ABOUT THE SPEAKER
Elliot Krane - Pediatric anesthesiologist
At 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.

More profile about the speaker
Elliot Krane | Speaker | TED.com
TED2011

Elliot Krane: The mystery of chronic pain

艾略特·克兰:慢性疼痛之谜

Filmed:
2,012,954 views

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。
- Pediatric anesthesiologist
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儿科医师 and an anesthesiologist麻醉师,
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我是一名儿科医生和麻醉师,
00:17
so I put children孩子 to sleep睡觉 for a living活的.
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我以帮孩子们入睡为生。
00:19
(Laughter笑声)
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(笑声)
00:21
And I'm an academic学术的, so I put audiences观众 to sleep睡觉 for free自由.
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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笑声)
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(笑声)
00:28
But what I actually其实 mostly大多 do
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但我主要从事的
00:30
is I manage管理 the pain疼痛 management管理 service服务
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还是提供管理疼痛的服务
00:32
at the Packard惠普 Children's儿童 Hospital醫院 up at Stanford斯坦福 in Palo帕洛阿尔托 Alto奥拓.
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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经验
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从经验上来讲,
00:37
from about 20 or 25 years年份 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带来 to you the message信息 this morning早上,
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今早,我想告诉你的是,
00:41
that pain疼痛 is a disease疾病.
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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疼痛 as a symptom症状 of a disease疾病,
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你会认为疼痛是一种症状。
00:47
and that's true真正 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症状 of a tumor or an infection感染
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它的确是肿瘤和感染的症状
00:52
or an inflammation or an operation手术.
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或者是发炎、手术中的症状。
00:54
But about 10 percent百分 of the time,
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但有约10%的情况下,
00:57
after the patient患者 has recovered恢复 from one of those events事件,
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病人虽然已经从上述情况下康复,
01:00
pain疼痛 persists仍然存在.
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但疼痛依然继续。
01:02
It persists仍然存在 for months个月
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有时候持续几个月
01:04
and oftentimes通常情况下 for years年份,
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甚至持续几年。
01:06
and when that happens发生,
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当这种情况发生时,
01:08
it is its own拥有 disease疾病.
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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发生
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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显示 you how it feels感觉 for my patients耐心.
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我想向你展示一下,病人对此的感受。
01:18
So imagine想像, if you will,
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如果可以,请你想象一下,
01:20
that I'm stroking行程 your arm with this feather羽毛,
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我用这根羽毛挠你,
01:22
as I'm stroking行程 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想像
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现在,我要你想象
01:27
that I'm stroking行程 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座位.
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请大家只管坐好!
01:31
(Laughter笑声)
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(笑声)
01:33
A very different不同 feeling感觉.
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非常迥异的感觉。
01:35
Now what does it have to do with chronic慢性 pain疼痛?
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这跟慢性疼痛有什么关联呢?
01:37
Imagine想像, if you will, these two ideas思路 together一起.
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如果这两个感觉被混淆了
01:40
Imagine想像 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行程 it with this feather羽毛,
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如果我是用这根羽毛去挠你,
01:45
but your brain was telling告诉 you
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结果你的大脑却告诉你
01:47
that this is what you are feeling感觉 --
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你现在的感觉是灼伤--
01:49
and that is the experience经验 of my patients耐心 with chronic慢性 pain疼痛.
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这就是我的患者对慢性疼痛的感受。
01:52
In fact事实, imagine想像 something even worse更差.
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事实上,想象下更糟糕的情况。
01:54
Imagine想像 I were to stroke行程 your child's孩子的 arm with this feather羽毛,
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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告诉 them
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结果他们的大脑却告诉他们
01:59
that they were feeling感觉 this hot torch火炬.
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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经验 of my patient患者, Chandler钱德勒,
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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照片.
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就是照片中的女孩。
02:06
As you can see, she's a beautiful美丽, young年轻 woman女人.
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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年份 old last year when I met会见 her,
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去年当我遇到她时,她16岁,
02:10
and she aspired渴望 to be a professional专业的 dancer舞蹈家.
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她渴望成为一名专业的舞者。
02:13
And during the course课程 of one of her dance舞蹈 rehearsals排练,
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在她的一次舞蹈排练中,
02:15
she fell下跌 on her outstretched伸开 arm and sprained扭伤 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大概 imagine想像, as she did,
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就像当时钱德勒的想法,
02:20
that a wrist sprain扭伤 is a trivial不重要的 event事件
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你可能也认为这就是人生当中
02:22
in a person's人的 life.
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一次普通的受伤。
02:24
Wrap it in an ACE高手 bandage绷带,
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用绷带缠起来
02:26
take some ibuprofen布洛芬 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结束 of the story故事.
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事情就会结束。
02:30
But in Chandler's钱德勒的 case案件, that was the beginning开始 of the story故事.
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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看着 like
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图中是当时她手臂的情况
02:36
when she came来了 to my clinic诊所 about three months个月 after her sprain扭伤.
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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脱色的,
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你可以看到手臂已经变色
02:41
purplish紫色 in color颜色.
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有点青紫
02:43
It was cadavericallycadaverically cold to the touch触摸.
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摸上去像尸体一样冷
02:45
The muscles肌肉 were frozen冻结的, paralyzed --
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肌肉僵硬--
02:47
dystonic肌张力障碍 is how we refer参考 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疼痛 had spread传播 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指尖, from her wrist up to her elbow弯头,
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到手指,又从手腕蔓延到手肘,
02:56
almost几乎 all the way to her shoulder.
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一直到她的肩膀。
02:58
But the worst最差 part部分 was,
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但最糟糕的
03:00
not the spontaneous自发 pain疼痛 that was there 24 hours小时 a day.
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不是每天24小时的自发性疼痛。
03:03
The worst最差 part部分 was that she had allodynia异常性疼痛,
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最糟糕的是她患上痛觉超敏症
03:06
the medical term术语 for the phenomenon现象 that I just illustrated插图
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这是一个医学术语
03:09
with the feather羽毛 and with the torch火炬.
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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最轻 touch触摸 of her arm --
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轻微的触碰她的手臂
03:13
the touch触摸 of a hand,
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触碰手掌,
03:15
the touch触摸 even of a sleeve, of a garment服装, 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造成 excruciating痛苦, burning燃烧 pain疼痛.
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也会造成难以忍受的烧灼痛
03:22
How can the nervous紧张 system系统 get this so wrong错误?
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神经系统怎么会犯这样的错呢?
03:25
How can the nervous紧张 system系统
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神经系统
03:27
misinterpret曲解 an innocent无辜 sensation感觉
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怎么会误解一个本来无害的触觉呢?
03:29
like the touch触摸 of a hand
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就像是把手的触摸
03:31
and turn it into the malevolent坏心肠的 sensation感觉
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误解成
03:34
of the touch触摸 of the flame火焰?
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触摸火焰的恶意感觉。
03:36
Well you probably大概 imagine想像 that the nervous紧张 system系统 in the body身体
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把身体里的神经系统
03:39
is hardwired硬线 like your house.
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想象成你家里的电线电路。
03:41
In your house, wires电线 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开关 to a junction连接点 box in the ceiling天花板
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从灯的开关到天花板上的接线盒
03:46
and from the junction连接点 box to the light bulb灯泡.
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从接线盒又到灯泡。
03:49
And when you turn the switch开关 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开关 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想像 the nervous紧张 system系统 is just like that.
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假设神经系统就是这样。
03:58
If you hit击中 your thumb拇指 with a hammer锤子,
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如果你用锤子敲大拇指,
04:00
these wires电线 in your arm -- that, of course课程, we call nerves神经 --
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你手臂里的电线——当然,我们称为神经——
04:03
transmit发送 the information信息 into the junction连接点 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电线, new nerves神经,
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新电线,新的神经
04:08
take the information信息 up to the brain
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把信息运送到大脑
04:10
where you become成为 consciously自觉 aware知道的 that your thumb拇指 is now hurt伤害.
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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情况, of course课程, in the human人的 body身体
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这个情况,当然,是发生在身体里的
04:16
is far more complicated复杂 than that.
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实际上更复杂一些。
04:19
Instead代替 of it being存在 the case案件
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相反
04:21
that that junction连接点 box in the spinal cord
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脊髓里的接线盒
04:23
is just simple简单 where one nerve神经 connects所连接 with the next下一个 nerve神经
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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释放 these little brown棕色 packets
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通过释放这些小棕色块
04:28
of chemical化学 information信息 called neurotransmitters神经递质
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也就是被称为神经递质的化学信息
04:31
in a linear线性 one-on-one一对一 fashion时尚,
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以一对一的线性方式
04:34
in fact事实, what happens发生
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事实上
04:36
is the neurotransmitters神经递质 spill out in three dimensions尺寸 --
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是神经递质发散出三维空间--
04:38
laterally横向, vertically垂直, 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开始 interacting互动
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它们和其他邻近的细胞之间
04:43
with other adjacent cells细胞.
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开始发生反应。
04:46
These cells细胞, called glial神经胶质 cells细胞,
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这些细胞,称为神经胶质细胞,
04:48
were once一旦 thought to be
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它们曾经被认为
04:50
unimportant不重要 structural结构 elements分子 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保持 all the important重要 things together一起,
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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神经.
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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神经胶质 cells细胞 have a vital重要 role角色
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在疼痛的案例中,神经胶质细胞
05:00
in the modulation调制, amplification放大
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在调节,扩大
05:02
and, in the case案件 of pain疼痛, the distortion失真
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和歪曲
05:05
of sensory感觉的 experiences经验.
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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神经胶质 cells细胞 become成为 activated活性.
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这些胶质细胞活跃起来。
05:10
Their DNA脱氧核糖核酸 starts启动 to synthesize合成 new proteins蛋白质,
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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哪一个 spill out
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同时发散出来
05:14
and interact相互作用 with adjacent nerves神经,
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与邻近的神经发生反应。
05:16
and they start开始 releasing释放 their neurotransmitters神经递质,
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释放出神经递质。
05:19
and those neurotransmitters神经递质 spill out
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神经递质又被发散出来
05:21
and activate启用 adjacent glial神经胶质 cells细胞, and so on and so forth向前,
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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直到 what we have
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直到
05:26
is a positive feedback反馈 loop循环.
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神经反射。
05:28
It's almost几乎 as if somebody came来了 into your home
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几乎就像是有人到你家
05:30
and rewired重新布线 your walls墙壁
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重新在你墙壁里布线,
05:32
so that the next下一个 time you turned转身 on the light switch开关,
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结果你下次打开灯的开关,
05:34
the toilet厕所 flushed three doors down,
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却意外的冲了三次马桶,
05:36
or your dishwasher洗碗机 went on,
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或者是启动了洗碗机,
05:38
or your computer电脑 monitor监控 turned转身 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事实, what happens发生
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但事实上,
05:44
with chronic慢性 pain疼痛.
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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疼痛 becomes its own拥有 disease疾病.
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也是为什么疼痛本身会变成一种疾病。
05:49
The nervous紧张 system系统 has plasticity可塑性.
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神经系统有可塑性。
05:51
It changes变化, and it morphs变种
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对刺激做出反应
05:53
in response响应 to stimuli刺激.
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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案件 like Chandler's钱德勒的?
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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对待 these patients耐心 in a rather crude原油 fashion时尚
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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对待 them with symptom-modifying改善症状 drugs毒品 --
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我们用控制症状的药物来治疗
06:07
painkillers止痛药 --
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也就是止疼药
06:09
which哪一个 are, frankly坦率地说, not very effective有效
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坦白说,对于这种病
06:11
for this kind of pain疼痛.
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不是很有效。
06:13
We take nerves神经 that are noisy嘈杂 and active活性
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我们只是让那些吵闹的神经
06:15
that should be quiet安静,
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消停下来,
06:17
and we put them to sleep睡觉 with local本地 anesthetics麻醉剂.
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用局部麻醉来使它们进入睡眠。
06:19
And most importantly重要的, what we do
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最重要的是,我们所做的
06:22
is we use a rigorous严格, and often经常 uncomfortable不舒服, process处理
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只是用枯燥且常不舒服的
06:26
of physical物理 therapy治疗 and occupational职业 therapy治疗
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物理治疗和职业治疗法
06:29
to retrain再培训 the nerves神经 in the nervous紧张 system系统
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来在神经系统里维持神经
06:32
to respond响应 normally一般
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使它们在日常生活的
06:35
to the activities活动 and sensory感觉的 experiences经验
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感官活动中
06:38
that are part部分 of everyday每天 life.
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做出正常的反应。
06:40
And we support支持 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集约 psychotherapy心理治疗 program程序
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进行全力的配合
06:45
to address地址 the despondency沮丧, despair绝望 and depression萧条
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解决那些
06:48
that always accompanies相伴
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伴随严重慢性疼痛而来的
06:50
severe严重, chronic慢性 pain疼痛.
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沮丧、绝望和抑郁。
06:52
It's successful成功,
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我们很成功!
06:54
as you can see from this video视频 of Chandler钱德勒,
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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个月 after we first met会见 her,
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在我们遇见她两个月之后,
06:58
is now doings行为 a back flip翻动.
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她正做着后空翻。
07:00
And I had lunch午餐 with her yesterday昨天
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昨天我刚和她一起吃了午饭,
07:02
because she's a college学院 student学生 studying研究 dance舞蹈 at Long Beach海滩 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绝对 fantastic奇妙.
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她现在简直是棒极了!
07:07
But the future未来 is actually其实 even brighter光明.
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未来更加美好!
07:11
The future未来 holds持有 the promise诺言
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未来有希望
07:14
that new drugs毒品 will be developed发达
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开发新的药物
07:16
that are not symptom-modifying改善症状 drugs毒品
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不是那些只会控制症状的药物
07:19
that simply只是 mask面具 the problem问题,
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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疾病修饰 drugs毒品
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去开发那种治病的药物
07:26
that will actually其实 go right to the root of the problem问题
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能真正从根本上解决问题
07:28
and attack攻击 those glial神经胶质 cells细胞,
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对付神经胶质细胞
07:30
or those pernicious有害 proteins蛋白质
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或对付那些由神经胶质细胞产生的
07:32
that the glial神经胶质 cells细胞 elaborate阐述,
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有害的蛋白质
07:35
that spill over and cause原因 this central中央 nervous紧张 system系统 wind-up结束,
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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可塑性,
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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扭曲 and amplifying放大
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歪曲和扩大了
07:44
the sensory感觉的 experience经验 that we call pain疼痛.
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我们称为疼痛的感觉体验。
07:46
So I have hope希望
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所以,我有一个愿望
07:48
that in the future未来,
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在将来
07:50
the prophetic预言的 words of George乔治 Carlin卡林 will be realized实现,
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乔治·卡林的预言会实现,
07:53
who said, "My philosophy哲学:
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他说,“我的哲学是:
07:55
No pain疼痛, no pain疼痛."
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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掌声)
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(鼓掌声)
Translated by Diwen Mueller
Reviewed by Angelia King

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ABOUT THE SPEAKER
Elliot Krane - Pediatric anesthesiologist
At 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.

More profile about the speaker
Elliot Krane | Speaker | TED.com