Medicine: Phantom Exorcises

Surgeons have known for 400 years that patients who undergo amputations continue to have "sensations," ranging from a pleasant tingling to excruciating pain, in the limb that is no longer there. They have dubbed it "pain in the phantom limb." Now surgeons are coming around to the idea that the best way to exorcise many cases of phantom pain is by phantom exercise.

Dr. Allen Sidney Russek of New York University's rehabilitation center pioneered the exercise method as part of an effort to treat both the physical and emotional aspects of the pain. It is especially important to get rid of phantom pain if an artificial limb is to be fitted, says Dr. Russek, or the patient may be deterred from trying to use the new limb.

Last week Dr. Russek described the case of an upstate New York electrician who lost his left arm and suffered massive scarring in an electrical burn last year. The patient, 38, felt that his phantom left arm was doubled behind him, that the hand was numb, and that every now and then electric shocks coursed up and down the arm, with sparks snapping off his fingertips.

Before he could fit an artificial arm, Dr. Russek had the patient (who is righthanded) exercise the phantom: standing in front of a blackboard, he closed his eyes, and "practiced" writing with his nonexistent left hand. The mental effort evidently worked through the nerve stumps and nearby muscles. After months of phantom writing, the electrician said that he had brought the phantom arm around in front of his body, and could raise it over his head. More tangibly, scar tissue that had been painfully contracted was stretched, so that an extensive grafting operation became unnecessary. Now virtually free of phantom pain, the patient has an artificial arm and is training to be a bookkeeper.