I'm a pediatrician and an anesthesiologist, so I put children to sleep for a living. (Laughter) And I'm an academic, so I put audiences to sleep for free. (Laughter) But what I actually mostly do is I manage the pain management service at the Packard Children's Hospital up at Stanford in Palo Alto. And it's from the experience from about 20 or 25 years of doing that that I want to bring to you the message this morning, that pain is a disease.
我係一名小兒科醫師亦係麻醉師, 我靠催眠D細路賺錢謀生。 (笑聲) 我仲係一名學者,我可以唔使錢催眠聽眾。 (笑聲) 但事實上我最做得最多嘅 係喺帕洛阿爾托市斯坦福帕卡德兒童醫院 進行痛楚管理。 喺果度嘅 有20至25年經驗 今日我想話比你地聽, 痛楚係一種疾病。
Now most of the time, you think of pain as a symptom of a disease, and that's true most of the time. It's the symptom of a tumor or an infection or an inflammation or an operation. But about 10 percent of the time, after the patient has recovered from one of those events, pain persists. It persists for months and oftentimes for years, and when that happens, it is its own disease. And before I tell you about how it is that we think that happens and what we can do about it, I want to show you how it feels for my patients. So imagine, if you will, that I'm stroking your arm with this feather, as I'm stroking my arm right now. Now, I want you to imagine that I'm stroking it with this. Please keep your seat. (Laughter) A very different feeling. Now what does it have to do with chronic pain? Imagine, if you will, these two ideas together. Imagine what your life would be like if I were to stroke it with this feather, but your brain was telling you that this is what you are feeling -- and that is the experience of my patients with chronic pain. In fact, imagine something even worse. Imagine I were to stroke your child's arm with this feather, and their brain [was] telling them that they were feeling this hot torch.
大多数情况, 你將痛楚睇成疾病嘅一種症狀。 好多時候都係啱嘅。 佢可以係腫瘤或某種感染 或者係某種炎症亦或者係手術嘅症狀。 但係有大概10%嘅情况, 患者從以上所講嘅情況恢復之後, 痛楚仍然持續。 而且持續好幾個月, 好多時仲係幾年。 哩種情況發生果陣, 佢就係疾病。 喺我講比你地聽佢點樣產生之前 以及我地可以點做之前, 我想同你地講下我D病人嘅感受。 如果可以,請你地想像一吓, 我用哩條羽毛掃你你嘅手臂, 就好似兒家我就掃緊自己。 請你地兒家開始想像吓 我用佢掃過哩度。 大家坐好D啊 (笑聲) 好唔同嘅感覺。 咁樣同慢性痛楚有咩關係呢? 想像吓,如果你將哩兩個想法混埋一齊。 想像你嘅生活會系點 如果我用羽毛掃過呢度, 但係你嘅大腦會話比你聽 哩個就係你嘅感覺 哩個就係我哥個慢性痛楚病人嘅經歷。 事實上,試想像某些更壞嘅事情。 想像我用羽毛掃過你細路嘅手臂, 佢地嘅大腦會話比佢地聽 佢地感覺到哩把高溫火焰。
That was the experience of my patient, Chandler, whom you see in the photograph. As you can see, she's a beautiful, young woman. She was 16 years old last year when I met her, and she aspired to be a professional dancer. And during the course of one of her dance rehearsals, she fell on her outstretched arm and sprained her wrist. Now you would probably imagine, as she did, that a wrist sprain is a trivial event in a person's life. Wrap it in an ACE bandage, take some ibuprofen for a week or two, and that's the end of the story. But in Chandler's case, that was the beginning of the story. This is what her arm looked like when she came to my clinic about three months after her sprain. You can see that the arm is discolored, purplish in color. It was cadaverically cold to the touch. The muscles were frozen, paralyzed -- dystonic is how we refer to that. The pain had spread from her wrist to her hands, to her fingertips, from her wrist up to her elbow, almost all the way to her shoulder.
哩個就係我個病人Chandler嘅經歷, 哩張係佢幅相。 你地見到佢係一個靚女。 我識佢果陣佢先至16歲, 佢渴望成為一位職業舞蹈員。 喺佢一次舞蹈排練嘅過程中, 佢跌親壓住咗伸出嘅手臂,跟住扭親埋手腕 兒家你地大概可以想象就好似佢感, 扭傷手腕喺人生中 只不過係件小事。 只需用ACE繃帶包紮吓, 只食一到兩個星期嘅布洛芬止痛藥, 就無乜事喇。 不過喺Chandler嘅病例中,服藥只係故事嘅開始。 哩個係佢手臂嘅樣 佢扭傷咗大概3個星期後先來穩我。 你地可以睇到佢嘅手臂, 已經褪色同埋發紫。 摸上去好似屍體咁凍。 肌肉僵硬、麻痹、 張力障礙。 痛楚從腕部擴展到手, 再到手指,痛楚從手腕擴展到肘部, 甚至幾乎到左肩部。
But the worst part was, not the spontaneous pain that was there 24 hours a day. The worst part was that she had allodynia, the medical term for the phenomenon that I just illustrated with the feather and with the torch. The lightest touch of her arm -- the touch of a hand, the touch even of a sleeve, of a garment, as she put it on -- caused excruciating, burning pain.
最惨嘅係, 並唔係自發嘅整日痛楚。 最慘嘅系佢掂下野就會痛, 醫學上叫觸痛 同剛才羽毛、高溫火焰一樣。 輕輕觸摸佢嘅手臂、 手, 甚至係衣袖 都會引發劇烈的、燒灼般嘅痛苦。
How can the nervous system get this so wrong? How can the nervous system misinterpret an innocent sensation like the touch of a hand and turn it into the malevolent sensation of the touch of the flame? Well you probably imagine that the nervous system in the body is hardwired like your house. In your house, wires run in the wall, from the light switch to a junction box in the ceiling and from the junction box to the light bulb. And when you turn the switch on, the light goes on. And when you turn the switch off, the light goes off. So people imagine the nervous system is just like that. If you hit your thumb with a hammer, these wires in your arm -- that, of course, we call nerves -- transmit the information into the junction box in the spinal cord where new wires, new nerves, take the information up to the brain where you become consciously aware that your thumb is now hurt.
神經系統系點解會錯成咁樣? 點解神經系統 誤解咗一個無辜嘅知覺 就好似摸佢隻手 會變成惡毒嘅知覺 火焰燒灼般嘅觸覺。 你大概可以想像機體中嘅神經系統 就好似你屋企裡面嘅導線。 在屋企裡面,導線佈滿牆壁, 從開關制到天花板嘅連接盒 從連接盒到燈泡。 當你開開關制,燈就著。 當你關閉開關制,燈就熄。 就用咁嘅方式想像神經系統。 如果一個錘打傷你嘅手指, 你手臂嘅導線,當然,我地稱為神經 將信息傳入脊髓裡面嘅連接盒 脊髓入面嘅新嘅線路、新嘅神經, 將信息上傳到大腦 你意識到你嘅手指受咗傷。
But the situation, of course, in the human body is far more complicated than that. Instead of it being the case that that junction box in the spinal cord is just simple where one nerve connects with the next nerve by releasing these little brown packets of chemical information called neurotransmitters in a linear one-on-one fashion, in fact, what happens is the neurotransmitters spill out in three dimensions -- laterally, vertically, up and down in the spinal cord -- and they start interacting with other adjacent cells. These cells, called glial cells, were once thought to be unimportant structural elements of the spinal cord that did nothing more than hold all the important things together, like the nerves. But it turns out the glial cells have a vital role in the modulation, amplification and, in the case of pain, the distortion of sensory experiences. These glial cells become activated. Their DNA starts to synthesize new proteins, which spill out and interact with adjacent nerves, and they start releasing their neurotransmitters, and those neurotransmitters spill out and activate adjacent glial cells, and so on and so forth, until what we have is a positive feedback loop.
不過在哩種情況下,當然,在人體內 要比哩個複雜好多。 並唔係甘純粹 連接盒在脊髓入邊 神經之間嘅聯繫非常簡單 通過釋放哩D棕色包裹 內涵化學信息,我地叫佢做神經遞質 線性一一傳導信息, 事實上, 神經遞質嘅釋放在三維空間裡進行 脊髓入面:橫向,縱向,垂直 佢地開始與相連嘅細胞 相互作用 哩D細胞叫做膠質細胞, 之前被認為係 脊髓中最唔重要嘅結構元素 除咗幫助所有重要嘅好似神經細胞甘嘅物質 聚合在一齊之外,無其他用途。 不過其實 膠質細胞扮演著一個重要角色 在調製,放大 同埋痛楚、扭曲 嘅感覺體驗入邊, 哩D膠質細胞被激活 佢地嘅DNA開始合成 新蛋白跟住釋放出来。 同相連嘅神經相互作用, 佢地開始釋放神經遞質 果D神經遞質釋放出去 激活相連嘅膠質細胞,一直持續向前, 直到找到 一個確定嘅反饋迴路。
It's almost as if somebody came into your home and rewired your walls so that the next time you turned on the light switch, the toilet flushed three doors down, or your dishwasher went on, or your computer monitor turned off. That's crazy, but that's, in fact, what happens with chronic pain. And that's why pain becomes its own disease. The nervous system has plasticity. It changes, and it morphs in response to stimuli.
就好似有人来到你屋企 重新在牆上拉線, 跟住下一次你開燈哥陣, 馬桶開始自動沖洗, 或者係你嘅洗碗機開咗, 或者係你嘅電腦屏幕開咗。 太瘋狂了, 但實際上就係咁 —— 慢性痛楚嘅情况。 也就係由痛楚變成疾病嘅原因。 神經系統有可塑性, 佢會改變,會變換 作為刺激嘅回應。
Well, what do we do about that? What can we do in a case like Chandler's? We treat these patients in a rather crude fashion at this point in time. We treat them with symptom-modifying drugs -- painkillers -- which are, frankly, not very effective for this kind of pain. We take nerves that are noisy and active that should be quiet, and we put them to sleep with local anesthetics. And most importantly, what we do is we use a rigorous, and often uncomfortable, process of physical therapy and occupational therapy to retrain the nerves in the nervous system to respond normally to the activities and sensory experiences that are part of everyday life. And we support all of that with an intensive psychotherapy program to address the despondency, despair and depression that always accompanies severe, chronic pain.
好,咁我地打算點做呢? Chandler嘅病例我地可以點做? 目前我地對於哩D患者嘅治療方法 仲停留在非常粗糙嘅階段。 我地用可以改變症狀嘅藥物來治療佢地 止痛药 講真,對於哩類痛楚來講 唔係特別有效。 對於本來安靜但係現在 亢奮過度嘅神經, 我地用局部麻醉方式令到佢地休眠。 最重要嘅係,我地所做嘅 係用一個嚴格嘅進程,通常並唔咁係舒服嘅 物理治療同職業療法 喺神經系統入面重新訓練神經 使到能正常應答 尤其係果D日常生活嘅所有 正常活動同感覺體驗。 我地全力支持 用密集嘅心裡療法計劃 打擊嚴重慢性痛楚所引起嘅 失望、绝望、 憂慮症狀。
It's successful, as you can see from this video of Chandler, who, two months after we first met her, is now doings a back flip. And I had lunch with her yesterday because she's a college student studying dance at Long Beach here, and she's doing absolutely fantastic.
Chandler嘅病例係成功嘅, 你地睇到嘅視頻来自Chandler, 兩個月後嘅现在, 正在進行後翻身跳轉。 我我昨天同佢一齊吃午餐, 因為佢喺在長灘市嘅大學學習舞蹈。 佢表演得太好了。
But the future is actually even brighter. The future holds the promise that new drugs will be developed that are not symptom-modifying drugs that simply mask the problem, as we have now, but that will be disease-modifying drugs that will actually go right to the root of the problem and attack those glial cells, or those pernicious proteins that the glial cells elaborate, that spill over and cause this central nervous system wind-up, or plasticity, that so is capable of distorting and amplifying the sensory experience that we call pain. So I have hope
未來會更加精彩。 未來將承諾 新藥將會發展 成唔係症狀控制嘅藥物 我地現在哩D藥物, 太輕易地掩飾痛楚。 但係改變症狀嘅藥物 將會真正瞄準問題嘅本源 攻擊果D會擴張神經膠質細胞 產生有害蛋白 有害嘅蛋白, 佢地嘅釋放會終結可塑嘅 樞神經系統, 咁樣就可以扭曲同放大 感覺體驗嘅能力 我地稱之為痛楚。 所以我希望
that in the future, the prophetic words of George Carlin will be realized, who said, "My philosophy: No pain, no pain."
在未来, George Carlin嘅预言可以被咁樣理解, 佢話:我嘅哲學: “唔痛,唔痛”
Thank you very much.
多谢大家
(Applause)
(鼓掌)