in that phantom limb. Right, and I think most people experience 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, all right. Well, that makes sense too, and that's just merciful. That's right. And for a lot of years, there was, you know, up until like the mid 20th century, there were a lot of psychological, or they were attributing this, at least to 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. Can you believe that? I know. But all the way up until 1954,

people were arguing, doctors were arguing, at the Mayo Clinic, that phantom limb pain suffers, if it was persistent, reflected a preexisting difficulty in adapting to problems, and maybe influenced by just knowing that it exists, like, oh yeah, I've read about this, I'm feeling that pain too. So if you suffer from 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 1987, 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, it was a tangential 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 phantom pain or else they were going to give you electroconvulsive therapy, maybe even a lobotomy, it doesn't, I didn't turn that up, but I guarantee someone got a lobotomy for phantom limb pain sometime in the 1930s or 40s. That would not surprise me. I would put a lot of money on that. They would lobotomize domestic housewives for not wanting to do dishes. Exactly. So you know somebody with phantom limb pain got that

treatment. Yeah. Should we take a break? Yeah. Yeah. I think so. All right. That was Chuck full of information. Yeah. So we can only go down from here. No, let's keep chalking it up, Chuck. All right. We'll be right back to Chuck it. me in this situation. If you do, you've come to the right place because I'm here to help this. I promise you. Oh God. Seriously, I swear. And you won't have to send an SOS because I'll be there for you. Oh man. And so my husband, Michael, um, hey, that's me. Yep. We know that Michael and a different hot sexy teen crush boy bander each week to guide you through life step by step. Oh, not another one. Kids relationships, life in general can get messy. You may be thinking this is the

story of my life. Just stop now. If so, tell everybody everybody about my new podcast and make sure to listen. So we'll never ever have to say bye, bye, bye. Listen to Frosted Tips with Lance Bass on the iHeart Radio app, Apple podcast or wherever you listen to podcasts. I'm Mangesh Atikala. And to be honest, I don't believe in astrology. But from the moment I was born, it's been a part of my life in India. It's like smoking. You might not smoke, but you're going to get secondhand astrology. And lately, I've been wondering if the universe has been trying to tell me to stop running and pay attention because maybe there is magic in the stars if you're willing to look for it. So I rounded up some friends and we dove in and let me tell you,

it got weird fast. Tantric curses, major league baseball teams, canceled marriages, K-pop. But just when I thought I had to handle on the sweet and curious show about astrology, my whole world came crashing down. Situation doesn't look good. There is risk to father. And my whole view on astrology, it changed. Whether you're a skeptic or a believer, I think your ideas are going to change too. Listen to Skyline Drive and the iHeart Radio app, Apple Podcast, or wherever you get your podcasts. Chucking it. Let's chuck it some more. Oh, hold its mouth open. It's stuff to fall. This is really interesting. Livia dug up a couple of first-person descriptions of phantom

pain syndrome. Is it a syndrome? I don't know. I don't know why I'm calling it that because of alien hand syndrome probably. Yeah. The thing is, I don't think it is a syndrome because a syndrome is usually a cluster of seemingly unrelated symptoms. So probably not. Oh, look at you, smarty pants. I can't remember what that was from. I think in our albinism episode, I learned what the difference between a syndrome and a non-syndrome. Yeah. So it's recent. Don't be too impressed. She dug up a couple of Norwegian academics. This is just to let you know 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. Basically, every time he walked

through a door, it would go through sideways. You hear something like this, and 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 people would see as abnormal, so it causes psychological impacts. Yeah. I mean, if you saw somebody with only one arm, just turn and go gingerly sideways through a doorway for no reason, yes, it would be a little odd, but the idea of your arm never being down, that goes back to what we were saying, the difference between being fascinated with it and the difference between having to live with it. Just think about what it feels like to have your arm up just for a minute or

two. Imagine always feeling that. Then the guy that you mentioned who is also in that Norwegian paper, you mentioned before where there was a patient who couldn't sleep on his back because he felt like his arm was twisted behind him at all times. 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 arm is 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. Those are on the lighter psychological side. On the other end of the spectrum, another man who I think lost both legs was woken up periodically thinking that the nail of one toe was growing into the next toe. Another amputee 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. Then other people report too, Chuck, this seems like something that would be easy to overlook that having consistent pain in this phantom limb remind them that they have a phantom limb, that they have 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. Right, especially if you're trying to rehabilitate and move on with your new normal. Exactly. We reached finally where we're at with our understanding of phantom limb pain. That's basically where we were in the 16th century if everyone had listened to

Ambrose Perret. That is that despite a lot, a lot of people getting amputations every year, in the U.S. alone, I think there's something like 185,000 amputations every year. The vast majority of them due to complications from vascular disease, including diabetes. Having a whole bunch of troops come back from Iraq and Afghanistan with amputations, needing treatment and rehabilitation, and 80% of these people suffering phantom limb pain, we still don't know what causes phantom limb pain, what the basis of it is. That's despite thinking we did for a little while there. In the late 90s, early 2000s, 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. Like we said with Perret, Michael Perret, was that his name? You thinking of Michael Buble? I was thinking of Eddie and the Cruisers. Maybe that's how I was thinking you were talking about why you mentioned Camarino. Oh man, they should remake that with Camarino. What a funny movie that would be. Who is the guy I'm 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 in maybe the 50s. Arthur Fonzarelli? No. No, I'll try to remember it. I'm going to portion off like 7% of my brain just to be

working on this problem while the other 93% is focused on this episode, okay? You know what? It's funny that I said Arthur Fonzarelli because our friend of the show, Paul F. Tompkins and sort of colleague Powell in real life for us, he mentions Arthur Fonzarelli more than any other human I've ever known in my life. Oh yeah? Yeah, in his show, Threatom and then conversationally on his other show, Stay of Homekins with his wife, Janie, he just, it's a great comedic effect. He brings up Fonzie a lot. It's pretty great. Well, yeah, I mean, if you want to get an easy laugh, just bring up Fonzie. Yeah, he times it out well. This is really well done. Like you just did it yourself.

I feel like I channeled Paul F. Tompkins here. So I can tell you what the show is now, if you want to know. It has nothing to do with the 50s 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 Lies Guy. Sure. He kind of looks like Ken Marino too. Yeah, yeah. If you put them next to each other, you'd be like, don't be ridiculous. But if you saw 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 Ken 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,

Lies Guy has a 7.8 out of 10 on IMDB and that is really high these days. Well, that says it all. Yeah. So I think where I was headed before I got sidetracked was, like you said, with Paray, they are still sort of looking at two schools of thought. And it could be a combination of both. But central nervous system stuff and then brain mapping and literal nerve issues. The first thing you're going to 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. It could be thickening of these severed nerve endings, like after the operation,

making things a little more sensitive. But there's still a lot of debate on this. Yeah. And that last one is called the neuroma theory. And that was a leading explanation for it. And it still could be right. But when they amputate your limb, they're also amputating a lot of other stuff than just like your leg. There's a lot of stuff that 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 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 dumbstruck. 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 limb, and we're talking like in the hours leading up to your amputation even. Oh, really? Yeah. That your brain remembers that.

So can you just be really recent? Yes. That's kind of evident. Your brain never got a chance to work out that it was no longer in pain. It's just continuing on. And they've done studies of people 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 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? Yeah, totally. So like you remember this kind of stuff, and that actually kind of leads to another theory of what causes this phantom limb pain. It's called proprioception theory. Yeah, lay it on me. So proprioception

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 proprioception. And this whole idea behind proprioception having to do with phantom limb 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 our limbs are in space, but 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 based on its expectations. And that's the proprioception theory 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. Well, that's the thing. So the neuroplasticity, that's the leading most dominant accepted explanation for phantom limb pain, which is that 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. But it's been challenged recently by findings that show your brains

actually doesn't seem to be restructuring itself at all. Yeah, there's a famous TED talk, a researcher from Cal San Diego named V.S. Ramachandran, 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 a 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 studies and meta analyses that have found that

that if it does work, it's very short term. Yeah. It's not like the brain completely remaps long term. So it's more like a SAV than a cure. That's what the studies have shown. But that's kind of surprising because it was, it was touted early on as like a, like this is going to 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 hasn't caught up to the idea that, that limbs not there any longer. And so you're, you think your limbs in a different position or the last position it was in, or it's in the pain that you used, 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, it can be like, oh, okay, good. I'm not actually experiencing any pain. I can stop that signal and you can go on with your merry 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 MRI 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, of causing your arm to function and 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, in 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 an effect on phantom limb pain. Hey, I'm Lance Bass, host of the new I Heart podcast, Frosted Tips with Lance Bass.

The hardest thing can be knowing who to turn to when questions arise or times get tough, or you're at the end of the road. Okay, I see what you're doing. Do you ever think to yourself, what advice would Lance Bass and my favorite boy bands give me in this situation? If you do, you've come to the right place because I'm here to help. This, I promise you. Oh God. Seriously, I swear. And you won't have to send an SOS because I'll be there for you. Oh man. And so my husband, Michael, um, hey, that's me. Yep. We know that Michael and a different hot, sexy teen crush boy band are each week to guide you through life step by step. Oh, not another one. Kids, relationships, life in general can get messy. You may be thinking this is the story of my life.

Just stop now. If so, tell everybody, everybody about my new podcast and make sure to listen. So we'll never ever have to say bye, bye, bye. Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple podcast, or wherever you listen to podcasts. I'm Mangesh Atikular, and to be honest, I don't believe in astrology. But from the moment I was born, it's been a part of my life. In India, it's like smoking. You might not smoke, but you're going to get second hand astrology. And lately, I've been wondering if the universe has been trying to tell me to stop running and pay attention. Because maybe there is magic in the stars, if you're willing to look for it. So I rounded up some friends and we dove in and let me tell you, it got weird fast. Tantric curses,

Major League Baseball teams, canceled marriages, K-pop. But just when I thought I had to handle on this sweet and curious show about astrology, my whole world came crashing down. Situation doesn't look good. There is risk to father. And my whole view on astrology, it changed. Whether you're a skeptic or a believer, I think your ideas are going to change too. Listen to Skyline Drive and the iHeart radio app, Apple podcast, or wherever you get your podcasts. All right. So we talked a little bit. Hold on. Hold on. Hold on. I'm sorry. I'm sorry. What happened? I just want to give an update here. Okay. You can probably understand why I confused Ken Wall as the lead of a kind of a mid-50s, like dark night kind of helping people

out, because Ken Wall was the lead in the 1979 greaser flick, The Wanderers. Okay. I knew he was in a greaser movie. I knew that. I think that's what I was confusing. Yeah. His hair looks good in a duck tail. I think I had confused The Wanderers with the 80s 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 the, was Wanderers like an outsider's ripoff? No, it was a little more true. Outsiders was weird and avant-garde or, I'm sorry. Did you say outsiders or what am I thinking of? What's the weird, the weird one?

Warriors. That's what I'm thinking. Oh, no. I'm thinking of Pony Boy. I think the outsiders came after The Wanderers and most probably something of an homage to that. No, it was a book from Wayback. Okay, fine. We're never going to get to the root of all of this. I'm losing my stuff. It's all Ken Wall's fault. I think it's all Kemmerino's fault. 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. 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 re-innovation and targeted sensory re-innovation, which is either using leftover motor nerves or leftover sensory nerves from that amputated limb, connecting those to muscles that lost their function. And all of this is in service of all the work they've done with prosthetic limbs to make them smarter and like, hey, 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, no, you've got a real limb there again. And so you don't have that venom limb pain. Yeah. I found this one mention of how apparently there's people who have prosthetics

are faced with this terrible choice where 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 increase their risk of cardiovascular disease, of heart attack, of all sorts of stuff like that, just by like overexerting 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 kind of getting around that by recreating as far as the brain's concerned, a limb very closely in the way that

you do that is like you said, 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 nerves and then muscle tissue also in your leg. And it will send that on up through 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 10 years ago. So I imagine the, 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. Right. 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, whether it's muscle tissue, nerves connected, formerly 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, 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, we'll come back and attach the, the, the sensory cables from a prosthetic to that muscle tissue. And we're going to be back in business and the brain's going to think like, Hey, I've got this, I got my foot back, I got my leg back, I got my arm back to the brain. 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 from amputations that happened years ago. And so if you give these nerves something to do productive, they're going to 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, or not, they think like they're,

they're seeing quite clearly that that helps alleviate and maybe cures phantom pain, just giving these nerves a productive job yet again, because they just want to work so bad. Yeah. But they got cut in half. Yeah. It's remarkable. On the less remarkable side, treatment-wise, and this is, I think, just residual, you know, I mean, that's a very forward-thinking way to do things, I think, with phantom limb pain, 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,

you know, muscle relaxers, beta blockers, stuff like that. And I'm not poo-pooing medication 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. So there are other, like, non-pharmaceutical techniques, too. One of them is kind of like a low-fi version of what you would get with a really advanced prosthetic. It's called TENS. It's been around since at least the 80s. My mom was a hospital administrator later in a career, and I remember we had pads of paper laying around our house that had, like, pictures of TENS units on them. Really? Yeah. I guess the TENS unit supplier gave us some free pads of paper.

That's so funny. So it's transcutaneous electrical nerve 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 what happens is you're kind of overwhelming that pain signal with a more robust electrical signal that just turns off that pain signal. And it actually helps really, really well. TENS helps a lot of people with back pain. Have you seen those, like, little 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 a TENS unit. And all it's doing is sending electrical impulses through your skin to your nerves and basically saying,

shut up pain signals. Here's something bigger. It's the Bonny rate treatment. Yeah. Yeah. Let's give them something to talk about. Or what was that ad move over something now? There's something leaning here. Move over bacon? I think so. But what was the product? I think it was sizzlene, wasn't it? No. That's a disappointment. Maybe. What was sizzlene? It was not good. I'll tell you that. I don't even know what that was. Remember stacums? The frozen... Dude, don't knock stacums. You like stacums? Well, it's the budget version of a Philly cheesesteak. Yes. And that's how I always ate it too. But even still, it's like, this is terrible.

It looked like a shoe insert. Yeah, I did. It did. I liked stacums for many years. Having said that, that was, you know, 40 years ago. And now, you know, if you make a homemade cheesesteak, you slice that ribeye, fold it up and roll it up and slice it really thin. Is that right? That's what you use as some good ribeye? Yeah. Nice. Flatten that out, pound it out really thin. Man, you have come so far. You have arrived. Because of pounding ribeye?

No, because you left stacums in the rear. Wow. You went from stacums to ribeye. What else? I think there's a few more treatments. There's biofeedback, of course. There are very simple things like just propping up the residual limb, them repositioning it, you know, being distracted. They say lifestyle changes, like, you know, yoga, meditation, music, stuff like that can help. Probably better than throwing opioids at the problem. Yeah. And again, I mean, just doing stuff like moving the limb, massaging it, 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 arm's 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 opioids, you know, like that's the reason why this is not just interesting, that it's an imperative that we understand it and learn to cure it fully. Agreed. So that's it for phantom limb pain and phantom limb sensation, everybody. If you thought that was pretty neat, there's a lot of interesting stuff to read about that

phenomenon, not syndrome though, we don't think. And since I said not syndrome, that means it's time for listener mail. I'm going to call this just sort of an enlightening email from a listener. Hey guys, long time listener, my first email to you was in 2013 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 isms about these expressions,

which serve to privilege or marginalize certain groups of people. My research is 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 latter fails to prepare children to react appropriately when they are faced with racism. And the same goes for anyism. As I wrote almost a decade ago, I still use your podcast with my grad students, and that is from Judd. Judson Laughter, he, him, his from UT in Knoxville. Go, Walls. Yeah, go, Walls. Right up the road. My, I guess, niece-in-law? Maybe. Okay. I think niece-in-law,

in-law potentially, just got into University of Tennessee, and it's like her dream. Like, she wants to go study the body farm. Chuck, doesn't that just do your hard work? Yeah, I love that. Yeah. 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 at StuffPodcast at iHeartRadio.com. Stuff you should know is a production of iHeartRadio. For more podcasts, My Heart Radio, visit the iHeartRadio app, Apple podcasts, or wherever you listen to your favorite shows. Life, tell everybody, yeah, everybody about my new podcast and make sure to listen so we'll never,

ever have to say bye-bye-bye. Listen to Frosted Tips with Lance Bass on the iHeart Radio app, Apple podcast, or wherever you listen to podcasts. I'm Munga Chauticular, and it turns out astrology is way more widespread than any of us want to believe. You can find it in Major League Baseball, International Banks, K-pop groups, even the White House. But just when I thought I had a handle on this subject, something completely unbelievable happened to me and my whole view on astrology changed. Whether you're a skeptic or a believer, give me a few minutes because I think your ideas are about to change too. Listen to Skyline Drive on the iHeart Radio app, Apple podcasts, or wherever you get your podcasts.