It starts with an itch and ends with Ramachandran

With the weekend coming up, here’s a nice longer read from the archives of The New Yorker

THE ITCH

Its mysterious power may be a clue to a new theory about brains and bodies.

BY ATUL GAWANDE JUNE 30, 2008

“One morning, after she was awakened by her bedside alarm, she sat up and, she recalled, “this fluid came down my face, this greenish liquid.” She pressed a square of gauze to her head and went to see her doctor again. M. showed the doctor the fluid on the dressing. The doctor looked closely at the wound. She shined a light on it and in M.’s eyes. Then she walked out of the room and called an ambulance. Only in the Emergency Department at Massachusetts General Hospital, after the doctors started swarming, and one told her she needed surgery now, did M. learn what had happened. She had scratched through her skull during the night—and all the way into her brain.

“They kept telling me I had O.C.D.,” M. said. A psychiatric team was sent in to see her each day, and the resident would ask her, “As a child, when you walked down the street did you count the lines? Did you do anything repetitive? Did you have to count everything you saw?” She kept telling him no, but he seemed skeptical. He tracked down her family and asked them, but they said no, too.

The second theory seemed less likely. If the nerves to her scalp were dead, how would you explain the relief she got from scratching, or from the local anesthetic? Indeed, how could you explain the itch in the first place? An itch without nerve endings didn’t make sense. The neurosurgeons stuck with the first theory; they offered to cut the main sensory nerve to the front of M.’s scalp and abolish the itching permanently. Oaklander, however, thought that the second theory was the right one—that this was a brain problem, not a nerve problem—and that cutting the nerve would do more harm than good. She argued with the neurosurgeons, and she advised M. not to let them do any cutting.

“But I was desperate,” M. told me. She let them operate on her, slicing the supraorbital nerve above the right eye. When she woke up, a whole section of her forehead was numb—and the itching was gone. A few weeks later, however, it came back, in an even wider expanse than before. The doctors tried pain medications, more psychiatric medications, more local anesthetic. But the only thing that kept M. from tearing her skin and skull open again, the doctors found, was to put a foam football helmet on her head and bind her wrists to the bedrails at night.

Some of her doctors have not been willing to let go of the idea that this has been a nerve problem all along. A local neurosurgeon told her that the original operation to cut the sensory nerve to her scalp must not have gone deep enough. “He wants to go in again,” she told me.

Our sensations of pain, itch, nausea, and fatigue are normally protective. Unmoored from physical reality, however, they can become a nightmare: M., with her intractable itching, and H., with his constellation of strange symptoms—but perhaps also the hundreds of thousands of people in the United States alone who suffer from conditions like chronic back pain, fibromyalgia, chronic pelvic pain, tinnitus, temporomandibular joint disorder, or repetitive strain injury, where, typically, no amount of imaging, nerve testing, or surgery manages to uncover an anatomical explanation. Doctors have persisted in treating these conditions as nerve or tissue problems—engine failures, as it were. We get under the hood and remove this, replace that, snip some wires. Yet still the sensor keeps going off.

So we get frustrated. “There’s nothing wrong,” we’ll insist. And, the next thing you know, we’re treating the driver instead of the problem. We prescribe tranquillizers, antidepressants, escalating doses of narcotics.

I called Ramachandran to ask him about M.’s terrible itch. The sensation may be a phantom, but it’s on her scalp, not in a limb, so it seemed unlikely that his mirror approach could do anything for her.

“Now, suppose she looks in this mirror and scratches the left side of her head. No, wait—I’m thinking out loud here—suppose she looks and you have someone elsetouch the left side of her head. It’ll look—maybe it’ll feel—like you’re touching the right side of her head.” He let out an impish giggle. “Maybe this would make her itchy right scalp feel more normal.” Maybe it would encourage her brain to make a different perceptual inference; maybe it would press reset. “Who knows?” he said.

It seemed worth a try.” (emphases added)

Grab a beverage and enjoy a fascinating read.

-Tim Cocks

 

 

PS: Anyone else itchy all over after reading the article?

 

 

Scratch the knowledge itch at a noigroup course

3 Responses to “It starts with an itch and ends with Ramachandran”

  1. barrettdorko

    Several members of Soma Simple discussed this in 2008 (there’s a thread) and itching has been examined elsewhere there. I remember Earl Pettman (legendary Canadian manual therapist with a great laugh) asking over beer late one night 20 years ago, “What is an itch?” I never forgot the question.

    Reply
  2. davidboltononoi

    Maybe when we talk of thought viruses we need to expand on our vocabulary and add itch, squeeze, throb, fizz, buzz etc. etc. etc. ……I think I have shared this before but my favorite was the patient who described the sensation in his foot to that of the feeling of “A Jack Russell peeing on it” !!!!!

    Reply

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