Phantom Limb Pain: Georgia Firefighter Still Feels Pain Years After His Arm Was Amputated

Phantom Limb Pain:Georgia Firefighter Still Feels Pain Years After His Arm Was Amputated

- Gene Hull knows his right arm is gone.  But tell that to his brain.

"I feel my arm constantly," Hull says. Like, I feel it right now."

The 53-year old Columbus Fire Department Captain's medical journey began 9 years ago.

 Diagnosed with cancer in the tissue around his right collarbone, Hull underwent surgery to amputate not just his right arm, but most of his shoulder.

But right when he came out of anesthesia, he got this really strange feeling.

"I talked to my doctor." Hull remembers. "And I told him I had the sensation my arm was still there."

They call this "phantom limb syndrome." Emory University interventional radiologist Dr. David Prologo says about 85 percent of people who lose a limb, still feel it.

"And what is worse is that that missing limb is painful," Dr. Prologo says.

To Hull, and a lot of survivors, the phantom limb pain felt like a jolt of electricity.

"Every so often I would get real sharp electrical jabs that would eliminate from my fingers and would run up to where my shoulder used to be," Hull says.

The problem is Gene's brain is getting abnormal pain signals from the nerves that were cut and damaged with his arm was amputated.   So, the brain perceives pain, in his case shocks, coming from a golf ball-sized area of nerve scar tissue right at the amputation point.

"The best way I can describe the pain is that if you take a wire and run it between your ring and your middle finger, all the way up to your elbow, and just shoot it with electricity," Hull says.

Dr. Prologo thinks he may have found a way to stop phantom limb pain, or at least turn it down.  Larry Garrufalo was awake, but sedated when he became the 18th patient in an Emory University clinical trial to test out cryoablation therapy, which uses cold to freeze and destroy the severed nerves thought to be causing the pain.

"The residual nerve forms a scar called a neuroma," says Prologo. "And that neuroma sends false signals to the brain about pain in a limb that's no longer present."

Prologo's approach is experimental, but promising.  It's minimally-invasive and can be performed on an outpatient basis.

As Garrufalo lies in CT scanner, Dr. Prologo inserts a cold-tipped probe through the skin; down into the scar tissue, located near the point Garrufalo's lower leg was amputated. Then, for 25 minutes, Prologo drops the temperature of the probe, freezing the neuroma, or scar tissue, to shut down the nerve transmissions to the brain.

Gene Hull had this same procedure six months ago. He came back for checkup. If you compare his "before" and "after" scans, the scar tissue is 95 percent gone. So is his pain.

"I feel great now," Hull says. "I still get a little bit of a twinge now and then but it's nothing compared to what it was."

It took 9 years, and an "outside the box" approach, but Gene Hull is pain-free, thanks to cryoablation.

"It's one of those things, you know: why haven't they thought of this earlier?"  Hull says.

Cryoablation is still experimental for phantom limb pain. Dr. Prologo says the potential is huge for military veterans who've lost a limb in combat. He's applying for a Department of Defense grant that would fund a multi-site clinical trial to test cryoablation in treating military amputees with phantom limb pain.

For more information about this study, contact the Emory University School of Medicine, Division of Interventional Radiology and Image Guided Medicine at 404-509-9132, 404-520-3233 or john.david.prologo@emory.edu.


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