Ketamine Therapy May Offer Hope For Healing Phantom Limb Syndrome
It was to be one of their Vespa excursions, down near the boot of Italy. He was a wildly adventurous guy who collected cars—he had twenty or so—and a collection of Vespas. Too far to scooter from Florence, they loaded a Vespa into a specialty vehicle, drove some hours and began their ride. In a remote rural area, on a dirt road, driving the hump in the middle of the road, she exposed on the back, he driving and behind the front fairing. A small car suddenly turned the corner. In an instant, her left leg was destroyed, amputated, her foot dangling from threads of flesh, much of her leg embedded in the fender and grill of the car. Thrown to the ground, she began to bleed out. Somehow in presence of mind she got him to rig a tourniquet above the shredded limb. Remarkably, she never lost consciousness, practicing yogic breathing throughout the ordeal. He was uninjured.
They were in a remote area with no people around. There was no phone reception. She would die if they did not find help immediately. The driver and her man got in the damaged car leaving her at the side of the road. It took them some 20 minutes to come back with help. The nearest ambulance was thirty minutes away, in Matera. When they arrived, she was on the way out—hypovolemic shock, and barely conscious.
They shot her up with morphine and took her to a small, deserted field where she then was helicoptered to the nearest hospital with a trauma center in Potenza. Four surgeons worked to amputate and save as much as they could of her leg—a below the knee stump of barely an inch and a half in length. She spent 10 days in the hospital and then checked herself out to get back to her home. She needed to breathe, to feel there would be a life left to her. Upon her return to Florence she was prescribed large amounts of narcotics, including fentanyl, that she would take for the next 7 months, disturbingly altering her experience of self.
Her Phenomenal Will to Heal
This woman, Michele Barocchi, is no ordinary character. She is thick with survival instincts, and self-sufficiency. Born of an American mother and an Italian physicist father, that relationship gave way before she was two years old. Michele spent most of her young adult life travelling between Tuscany and California until she was 33, when she decided to move back to her native land and work as a research scientist at the former Novartis (currently GSK) in Siena, Italy.
Michele is an accomplished and independent person. She has a masters in public health and a PhD in infectious disease and immunology. She worked in urban slums in Brazil studying the epidemiology of leptospirosis and later in the lab studying the molecular biology of the disease.
Phantom limb syndrome, of which pain is but one agonizing part of the complex, occurs in over 50% of amputees. It is often chronic and present for years, occurring unpredictably and without relation to an inciting cause. The pain is variously described as aching, cramping, shooting, burning, tingling, stabbing and a mix of these. In Michele’s case, it began virtually immediately. Her experience was that below her left knee’s short stump, there was the sensation of a projection of her leg extending two inches beyond, or as she demonstrates a finger length beyond where her actual remaining leg ended.
For Michele, an episode of phantom limb pain begins with a sensation of pins and needles, extending from the end of the stump, followed by twitching, then a sense of hot discharges, like waves of electricity, experienced all below the stump. In the first months, the waves or “contractions” as she calls them, occurred nearly contiguously lasting 30 seconds with an interval between each as long as four minutes and as short as 30 seconds. She would scream in agony despite the opiates, fentanyl, and other medications. Sleep and mental clarity were impossible. The stump was infected and required constant care. It still does.
Given her childhood, Michele has had great experience in making her own way and following her instincts. In frustration, after six months of heavy and only partially effective analgesics, she voluntarily discontinued these medications and went through the withdrawal on her own, motivated by the desire to feel who she was despite the consequences. She had an acupuncture session and experienced her full leg’s presence to her toes. This is the only occurrence of this sort.
Michele utilized CBD, massage therapy, and breathwork. She returned to her earlier psychedelic path, focusing on ayahuasca, and travelling to the Peruvian Amazon repeatedly for more than three years, sitting in isolation in dietas, and learning to prepare the medicine. The experiences support her struggle, but do not staunch her pain. It is a prolonged and constant struggle to heal. Hypervigilance, fear of cars, fear of impending pain, depression, involuntary recollections of the accident and its aftermath, irritability all are part of her struggle—and her phenomenal will to heal.
Evolution of the Pain
After six years of the phantom limb pain occurring many times each day, in Michele’s words, ‘It starts to taper away. It begins to resolve on its own, but it doesn’t disappear. It comes back when it wants. I don’t know why. I looked in the literature. No one knows why this kind of pain gets triggered. It just arrives sporadically – five to six episodes a year. One episode every two months, which lasts four to five days, many times a day.’ According to Michele, it was an unbearable life, constantly wondering when the pain would return and how long it would last.
In January 2022, after nearly seven years of agony and struggle, Michele is somewhat casually offered ketamine for insufflation. Her provider had heard that ketamine had remarkable powers to heal chronic pain, but did not know if it would work on her phantom pain. This took place on what is called the Epiphany in the Italian religious calendar, Friday January 7th .
One day Michele is in the midst of an episode and ingests some ketamine. Experiencing a profound ketamine dissociation, she returns to full consciousness with the miracle of being pain free. A first of its kind, even with all the many remedies she has tried. A sudden epiphany of potential relief and the possibility of a pain free life. Indeed, she has no further episodes, until November of the same year, when she blocked the full episode with ketamine. It is now August 2024 and there have been no further episodes. The use of ketamine not only alleviated her pain but also opened new avenues for understanding the complex relationship between physical pain and mental health.
Despite continuing symptoms of PTSD, she has been set free to pursue her life. Michele is now channelling her experience into action, working to establish a MAPS (Multidisciplinary Association for Psychedelic Studies) affiliate in Italy and teaching breathwork.
New Hope Calls For More Research
The literature on ketamine’s clinical use for phantom limb pain is small and inadequate, with only a handful of case reports. It is suggestive, but compromised in its application by the investigator’s ignorance of ketamine’s dissociative properties, which are labelled as undesirable side effects. These stopped further investigation. Inadequate low doses and an absence of a series of treatments further limit these investigations. Ketamine has many interesting impacts on pain and a variety of syndromes — all of which are in various states of exploration. Michele’s experience did not occur in a clinical setting and cannot be reported as a case study per se.
Michele and I offer this account here as a dynamic possibility for the exploration of ketamine treatment for the agonies of phantom limb syndrome and to further the understanding of the intrinsic link between pain and mental health.
We are hopeful that there will soon be a clinical research study of ketamine and phantom limb pain, which we believe will support Michele’s remarkable experience.