MEN IN A WAR

If they've lost a limb
Still feel that limb
As they did before

He lay on a cot
He was drenched in a sweat
He was mute and staring
But feeling the thing
He had not

--Suzanne Vega, Men in a War
from Days of Open Hand (1990)

Learn more about Crystal Davis
and other Iraq war veterans in
Ward 57 at Walter Reed Medical Center

Suzanne Vega is not a neuropsychologist or a neurologist, but she describes phantom limb pain as eloquently as Oliver Sacks or Ramachandran and Blakeslee in Phantoms in the Brain:

Tom was not crazy. His impression that his missing arm was still there is a classic example of a phantom limb--an arm or a leg that lingers in the minds of patients long after it has been lost in an accident or removed by a surgeon. Some wake up from anesthesia and are in shock when told that their arm had to be sacrificed, because they still vividly feel its presence. Only when they look under the sheets do they come to the shocking realization that the limb is really gone. Moreover, some of these patients experience excruciating pain in the phantom arm, hand, or fingers, so much so that they contemplate suicide. The pain is not only unrelenting, it's also untreatable; no one has the foggiest idea of how it arises or how to deal with it.

What are the mechanisms underlying phantom limb pain? The Wellcome Trust has an informative website, Pain: Science, medicine, history, culture, that accompanies its 'Pain: Passion, compassion, sensibility' exhibition at the Science Museum in London. According to Jonathan Cole,

There may be many mechanisms underlying phantom limb pain. Damage to nerve endings is often important: subsequent erroneous regrowth can lead to abnormal and painful discharge of neurons in the stump, and may change the way that nerves from the amputated limb connect to neurons within the spinal cord. There is also evidence for altered nervous activity within the brain as a result of the loss of sensory input from the amputated limb.

According to Suzanne Vega,

If your nerve is cut
If you're kept on the stretch
You don't feel your will
You can't find your gut

And she lay on her back
She made sure she was hid
She was mute and staring
Not feeling the thing
That she did

--Suzanne Vega, ibid

What is being done to help those suffering with such excruciating pain? The latest treatment, developed by researchers at the University of Manchester, involves a virtual reality world that lets amputees see and move a 3D phantom limb. Jonathan Cole describes his own work using virtual reality [and explains why these approaches are superior to earlier visual tricks that fool people into thinking they're moving their amputated limb, such as the mirror box]. In essence,

attempts to link the visual and motor systems might be helping patients recreate a coherent body image, and so reduce pain as a result of reduced and disordered input...

...in experiments still being developed, we are constructing an arm in virtual reality which subjects with phantom limb pain will move themselves using motion capture techniques. Movement of their stump will be captured by a movement-tracking device, and used to project the movement of the reconstituted limb in virtual reality. We anticipate that this will lead to a sense of re-embodiment in the virtual arm and hence to a reduction of the pain.

These new approaches are all based on a shift in emphasis in phantom limb pain away from the site of damage – the stump – to the centre of pain processing: the brain. It appears that disordered inputs from the limb's sensory systems, combined with disrupted motor signal back to the limb, generate a mismatch between the brain's built-in map of the physical body and what is actually perceived. For some reason, this mismatch results in pain.

Returning to the title of this post, MEN IN A WAR, what is being said and done by the President of the United States?

Our past efforts to secure Baghdad failed for two principal reasons: There were not enough Iraqi and American troops to secure neighborhoods that had been cleared of terrorists and insurgents. And there were too many restrictions on the troops we did have.

. . .

So America will change our strategy to help the Iraqis carry out their campaign to put down sectarian violence and bring security to the people of Baghdad. This will require increasing American force levels. So I have committed more than 20,000 additional American troops to Iraq.