TED2011
Elliot Krane: The mystery of chronic pain
艾略特·克兰：慢性疼痛之谜
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我们认为疼痛是一种症状，但经神经系统的反射，疼痛本身已经成为一种疾病。我们就从一个女孩手腕扭伤后演变成噩梦的故事说起。艾略特·克兰讲述了关于慢性疼痛的繁复奥秘，探索慢性疼痛的病理以及治疗的方式。
Elliot Krane - Pediatric anesthesiologist
At the Lucile Packard Children's Hospital at Stanford, Elliot Krane works on the problem of treating pain in children. Full bio
At the Lucile Packard Children's Hospital at Stanford, Elliot Krane works on the problem of treating pain in children. Full bio
Double-click the English transcript below to play the video.
00:15
I'm a pediatrician and an anesthesiologist,
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我是一名儿科医生和麻醉师，
00:17
so I put children to sleep for a living.
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我以帮孩子们入睡为生。
00:19
(Laughter)
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（笑声）
00:21
And I'm an academic, so I put audiences to sleep for free.
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我也是一名大学教师，所以我免费让听我讲课的人打瞌睡。
00:24
(Laughter)
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（笑声）
00:28
But what I actually mostly do
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但我主要从事的
00:30
is I manage the pain management service
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还是提供管理疼痛的服务
00:32
at the Packard Children's Hospital up at Stanford in Palo Alto.
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在帕罗奥多市 斯坦福大学的 帕卡德儿童医院。
00:35
And it's from the experience
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从经验上来讲，
00:37
from about 20 or 25 years of doing that
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根据我20或25年的执业经验
00:39
that I want to bring to you the message this morning,
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今早，我想告诉你的是，
00:41
that pain is a disease.
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疼痛是一种病。
00:43
Now most of the time,
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大多数时候，
00:45
you think of pain as a symptom of a disease,
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你会认为疼痛是一种症状。
00:47
and that's true most of the time.
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大多数情况下，这种想法是正确的。
00:49
It's the symptom of a tumor or an infection
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它的确是肿瘤和感染的症状
00:52
or an inflammation or an operation.
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或者是发炎、手术中的症状。
00:54
But about 10 percent of the time,
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但有约10％的情况下，
00:57
after the patient has recovered from one of those events,
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病人虽然已经从上述情况下康复，
01:00
pain persists.
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但疼痛依然继续。
01:02
It persists for months
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有时候持续几个月
01:04
and oftentimes for years,
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甚至持续几年。
01:06
and when that happens,
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当这种情况发生时，
01:08
it is its own disease.
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疼痛本身就是一种疾病。
01:10
And before I tell you about how it is that we think that happens
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在我向你讲解它是如何发生
01:13
and what we can do about it,
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我们可以采取何种措施之前，
01:15
I want to show you how it feels for my patients.
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我想向你展示一下，病人对此的感受。
01:18
So imagine, if you will,
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如果可以，请你想象一下，
01:20
that I'm stroking your arm with this feather,
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我用这根羽毛挠你，
01:22
as I'm stroking my arm right now.
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就像现在我挠自己的手臂一样。
01:25
Now, I want you to imagine
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现在，我要你想象
01:27
that I'm stroking it with this.
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如果我是用这个（喷火枪）“挠”你呢？
01:29
Please keep your seat.
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请大家只管坐好！
01:31
(Laughter)
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（笑声）
01:33
A very different feeling.
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非常迥异的感觉。
01:35
Now what does it have to do with chronic pain?
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这跟慢性疼痛有什么关联呢？
01:37
Imagine, if you will, these two ideas together.
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如果这两个感觉被混淆了
01:40
Imagine what your life would be like
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想象一下你的生活将会怎样
01:42
if I were to stroke it with this feather,
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如果我是用这根羽毛去挠你，
01:45
but your brain was telling you
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结果你的大脑却告诉你
01:47
that this is what you are feeling --
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你现在的感觉是灼伤--
01:49
and that is the experience of my patients with chronic pain.
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这就是我的患者对慢性疼痛的感受。
01:52
In fact, imagine something even worse.
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事实上，想象下更糟糕的情况。
01:54
Imagine I were to stroke your child's arm with this feather,
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想象下我用这根羽毛去挠你孩子的胳膊，
01:57
and their brain [was] telling them
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结果他们的大脑却告诉他们
01:59
that they were feeling this hot torch.
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他们感受到的是这个灼热的喷火枪。
02:02
That was the experience of my patient, Chandler,
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这就是我的患者，钱德勒的遭遇，
02:04
whom you see in the photograph.
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就是照片中的女孩。
02:06
As you can see, she's a beautiful, young woman.
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正如你看到的，她是个漂亮的年轻姑娘。
02:08
She was 16 years old last year when I met her,
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去年当我遇到她时，她16岁，
02:10
and she aspired to be a professional dancer.
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她渴望成为一名专业的舞者。
02:13
And during the course of one of her dance rehearsals,
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在她的一次舞蹈排练中，
02:15
she fell on her outstretched arm and sprained her wrist.
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她摔倒压在了自己向外伸展的手臂上，并且扭伤了手腕。
02:18
Now you would probably imagine, as she did,
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就像当时钱德勒的想法，
02:20
that a wrist sprain is a trivial event
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你可能也认为这就是人生当中
02:22
in a person's life.
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一次普通的受伤。
02:24
Wrap it in an ACE bandage,
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用绷带缠起来
02:26
take some ibuprofen for a week or two,
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吃点布洛芬，一周或两周
02:28
and that's the end of the story.
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事情就会结束。
02:30
But in Chandler's case, that was the beginning of the story.
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但是在钱德勒这次的遭遇中，这只是故事的开始。
02:34
This is what her arm looked like
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图中是当时她手臂的情况
02:36
when she came to my clinic about three months after her sprain.
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当她来到我的诊所时，已经是扭伤发生约三个月后
02:39
You can see that the arm is discolored,
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你可以看到手臂已经变色
02:41
purplish in color.
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有点青紫
02:43
It was cadaverically cold to the touch.
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摸上去像尸体一样冷
02:45
The muscles were frozen, paralyzed --
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肌肉僵硬--
02:47
dystonic is how we refer to that.
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我们通常所说的瘫痪性肌张力异常。
02:50
The pain had spread from her wrist to her hands,
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疼痛从她的手腕蔓延到手掌，
02:53
to her fingertips, from her wrist up to her elbow,
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到手指，又从手腕蔓延到手肘，
02:56
almost all the way to her shoulder.
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一直到她的肩膀。
02:58
But the worst part was,
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但最糟糕的
03:00
not the spontaneous pain that was there 24 hours a day.
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不是每天24小时的自发性疼痛。
03:03
The worst part was that she had allodynia,
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最糟糕的是她患上痛觉超敏症
03:06
the medical term for the phenomenon that I just illustrated
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这是一个医学术语
03:09
with the feather and with the torch.
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说的就是我刚才用羽毛和喷火枪所演示的那种情况
03:11
The lightest touch of her arm --
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轻微的触碰她的手臂
03:13
the touch of a hand,
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触碰手掌，
03:15
the touch even of a sleeve, of a garment, as she put it on --
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即使是她自己穿衣服时触碰到手袖、衣物
03:18
caused excruciating, burning pain.
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也会造成难以忍受的烧灼痛
03:22
How can the nervous system get this so wrong?
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神经系统怎么会犯这样的错呢？
03:25
How can the nervous system
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神经系统
03:27
misinterpret an innocent sensation
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怎么会误解一个本来无害的触觉呢？
03:29
like the touch of a hand
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就像是把手的触摸
03:31
and turn it into the malevolent sensation
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误解成
03:34
of the touch of the flame?
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触摸火焰的恶意感觉。
03:36
Well you probably imagine that the nervous system in the body
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把身体里的神经系统
03:39
is hardwired like your house.
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想象成你家里的电线电路。
03:41
In your house, wires run in the wall,
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在你家里，电线布满在墙壁里，
03:43
from the light switch to a junction box in the ceiling
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从灯的开关到天花板上的接线盒
03:46
and from the junction box to the light bulb.
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从接线盒又到灯泡。
03:49
And when you turn the switch on, the light goes on.
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当你打开开关的时候，灯泡亮了
03:51
And when you turn the switch off, the light goes off.
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等你关闭开关的时候，灯泡熄灭。
03:54
So people imagine the nervous system is just like that.
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假设神经系统就是这样。
03:58
If you hit your thumb with a hammer,
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如果你用锤子敲大拇指，
04:00
these wires in your arm -- that, of course, we call nerves --
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你手臂里的电线——当然，我们称为神经——
04:03
transmit the information into the junction box in the spinal cord
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在脊髓里传递信息到接线盒
04:06
where new wires, new nerves,
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新电线，新的神经
04:08
take the information up to the brain
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把信息运送到大脑
04:10
where you become consciously aware that your thumb is now hurt.
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因此你能自觉意识到你的大拇指受伤了。
04:14
But the situation, of course, in the human body
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这个情况，当然，是发生在身体里的
04:16
is far more complicated than that.
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实际上更复杂一些。
04:19
Instead of it being the case
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相反
04:21
that that junction box in the spinal cord
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脊髓里的接线盒
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is just simple where one nerve connects with the next nerve
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仅仅是一段神经联系另一段神经的地方
04:26
by releasing these little brown packets
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通过释放这些小棕色块
04:28
of chemical information called neurotransmitters
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也就是被称为神经递质的化学信息
04:31
in a linear one-on-one fashion,
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以一对一的线性方式
04:34
in fact, what happens
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事实上
04:36
is the neurotransmitters spill out in three dimensions --
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是神经递质发散出三维空间--
04:38
laterally, vertically, up and down in the spinal cord --
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在脊髓里横向、纵向、以及上下地--
04:41
and they start interacting
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它们和其他邻近的细胞之间
04:43
with other adjacent cells.
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开始发生反应。
04:46
These cells, called glial cells,
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这些细胞，称为神经胶质细胞，
04:48
were once thought to be
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它们曾经被认为
04:50
unimportant structural elements of the spinal cord
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是脊髓里不重要的结构构件
04:52
that did nothing more than hold all the important things together,
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仅仅是把其他重要的东西连接在一起，
04:54
like the nerves.
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比如说神经。
04:56
But it turns out
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结果却发现
04:58
the glial cells have a vital role
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在疼痛的案例中，神经胶质细胞
05:00
in the modulation, amplification
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在调节，扩大
05:02
and, in the case of pain, the distortion
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和歪曲
05:05
of sensory experiences.
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感觉体验的作用中起着非常重要的作用。
05:08
These glial cells become activated.
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这些胶质细胞活跃起来。
05:10
Their DNA starts to synthesize new proteins,
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它们的脱氧核糖核酸开始合成新的蛋白质
05:12
which spill out
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同时发散出来
05:14
and interact with adjacent nerves,
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与邻近的神经发生反应。
05:16
and they start releasing their neurotransmitters,
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释放出神经递质。
05:19
and those neurotransmitters spill out
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神经递质又被发散出来
05:21
and activate adjacent glial cells, and so on and so forth,
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激活了邻近的胶质细胞，然后如此循环往复，
05:24
until what we have
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直到
05:26
is a positive feedback loop.
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神经反射。
05:28
It's almost as if somebody came into your home
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几乎就像是有人到你家
05:30
and rewired your walls
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重新在你墙壁里布线，
05:32
so that the next time you turned on the light switch,
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结果你下次打开灯的开关，
05:34
the toilet flushed three doors down,
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却意外的冲了三次马桶，
05:36
or your dishwasher went on,
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或者是启动了洗碗机，
05:38
or your computer monitor turned off.
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或者是电脑显示器被关闭。
05:40
That's crazy,
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乱套了！
05:42
but that's, in fact, what happens
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但事实上，
05:44
with chronic pain.
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这就是患上慢性疼痛后，会发生的事情。
05:46
And that's why pain becomes its own disease.
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也是为什么疼痛本身会变成一种疾病。
05:49
The nervous system has plasticity.
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神经系统有可塑性。
05:51
It changes, and it morphs
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对刺激做出反应
05:53
in response to stimuli.
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它会改变，也会变异。
05:55
Well, what do we do about that?
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那我们该怎么办呢？
05:57
What can we do in a case like Chandler's?
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针对钱德勒这样的情况我们该怎么做呢？
06:00
We treat these patients in a rather crude fashion
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我们用相对粗糙的一种方式来治疗这些患者
06:02
at this point in time.
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目前是这样的。
06:04
We treat them with symptom-modifying drugs --
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我们用控制症状的药物来治疗
06:07
painkillers --
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也就是止疼药
06:09
which are, frankly, not very effective
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坦白说，对于这种病
06:11
for this kind of pain.
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不是很有效。
06:13
We take nerves that are noisy and active
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我们只是让那些吵闹的神经
06:15
that should be quiet,
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消停下来，
06:17
and we put them to sleep with local anesthetics.
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用局部麻醉来使它们进入睡眠。
06:19
And most importantly, what we do
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最重要的是，我们所做的
06:22
is we use a rigorous, and often uncomfortable, process
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只是用枯燥且常不舒服的
06:26
of physical therapy and occupational therapy
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物理治疗和职业治疗法
06:29
to retrain the nerves in the nervous system
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来在神经系统里维持神经
06:32
to respond normally
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使它们在日常生活的
06:35
to the activities and sensory experiences
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感官活动中
06:38
that are part of everyday life.
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做出正常的反应。
06:40
And we support all of that
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对此，我们用密集的心理治疗方案
06:42
with an intensive psychotherapy program
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进行全力的配合
06:45
to address the despondency, despair and depression
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解决那些
06:48
that always accompanies
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伴随严重慢性疼痛而来的
06:50
severe, chronic pain.
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沮丧、绝望和抑郁。
06:52
It's successful,
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我们很成功！
06:54
as you can see from this video of Chandler,
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正如你从这个视频短片中看到的钱德勒，
06:56
who, two months after we first met her,
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在我们遇见她两个月之后，
06:58
is now doings a back flip.
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她正做着后空翻。
07:00
And I had lunch with her yesterday
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昨天我刚和她一起吃了午饭，
07:02
because she's a college student studying dance at Long Beach here,
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因为现在，她是在长滩学习舞蹈的一名大学生。
07:05
and she's doing absolutely fantastic.
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她现在简直是棒极了！
07:07
But the future is actually even brighter.
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未来更加美好！
07:11
The future holds the promise
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未来有希望
07:14
that new drugs will be developed
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开发新的药物
07:16
that are not symptom-modifying drugs
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不是那些只会控制症状的药物
07:19
that simply mask the problem,
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它们仅仅是粉饰问题。
07:21
as we have now,
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而是，正如我们现在看到的，
07:23
but that will be disease-modifying drugs
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去开发那种治病的药物
07:26
that will actually go right to the root of the problem
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能真正从根本上解决问题
07:28
and attack those glial cells,
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对付神经胶质细胞
07:30
or those pernicious proteins
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或对付那些由神经胶质细胞产生的
07:32
that the glial cells elaborate,
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有害的蛋白质
07:35
that spill over and cause this central nervous system wind-up,
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它们溢出后使中枢神经系统产生发条拧紧现象，
07:38
or plasticity,
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产生神经的可塑性，
07:40
that so is capable
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因此就有可能
07:42
of distorting and amplifying
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歪曲和扩大了
07:44
the sensory experience that we call pain.
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我们称为疼痛的感觉体验。
07:46
So I have hope
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所以，我有一个愿望
07:48
that in the future,
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在将来
07:50
the prophetic words of George Carlin will be realized,
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乔治·卡林的预言会实现，
07:53
who said, "My philosophy:
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他说，“我的哲学是：
07:55
No pain, no pain."
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没痛就不痛。”
07:59
Thank you very much.
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非常感谢
08:01
(Applause)
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（鼓掌声）
ABOUT THE SPEAKER
Elliot Krane - Pediatric anesthesiologistAt the Lucile Packard Children's Hospital at Stanford, Elliot Krane works on the problem of treating pain in children.
Why you should listen
It's an awful problem to contemplate: How do you help a young child in pain? As director of Pain Management Services at Lucile Packard Children's Hospital at Stanford, Elliot Krane works on solving this problem, studying and treating kids who are undergoing surgeries, suffering from complications of diabetes -- and kids suffering "neuropathic pain" resulting from injury to the nervous system itself.
Elliot Krane | Speaker | TED.com