Erasing the body's painful memories; Procedure: A delicate operation on his spinal cord takes away a Canadian farmer's increasingly debilitating phantom pain.


Of all the injuries Earl Moncrieff suffered in the terrible, head-on car collision, the trauma to his left hand was the worst. The throbbing, constant pain often crescendoed without warning, as if someone had suddenly banged his hand with a sledgehammer. Years after the crash, he would cry out and drop to his knees in the middle of the supermarket.

But there was one problem that prevented doctors from treating him: Moncrieff no longer had a left hand.

Along with much of his left arm, it had been all but severed in the accident. Although doctors initially reattached the arm, they eventually realized Moncrieff would never regain use of the limb. In 1996, they cut it off several inches above the elbow, hoping to ease his pain.

Instead, something strange happened: The agony worsened. It was as if his body was playing an eerie trick on him. He could still feel his arm and the outline of each of his fingers as clearly, as sharply, as before. Phantom pain, the doctors called it.

Moncrieff, who owns a cattle and grain farm in a small town outside Calgary, Canada, had to stop working. He gulped narcotics every few hours, and rested heated bags of grain on the stump below his left shoulder. Nothing helped -- nor could any of the dozens of specialists in Canada that Moncrieff sought out.

Then Moncrieff's primary doctor remembered: There was a Canadian neurosurgeon who left Calgary to work at Johns Hopkins years earlier. The neurosurgeon, Allan Belzberg, specialized in the delicate, risky area of nerves inside the spinal cord that lead to the limbs -- the area responsible for Moncrieff's pain.

Belzberg knew that the nerves, damaged in the accident, were going haywire -- sending abnormal messages that the brain interpreted as pain. The only way to cease the messages was to snuff out the nerves in a surgery that carried a risk of paralysis.

"The pain was just so bad," Moncrieff said, "I decided it had to be worth it."

The surgery was a painstaking process. Wielding a tiny electrode, Belzberg peered through a microscope and burned the spinal cord in 92 places, where scar tissue indicated nerve damage. It took five hours.

As soon as Moncrieff woke up, the neurosurgeon asked him to move his legs -- then sighed with relief.

Yesterday, in a small examining room at Hopkins, Moncrieff met with Belzberg a final time before returning to Canada. The doctor asked Moncrieff to describe his pain, on a scale of one to 10, before the surgery.

"On some days, 15," said Moncrieff, whose shirt sleeve was pinned up at the shoulder.

And today?


Losing an arm could have been devastating. Simple things, like buttoning a shirt, are now a struggle.

Moncrieff thinks about the simple things a lot these days -- not the things he can no longer do, but the things he can finally enjoy.

"I don't know if I'll be able to farm again," he said, "but just being able to enjoy life again. ... Just to be able to walk without hurting."

He can drive again, now that narcotics no longer cloud his brain, and take his wife to the movies, and play with his three grandchildren. He imagines a future, different from what he once envisioned, perhaps, but still filled with possibility, and he smiles.

Pub Date: 2/09/99

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