Can people born without a limb experience phantom limb pain?
The American Civil War of 1861 was a bloody conflict, leaving more than a million casualties, with an estimated 700,000 deaths. The weapons of war, particularly the firearms, may have been inaccurate - but they were remarkably injurious when they hit their mark. And with explosives like early hand grenades and rocket shells, soldiers were often met with hot shrapnel and percussive blasts.
And it didn’t help that a regiment of soldiers may only have one or two surgeons on hand to treat their wounds. The number of injured quickly overwhelmed the surgeon once the shooting and explosions began. To save lives, surgeons had to work as quickly as possible. Stabilize, then move onto the next patient.
Often times, the bullet wound shatters the bone, fragmenting it into several tiny shards. There was absolutely no time to remove each and every piece of debris from the bullet hole. It was far more cost-efficient to simply amputate the injured limb. Battlefield surgery was crude, and sawing off the injured limb was the easiest way to treat the soldiers in the short term, and to prevent a slow spread of gangrenous infection in the long term.
Because of the expediency that was needed in the theater of war, approximately one in thirteen veterans had to have a limb amputated.
Taken from https://en.wikipedia.org/wiki/American_Civil_War
One of the best known physicians of the Civil War era was Silas Weir Mitchell, a neurologist trained in Philadelphia. The bloody war had provided him with the opportunity to describe many unique case studies, mostly soldiers wounded in combat.
One of his most notable patients was George Dedlow, who Mitchell wrote about in an 1866 article in Atlantic Monthly. In this essay, Mitchell described a neurological examination of the soldier who had lost all four limbs in a battle. In describing Dedlow and other patients with missing limbs, he was one of the first to offer a description of phantom limbs, the perception that an amputated limb was still intact:
“Where the leg, for instance, has been lost, they feel as if the foot was present, but as though the leg were shortened. If the thigh has been taken off, there seems to them to be a foot at the knee; if the arm, a hand seems to be at the elbow, or attached to the stump itself.”
Although the feeling of the body part being there is innocuous, sometimes the patient experiences an intense pain of the missing limb. Patients describe this phantom limb pain as a throbbing or tingling, or more severely, a clenching, burning, or stabbing pain.1 Neurologist VS Ramachandran describes more of these sensations in his book, Phantoms in the Brain.
While these pains are most commonly experienced following limb amputations, internal organs are also susceptible to phantom pains, ranging from the appendix to the uterus - women have reported pain sensations identical in “quality, intensity, duration and location” to menstrual cramps following complete hysterectomy.2,3
(And here I suspect that half of you are wondering, and the answer is yes, phantom penises also exist. In one case study, a man had a complete penis removal following the discovery of a painful carcinoma. In the years following the penectomy, he experienced phantom pain similar to the pre-operative pain, phantom urine passing, and even phantom erections upon the presentation of erotic content)4.
Do people who are missing limbs from birth experience phantom limbs and phantom pain?
In the cases of amputation following a bullet wound, the person has had several years of knowing what it was like to have the hand, arm, foot, or leg present (the average age of a Civil War soldier was 26). But what about for people who are born without their limbs?
It turns out they are also susceptible to phantom limb and pain sensations, but at a significantly lower rate than people who have amputations. One study found that 20% of people with congenital limb loss can experience phantom limbs and phantom pain. Some notable case studies include:
A 14-year old boy who has weekly dreams where his hands are intact, and upon waking, perceives functional phantom hands
An 11-year old girl who learned to count and solve math problems on her phantom fingers
A woman who gesticulates during speech, despite having been born with no arms
The implication behind these phantom limbs is interesting. It suggests that the developing brain has a set schema for what might be expected from a typically-developing human: two arms and two legs. The parietal lobe expects to receive these inputs, regardless of whether the limbs actually develop. And when the brain doesn’t get those inputs from the body parts, it may create the phantom sensations to keep the deafferented sections of the brain active.