Stories to ignite curiosity
The following stories from the world of neuroscience are striking to me and could be really worthwhile for every health professional – they can make you think, and ignite your curiosity. These stories demonstrate how life and human beings are interestingly cool and sophisticated. There are some powerful therapeutic narratives to explain sensorimotor cortex influences on our life, especially when we have the patients there at the right moment and time.
Phantom penises are not new, since the first written reports about ‘sensory ghosts’ back in 1870, the first mention of the phantom penis was in 1950. It had been reported by men who underwent penile surgery because of cancer. The same study reports patients experiencing phantom erection 20 years after surgery (1). There is obviously a strong mechanism at play, even though it is not as widely discussed as other phantom conditions.
A hypothesis from V.S. Ramachandran
The neurosurgeon V.S Ramachandran, well known for his theories and research regarding phantom limbs, has put forward a hypothesis regarding phantom penises(2):
“We predict that male-to-female transsexuals, who have undergone gender reassignment surgery, will experience a far lower incidence of having a phantom penis than men who have had their penis amputated for other reasons. Similarly, female-to-male transsexuals who have had chest reconstruction surgery will not experience phantom breast sensations as frequently as women who undergo mastectomy for cancer”
“some female-to-male transsexuals will have the vivid sensation of having a penis – a phantom penis – even though there is not one physically there.”
The medical hypothesis has not yet been followed up, but there is a good chance that the results will be consistent with findings in phantom limb sensations after amputation. Especially because the male penis is located in the sensorimotor cortex (S1) just like many other representations of the body. (3)
A vital question
This raises the question – why would males who underwent a penile amputation in the process of gender reassignment be less likely to have a phantom sensation. Following on from Ramachandran’s thinking, we could say – if you don’t want to lose your body part you will also be less likely to lose it in your brain’s representation. This seems to be supported by research amongst women who have undergone mastectomy following breast cancer – with 17-34% reporting phantom breasts, with a good number experiencing horrendous, ongoing pain.
Well, here is a nice nugget to share and explain how the brain, and particularly the bodily representations (S1) are able to change – loving your body part helps you to keep it! Conversely, those who have a body part that is not fundamentally ‘them’ and who have perhaps long ago ‘amputated’ this part of their physical body in their representation, are less likely to experience a phantom because the representation is already greatly weakened, or perhaps no longer there.
There is a cautionary story to be told too – don’t leave your injured body area ‘out in the cold’, don’t give it a name – it is you! Loss of body ownership is not helpful in getting better and is not uncommon in conditions such as stroke and low back pain (5).
By using this nugget you might get to a vital point. The brain never sleeps – it is always changing and adapting, it can lose a body part, but it can regain, or even add one too.
-Bart van Buchem
Bart is teaching Explain Pain (Begrijp de Pijn) in Emnes on the 17 and 25 June 2016 – enquire HERE
Bart lives in Haarlem, The Netherlands, where he works in private multidisciplinary practice (Praktijk Noorder Spaarne) and specialises in treating and supporting people with chronic pain. Bart is responsible for founding the NOI Faculty in the Netherlands and together with Mark Langerhorst he translated the ‘Explain Pain’ text into Dutch. Bart has completed his Masters in Physiotherapy and is enrolled in a PhD program working on the development of an Explain Pain curriculum for clinicians and patients. This research includes a RCT in a CBT + Explain Pain intervention in order to fit the Explain Pain approach into the usual care program of a multidisciplinary pain centre. Bart teaches physiotherapy both at undergraduate and postgraduate level with a focus on pain topics and as a NOI teacher he teaches Explain Pain courses across the Netherlands.
- Wade NJ, Finger S. Phantom penis: historical dimensions. J Hist Neurosci [Internet]. 2010;19(4):299–312. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20938855
- Ramachandran VS, McGeoch PD. Occurrence of phantom genitalia after gender reassignment surgery. Med Hypotheses. 2007;69(5):1001–3.
- Kell CA. The Sensory Cortical Representation of the Human Penis: Revisiting Somatotopy in the Male Homunculus. J Neurosci [Internet]. 2005;25(25):5984–7. Available from: http://www.jneurosci.org/cgi/doi/10.1523/JNEUROSCI.0712-05.2005
- Ahmed A, Bhatnagar S, Rana SPS, Ahmad SM, Joshi S, Mishra S. Prevalence of phantom breast pain and sensation among postmastectomy patients suffering from breast cancer: A prospective study. Pain Pract. 2014;14(2):17–28.
- Moseley GL. I can’t find it! Distorted body image and tactile dysfunction in patients with chronic back pain. Pain [Internet]. International Association for the Study of Pain; 2008;140(1):239–43. Available from: http://dx.doi.org/10.1016/j.pain.2008.08.001
We’re hitting the road and taking our NOI courses right across this great southern land:
Townsville 29 April – 1 May Explain Pain and Graded Motor Imagery (Final places and final days – don’t miss out)
Canberra 3 – 4 May Mobilisation of the Neuroimmune System (only Australian MONIS course for 2016)
Canberra 6 – 8 May Explain Pain and Graded Motor Imagery
Adelaide 14-15 May Pain, Plasticity and Rehabilitation (only Australian PPR course for 2016)
Noosa 17 – 19 June Explain Pain and Graded Motor Imagery
Perth 15 – 17 October Explain Pain and Graded Motor Imagery
EP3 events have sold out three years running in Australia, and we are super excited to be bringing this unique format to the United States in late 2016 with Lorimer Moseley, Mark Jensen, David Butler, and few NOI surprises.
EP3 EAST Philadelphia, December 2, 3, 4 2016
EP3 WEST Seattle, December 9, 10, 11 2016
To register your interest, contact NOI USA:
p (610) 664-4465