so I put children to sleep for a living.

我是一名小兒麻醉科醫生，

(Laughter)

所以我靠把孩子們弄睡來賺錢生活。

And I'm an academic, so I put audiences to sleep for free.

（眾笑）

(Laughter)

也是個專業學者,所以會免費催眠聽眾睡覺。

But what I actually mostly do

（眾笑）

is I manage the pain management service

但實際上我大部份的時間是在

at the Packard Children's Hospital up at Stanford in Palo Alto.

帕羅奧多市史丹佛大學附屬兒童醫院( Packard Children's Hospital )

And it's from the experience

裡幫助病童控制護理他們的疼痛。

from about 20 or 25 years of doing that

我已經擁有

that I want to bring to you the message this morning,

大約20年或25年的經驗，

that pain is a disease.

所以今天上午我想給你們傳遞一個消息:

Now most of the time,

疼痛是一種疾病。

you think of pain as a symptom of a disease,

大多數的時候，

and that's true most of the time.

我們都覺得疼痛是疾病所引起的一種症狀。

It's the symptom of a tumor or an infection

通常這是對的。

or an inflammation or an operation.

的確疼痛是腫瘤,感染,

But about 10 percent of the time,

發炎或手術後的症狀。

after the patient has recovered from one of those events,

但是,大約有百分之十的機會，

pain persists.

當病人已經完成痊癒後，

It persists for months

疼痛仍然存在。

and oftentimes for years,

有時持續幾個月，

and when that happens,

甚至於常常疼痛多年。

it is its own disease.

當發生這種情況時，

And before I tell you about how it is that we think that happens

疼痛本身就是一種疾病。

and what we can do about it,

在我還沒告訴你們,我們對慢性疼痛為何發生的推理,

I want to show you how it feels for my patients.

及我們可能治療它的方法之前,

So imagine, if you will,

我想讓你們瞭解我的病人疼痛的感覺。

that I'm stroking your arm with this feather,

如果你願意,想像一下，

as I'm stroking my arm right now.

我正用這個羽毛輕撫你的手臂,

Now, I want you to imagine

就像我現在輕撫自己手臂一樣

that I'm stroking it with this.

現在,我要您們想像,

Please keep your seat.

我是用噴火槍的火焰來"撫摸"你的手臂。

(Laughter)

請大家坐好,不要跑掉.

A very different feeling.

（眾笑）

Now what does it have to do with chronic pain?

一個非常不同的感覺吧。

Imagine, if you will, these two ideas together.

咦,這跟慢性疼痛有什麼關係啊?

Imagine what your life would be like

如果你願意再想像一下,把這兩個例子擺在一起。

if I were to stroke it with this feather,

想像一下你的生活會是什麼行情?

but your brain was telling you

如果我是用羽毛碰觸你,

that this is what you are feeling --

但你的大腦卻一再告訴你-

and that is the experience of my patients with chronic pain.

你正在被火紋身-(這就是你的感覺)

In fact, imagine something even worse.

這就是我的病人對慢性疼痛的經驗。

Imagine I were to stroke your child's arm with this feather,

事實上,更可怕的是,

and their brain [was] telling them

如果我是用羽毛碰觸你的孩子的手臂,

that they were feeling this hot torch.

他們的大腦卻告訴自己。

That was the experience of my patient, Chandler,

他們正被非常炙熱的火炬煎烤著.

whom you see in the photograph.

這就是我的病人,璇得拉,的經驗。

As you can see, she's a beautiful, young woman.

這是她的照片。

She was 16 years old last year when I met her,

正如你所看到的,她是一個美麗年輕的女孩。

and she aspired to be a professional dancer.

去年我見到她時她16歲，

And during the course of one of her dance rehearsals,

她渴望成為一名專業舞蹈演員。

she fell on her outstretched arm and sprained her wrist.

然而有一次舞蹈排練過程中,

Now you would probably imagine, as she did,

她跌落壓在在她自己伸展的一隻手臂上,並扭傷手腕。

that a wrist sprain is a trivial event

你可能會以為,在一個人的日常生活中,

in a person's life.

手腕扭傷是一個

Wrap it in an ACE bandage,

很小的事件。

take some ibuprofen for a week or two,

只要用一個ACE繃帶纏繞手腕,

and that's the end of the story.

再吃一至兩個星期的布洛芬止痛劑,

But in Chandler's case, that was the beginning of the story.

就可以了。

This is what her arm looked like

但是對璇得拉而言,她的血淚史才剛開始.

when she came to my clinic about three months after her sprain.

這是她來到我的診所時手臂的樣子,

You can see that the arm is discolored,

大概是發生意外扭傷三個月後，

purplish in color.

你可以看到那手臂已變色，

It was cadaverically cold to the touch.

帶點紫色。

The muscles were frozen, paralyzed --

摸起來有屍體一樣的冰冷感覺。

dystonic is how we refer to that.

肌肉已經凍結癱瘓--

The pain had spread from her wrist to her hands,

所謂肌肉張力不足異常.

to her fingertips, from her wrist up to her elbow,

疼痛已經從她的手腕擴散到她的手掌,

almost all the way to her shoulder.

到她的指尖,疼痛也從手腕漫延到胳膊肘,

But the worst part was,

幾乎到達她的肩膀。

not the spontaneous pain that was there 24 hours a day.

但是,最糟糕的是，

The worst part was that she had allodynia,

並非那持續每一天24小時自發性的疼痛,

the medical term for the phenomenon that I just illustrated

最糟糕的是她有痛覺過敏症,

with the feather and with the torch.

觸感痛是醫學上的術語。所產生的症狀

The lightest touch of her arm --

是跟羽毛與火炬的故事一樣。

the touch of a hand,

最輕微的觸摸她的手臂-

the touch even of a sleeve, of a garment, as she put it on --

觸摸她的手,

caused excruciating, burning pain.

甚至於當她穿衣時被衣袖觸到,被衣服磨到--

How can the nervous system get this so wrong?

都會造成難以忍受的燒灼痛。

How can the nervous system

神經系統為什麼會錯得那麼離譜?

misinterpret an innocent sensation

為什麼神經系統

like the touch of a hand

會曲解一個無害的感覺,

and turn it into the malevolent sensation

比如被手摸到,

of the touch of the flame?

轉達成被火焰灼傷

Well you probably imagine that the nervous system in the body

的惡意感覺?

is hardwired like your house.

你可能會想像人身體內的神經系統

In your house, wires run in the wall,

就像我們房子內的電線系統.

from the light switch to a junction box in the ceiling

房子裡,電線有系統的被嵌在牆壁裡,

and from the junction box to the light bulb.

從電燈開關到天花板的轉接箱,

And when you turn the switch on, the light goes on.

在從轉接箱到燈泡。

And when you turn the switch off, the light goes off.

當你打開開關,燈會亮起。

So people imagine the nervous system is just like that.

而當你關閉開關,燈就熄滅。

If you hit your thumb with a hammer,

因此,大家想神經系統就是像這樣子。

these wires in your arm -- that, of course, we call nerves --

如果你的拇指被錘子打著,

transmit the information into the junction box in the spinal cord

你的手臂內的電線--當然,我們稱之為神經

where new wires, new nerves,

-發送信息去脊髓的轉接箱,

take the information up to the brain

在那兒新線,新神經

where you become consciously aware that your thumb is now hurt.

傳遞信息到大腦，

But the situation, of course, in the human body

然後你會意識到你的拇指受傷了。

is far more complicated than that.

當然,在人體內的

Instead of it being the case

情況更為複雜得多。

that that junction box in the spinal cord

並不是單純的

is just simple where one nerve connects with the next nerve

像是在脊髓內的轉接箱,

by releasing these little brown packets

在那裡一個神經結連絡另一個神經結

of chemical information called neurotransmitters

通過釋放包含化學信息的小棕色包

in a linear one-on-one fashion,

就是神經傳導素來

in fact, what happens

線性一對一傳導訊息。

is the neurotransmitters spill out in three dimensions --

事實上，

laterally, vertically, up and down in the spinal cord --

神經傳導素的釋放是三方向的--

and they start interacting

在脊髓中:橫向，縱向，上下-

with other adjacent cells.

然後他們開始

These cells, called glial cells,

與其他相鄰的細胞相互影響.

were once thought to be

這些細胞被稱為神經膠質細胞，

unimportant structural elements of the spinal cord

以前被認為是

that did nothing more than hold all the important things together,

不重要的脊髓結構元素,

like the nerves.

除了幫助所有重要的物質(像神經細胞)

But it turns out

聚集一起外,一無用處。

the glial cells have a vital role

但事實證明，

in the modulation, amplification

膠質細胞,扮演至關重要的角色

and, in the case of pain, the distortion

不僅調配,放大,

of sensory experiences.

對疼痛的感覺,在扭曲的

These glial cells become activated.

感官經驗中

Their DNA starts to synthesize new proteins,

這些膠質細胞就活化起來。

which spill out

他們的DNA開始合成新的蛋白質，

and interact with adjacent nerves,

然後釋放出來

and they start releasing their neurotransmitters,

與相鄰神經互動

and those neurotransmitters spill out

然後神經細胞被活化,釋出神經傳導素,

and activate adjacent glial cells, and so on and so forth,

這些神經傳導素被釋放

until what we have

活化鄰近的神經膠質細胞.然後相同故事一再重演.

is a positive feedback loop.

直到一個

It's almost as if somebody came into your home

正向回饋循環系統產生。

and rewired your walls

這幾乎好像有人走進你的家,

so that the next time you turned on the light switch,

重新佈署你的牆中的電線系統.

the toilet flushed three doors down,

所以當下次你開燈時

or your dishwasher went on,

廁所馬桶自動乒乒乓乓沖洗.

or your computer monitor turned off.

或者洗碗機自動起動,

That's crazy,

或電腦顯視窗自動關閉.

but that's, in fact, what happens

這簡直是瘋了,

with chronic pain.

但事實就是這樣.這就是

And that's why pain becomes its own disease.

慢性疼痛的行情.

The nervous system has plasticity.

這也就是為什麼疼痛本身變成了疾病的原因。

It changes, and it morphs

神經系統具有(對環境改變的)可塑適應性。

in response to stimuli.

它會改變或者說變種

Well, what do we do about that?

來反應不同的刺激.

What can we do in a case like Chandler's?

那麼,我們該怎麼辦呢？

We treat these patients in a rather crude fashion

有什麼我們可以幫助璇得拉的呢?

at this point in time.

目前我們對這些病人的治療方法,還停留在

We treat them with symptom-modifying drugs --

一個相當粗糙的階段.

painkillers --

我們隨他們症狀改變調整藥物

which are, frankly, not very effective

--止痛藥--

for this kind of pain.

坦率地說,對這種痛苦

We take nerves that are noisy and active

藥物不是很有效。

that should be quiet,

對於原本是安靜但現在

and we put them to sleep with local anesthetics.

嘈雜過動的神經,

And most importantly, what we do

我們使用局部麻醉劑使它們睡覺.

is we use a rigorous, and often uncomfortable, process

但最重要的方法是,我們

of physical therapy and occupational therapy

採用很嚴格的，而且通常非常不舒服的

to retrain the nerves in the nervous system

物理治療及職業治療的過程來

to respond normally

再教育神經系統裡的神經,

to the activities and sensory experiences

反應正常。

that are part of everyday life.

尤其是那些日常生活的一切

And we support all of that

正常活動與感官經驗。

with an intensive psychotherapy program

我們利用

to address the despondency, despair and depression

密集心理治療課程

that always accompanies

來支持所有這一切因

severe, chronic pain.

嚴重慢性疼痛所伴隨引起的

It's successful,

沮喪,絕望和憂鬱症。

as you can see from this video of Chandler,

璇得拉的例子是成功了，

who, two months after we first met her,

你可以看到這個視頻中的璇得拉,

is now doings a back flip.

距離她第一次踏入我們的診療室後兩個月的現在,

And I had lunch with her yesterday

她已經可以表演後翻轉。

because she's a college student studying dance at Long Beach here,

昨天我和她一起吃午飯，

and she's doing absolutely fantastic.

因為她在Long Beach的一間大學學習舞蹈專業,

But the future is actually even brighter.

現在康復非常好,在校表現很棒.

The future holds the promise

實際上未來的藍圖將更美好。

that new drugs will be developed

曙光已出現,

that are not symptom-modifying drugs

新的有效藥品已經快要問世.

that simply mask the problem,

未來的藥品不再是只是症狀控制的藥物，

as we have now,

如我們所知現在的藥物

but that will be disease-modifying drugs

只會掩蓋了疼痛症狀而已。

that will actually go right to the root of the problem

新的藥品將為疾病本身作必要的修改(對症下藥)，

and attack those glial cells,

會確切的尋覓到疼痛根本的問題,

or those pernicious proteins

攻擊神經膠質細胞,

that the glial cells elaborate,

或那些神經膠質細胞

that spill over and cause this central nervous system wind-up,

所產生的有害的蛋白質,

or plasticity,

這些蛋白質釋出後會,導致這個中心神經系統罷工

that so is capable

或變異。

of distorting and amplifying

這麼就可以對抗

the sensory experience that we call pain.

扭曲和放大的感官經驗，

So I have hope

也就是我們所指的疼痛。

that in the future,

所以我希望

the prophetic words of George Carlin will be realized,

在不久的將來，

who said, "My philosophy:

喬治卡林的聞名真言可被實現:

No pain, no pain."

“我的哲學：

Thank you very much.

沒有痛苦，沒有痛苦。“

(Applause)

謝謝大家。