How to Hack Your Brain When You're in Pain | Amy Baxter | TED

翻译人员: Alvin Lee 校对人员: Yip Yan Yeung

So if you whack your thumb with a hammer, you think pain is in your thumb.

如果你用锤子捶你的大拇指， 你以为疼的是你的大拇指。

Physicians have a more sophisticated understanding.

医生有一种更复杂的解释。

We know that it's an alarm that goes, on nerves, to your spine,

我们知道，这是一种警报， 通过神经传到脊柱，

where it is translated to your brain, and pain actually happens ...

然后再传导到你的大脑， 疼痛其实发生在……

somewhere.

某个地方。

It's a little vague.

有点说不清楚。

我们在医学院时，

We actually only get two days of pain education

throughout all of medical school, so ...

其实总共只上过两天的疼痛课。

In fact, the only pain lecture I remember from the '90s

其实，我唯一记得的一节疼痛课， 还是 90 年代，

was in a dark room like this,

当时就是在这样一个比较暗的房间里，

after being awake for 30 hours and hungry,

连续 30 个小时保持不睡不吃后，

and finding out our noon lecture was sponsored by OxyContin.

发现我们中午的课 是奥施康定赞助的。

We got pens, we got great lasagna,

他们给我们发了笔， 提供了很好吃的千层面，

and they had very cool slides that showed pain stopped by opioids.

做了一些非常酷的幻灯片， 展示了阿片类药物如何止痛。

And we learned that home opioids aren't addictive,

我们了解到家用阿片类药物 并不会让人上瘾，

and if you stay ahead of pain --

如果你能赶在疼痛袭来之前——

（笑声）

(Laughter)

那你就可以让你的病人免于疼痛。

you can keep your patients pain-free.

And beyond the obviously egregious marketing,

除了很明显的极端营销外，

I think it was framing "pain-free" as the goal

它标榜以“无痛”为目标，

that has destroyed countless lives.

而这个目标毁掉了无数生命。

My friend's son Christopher started having severe abdominal pain

我朋友的儿子克里斯多弗 开始有严重的腹痛问题，

during this "no-pain" era.

正是在那个“无痛”的时代。

Eventually, he was diagnosed with a colon disease

最终，他确诊为得了一种结肠病，

and had surgery his senior year.

高三的时候做了手术。

They sent Christopher home with 90 OxyContin,

克里斯多夫弗出院时， 医院给他开了 90 盒奥施康定，

and then 90 more,

之后又开了 90 盒，

and then, as the pain started getting faster and faster ...

再后来，随着疼痛 发生得越来越频繁……

Uncontrolled pain is terrifying.

不受控制的疼痛是很可怕的。

So when his ran out and his friends' medicine cabinets ran out,

所以当他的药吃完了， 他朋友家的药也吃完了，

Christopher tried heroin.

克里斯多弗开始尝试海洛因。

And Christopher Wolf lost his battle with substance use at age 32.

克里斯多弗·沃尔夫 最终死于过度使用药物，终年 32 岁。

So did we misunderstand pain?

是我们误解了疼痛吗？

What if pain isn’t an alarm to silence

假如疼痛并不是一个 需要你关掉的警报，

but a learning system for survival?

而是一个生存学习系统呢？

TED pose.

TED 专属姿势。

(Laughter)

（笑声）

(Cheers and applause)

（欢呼、鼓掌）

Pain is every organism's primary learning system for survival.

疼痛是每个有机体的 主要生存学习体系。

I mean, it's like, "Ouch. Don't touch that."

就好像疼痛在告诉你： “啊，痛！别碰那里。”

Or, to paraphrase "The Princess Bride,"

或者改动一下 《公主新娘》里的台词：

"Life is pain, Highness."

“人生就是疼痛，殿下。”

"Pain-free" was marketing,

“无痛”是营销，

让医生觉得一片药 就能解决疼痛问题。

and it made physicians think that one pill could solve pain.

It still makes people feel like you can't be happy

这依然让人觉得， 如果你哪儿痛的话，

if you have some pain,

就不会快乐，

and we now know

现在我们知道，

that if you want to move past pain, it takes work.

如果你想尽快摆脱疼痛的话， 需要花些功夫。

Setting the bar at "pain-free" was too high.

“无痛”这个标准太高了。

Plenty of people could have been more comfortable,

很多人本可以更舒服一些，

but they gave up because pain-free was out of reach.

但因为无法达到“无痛”， 于是他们就放弃了。

We have really good new information that I'm going to share,

我有一些好消息要分享给大家，

and so from now on, I want you to think about pain

从现在开始，我希望你把疼痛

as a Venn diagram,

想象成一个文氏图，

with physiology, fear and control.

里面有生理学、恐惧和控制。

I'm going to tell you how each of these can give you power over pain.

我会告诉你每一部分 如何帮你克服疼痛。

Right now, I'm translating these, in my research,

目前我也正在研究把这些概念转化到

into a low-back pain device to reduce opioid use.

一种应对腰背痛的设备上， 以减少阿片类药物的使用。

But 20 years ago,

但 20 年前，

I just wanted to have a fast cure for needle pain,

我只想快速解决打针的疼痛问题，

for IV access and my kids' shots.

包括静脉注射和我孩子打针时的疼痛。

I was driving home one night after a graveyard shift,

一天晚上，我值完夜班开车回家，

and my hands were vibrating on the steering wheel,

我握着方向盘的手在颤抖，

因为我需要让车轮保持平衡。

because we needed to get the tires balanced.

I was ignoring that to think about pain,

所以我当时没有注意到痛，

and when I got home and reached for the door in my house,

等我回到家，准备伸手开门时，

my hand was numb.

我的手麻了。

Vibration.

因为（方向盘的）震动。

So I burst in, my Boy Scout husband grabbed some frozen peas,

于是我冲进家里，我那参加过童子军的丈夫 拿来了一些冻青豆，

and we had ourselves a genuine eureka moment,

突然，我俩灵光乍现，

where cold and vibration blocked pain.

发现低温和震动可以止痛。

Over the next decade, I found the right frequency to block pain,

在接下来的十年里， 我发现了止痛的震动频率，

I got a grant, and I created Buzzy, which is vibration plus ice ...

我拿到了一笔经费，做出了 Buzzy 这款产品， 它就是利用震动加冰……

in a bee shape.

是小蜜蜂形状的。

And you put it on your arm when you’re getting an injection.

你打针的时候 可以把这个小蜜蜂放在手臂上。

And to date, 45 million needle procedures had decreased pain,

到今天为止，在全球范围内， 我们减轻了 4500 万次打针时的疼痛感，

进行了 80 次独立随机对照试验，

and over 80 randomized controlled trials, independently, all around the world,

并公布了相关情况。

have been published.

But ...

但是……

(Cheers and applause)

（欢呼声和掌声）

At about 30 randomized controlled trials in,

在大概第 30 次随机对照试验时，

one of my colleagues came to me

我的一个同事找到我，

and confided that he was in opioid recovery.

跟我透露， 他当时正在戒阿片类药物。

And he asked whether or not Buzzy could let him get through

他问我 Buzzy 能否帮助他

a total knee replacement drug-free.

不用药物就能挺过膝关节置换手术。

I'd never thought about it.

我之前从未往这方面想过。

It's the same pain nerve for knees as for needles,

膝盖和打针的疼痛神经是一样的。

so I said maybe.

于是，我说那试试吧。

And he did it.

然后他做到了。

Vibration plus cold replaced OxyContin.

震动加低温取代了奥施康定。

(Applause)

（掌声）

So at that point, I went all in, to figure out why.

所以，从那时起，我开始全面投入， 试图弄清楚背后的原因。

And here is what we know.

以下是我们了解到的。

So the reason that vibration decreases pain

震动可以减轻疼痛的原因是

is because the physiology of the nerves

神经的生理机能，

of light touch, pressure, stretching and motion

感受轻触、压力、拉伸和运动 的神经比痛觉神经

all races pain to the spine.

能更快地传导到脊髓。

Now people have tried electricity to trigger the light-touch nerves,

现在，人们已经尝试 用电击来刺激轻触神经，

but we now know that motion, shown in green,

但我们现在了解到， 显示为绿色的运动感受神经，

is what's most effective at shutting the gate on sharp pain.

能最有效地关闭 剧烈疼痛感受的大门。

This is called gate control,

这被称为大门控制，

and the exact right frequency of vibration triggers the nerves that decrease pain.

是触发减轻疼痛作用神经的 准确震动频率。

The physiology of ice is different.

而冰块的作用是不同的。

So the cold goes up to the brain, where the conductor goes,

冷的感觉传导到大脑， 那里是控制中心，

"Obnoxious, but not dangerous.

“有点难受，但是不危险。

I will decrease sensations coming from everywhere."

那我就把所有的感知能力都下调吧。”

And it decreases pain everywhere.

于是所有的痛觉都降低了。

If a child was so freaked out from previous experiences

如果小孩子 因为之前的经历太害怕打针，

that even the swab hurt ...

哪怕只是消毒都觉得痛……

physiology wasn't as helpful.

那生理学就没什么用了。

So we added distraction, like a monkey poster.

于是我们加上了分散注意力的东西， 比如一张猴子海报。

And what we discovered

我们发现

was combining counting plus making a decision

结合数数和做出决定

cut pain in half.

能把疼痛减少一半。

So, for example, "How many monkeys are actually touching the bed?"

比如，“有几只猴子碰到了床？”

activates the decision switchboard.

会激活决策枢纽。

I know what you guys are doing. It's five.

我知道你们都在数，答案是 5。

(Laughter)

（笑声）

Here is your pain hack for the day, though.

这就是今天你们得到的止痛秘诀。

If you do not have monkeys on hand, then find any sentence

如果你们手边没有猴子， 就随便找一句话

and count how many of the letters have holes in them.

数一下有多少个字母是带洞的。

Counting, deciding. So, like, you've got a g-hole,

数数，做决定。 比如，这里有 g 是带洞的，

o-hole, a ... hole.

o 是带洞的，a……也带个洞。

(Laughter)

（笑声）

(Laughter and applause)

（笑声和掌声）

I guarantee you and your family will use this.

我保证你和你的家人 一定能用得上这个。

(Laughter)

（笑声）

The biggest hack, though, is understanding why distraction works.

但其实最大的秘诀，是弄清楚 为什么转移注意力会有效。

And now, through functional MRI, we can actually see pain happen.

如今，通过有效的磁共振成像， 我们能够真的看到疼痛的发生。

And it's not one place.

它并不只发生在一处。

Pain is a symphony of connections,

疼痛是一系列连接，

from the sensation area to the conductor,

从感觉区到指挥区，

to the decision switchboard,

到决策枢纽，

and then to fear, memory, meaning, control.

然后再到恐惧、记忆、 意义、控制等区域。

So if the decision switchboard is occupied sorting monkeys,

因此，如果决策枢纽正忙着数猴子，

it can't notify fear and meaning,

那它就无暇顾及恐惧和意义，

and you feel less pain.

你就不会觉得那么痛。

What you feel

你的感觉

is mostly what you expect to feel.

其实大部分时候是你期待的感觉。

Stay with me.

容我举个例子。

If you're a kid,

如果你是个孩子，

the same punch hurts more from a bully than from your buddy.

同样一拳，欺负你的孩子打的， 跟你好朋友打的相比，会更痛。

And if you're an adult and you feel something,

如果你是个成年人， 你感到哪里有点痛，

the second you think it's cancer, it hurts more and more,

如果你开始想，可能是癌症， 那就会越来越痛，

until you find out it's not.

直到你检查完，发现并不是。

And those same kids who had horrible shot experiences

而同样的孩子， 哪怕经历过非常痛的打针，

can tolerate all kinds of needle pain ...

也可以忍受各种针头带来的痛苦，

to look cool.

只为了显得很酷。

(Laughter)

（笑声）

Because it is a different context.

因为情况完全不同。

These patterns, called connectomes,

这些模式，被称为连接组，

are very personal,

是非常因人而异的，

because experiences lay down more of the same sensation.

因为经历会加强相似的感觉。

And we now know that people who have certain areas in the brain connected

我们发现，大脑连接区域不同的人，

feel more pain than people with different areas connected.

对于疼痛的感受程度也不同， 某些人会更容易感到痛。

And more importantly,

更重要的是，

untreated pain or intense pain can lay down heavier connections,

未经处理的或者剧烈的疼痛， 会形成更强烈的连接，

so that even when your body is healed, you will still feel more pain.

因此即便你的身体已经痊愈， 但你仍然会感到更多的疼痛。

It's this very plasticity and personalization

就是这种易受影响的、 非常个人化的特点

which makes the physiology, fear, control matrix so useful.

才使得这个生理学、 恐惧和控制的矩阵如此有用。

Because choosing physiologic options

因为选择那些对你有用的，

that you can layer, that work for you,

你可以使用的生理学选项，

decreases pain,

可以减轻疼痛，

like heat, cold, vibration, deep relaxation, acupuncture,

比如热、冷、震动、深度放松、针灸、

capsaicin, exercise, meditation ...

辣椒碱、运动、冥想……

There's more.

还有很多。

Christopher probably had 10 of these around his house

克里斯多弗可能有 10 个选项，

and just didn't know it.

只是他当时不知道而已。

Having control over your options decreases pain.

拥有控制权能减轻疼痛。

Deep breathing increases control.

深呼吸可以增加控制。

Choosing what to focus on increases control.

选择关注点放在哪里能增加控制。

Fear and control are the volume knobs for pain.

恐惧和控制是疼痛的调节按钮。

Fear controls so many of our sensations, this shouldn't be unusual,

恐惧掌控着我们许多感觉， 这没什么可惊讶的，

but we don't practice it for pain.

但我们从未练习过用它来控制疼痛。

So if you're home alone and you hear a clunk ...

如果你独自在家，听到一些声响，

your hearing becomes hypersensitive.

你的听觉会变的超级敏感。

But when you remember your kid's home from college,

但如果你想起来， 孩子从学校回家了，

your fear dials down and your brain overrides it and says,

你的恐惧会变低， 你的大脑会无视它，说，

"Don't worry about it."

“不要担心。”

Saint Augustine called pain the greatest of evil.

圣奥古斯丁把疼痛称为最大的恶。

But if it is a survival system, it cannot be all evil.

但如果疼痛是一种求生机制， 那就不全是恶了。

So instead,

因此要换个想法，

think of pain as your nagging, safety-obsessed, exaggerating friend

把疼痛看做你一个爱唠叨的、 很重视安全的、有时有点夸张的朋友，

who’s sometimes wrong.

他/她时不时会犯点错。

And it’s OK to ignore or override your friend

有时无视或者冷落 你的朋友是没关系的，

if you know that you're safe.

只要你明白自己是安全的。

This takes practice.

这个需要练习。

On a flight that was turbulent,

有一次我坐飞机，有点颠簸，

I had an entire cup of scalding-hot coffee dumped straight on my ankle.

我把一整杯滚烫的咖啡 倒在我脚踝上。

Electric jolt through my scalp.

我的头皮一阵发麻。

I ripped off my sock; it was already red.

我脱下袜子，脚踝已经变红。

It was going to blister.

马上就要出现水泡了。

There was no way I could get my foot into that little sink

飞机上的洗手盆那么小， 我根本没法把脚放进去，

to get cold water on it.

淋冷水帮助降温。

And then I remembered.

这时我想起来。

Physiology hack.

用生理学的方法。

I had an unopened cold beer.

我有一罐没开的冰啤酒。

(Laughter)

（笑声）

Medical-grade cold beer went on my ankle, stat.

医疗级别的冰啤酒 放在了我脚踝上。

(Laughter and applause)

（笑声和掌声）

I had a vibrator in my carry-on, because I would.

我随身行李里还有一个震动器， 我肯定要带着的。

On my ankle. And then --

绑在了我脚踝上。然后……

(Laughter and applause)

（笑声和掌声）

The pain kind.

别想歪，是用来镇痛的（震动器）。

(Laughter)

（笑声）

And then my fear hack.

然后开始处理我的恐惧。

I'm like, "There's a barf bag that has holy letters,

我想，“这里有个呕吐袋， 上面有神奇的字母，

but I'm going to put it in the pocket pouch and save it,

但我要把它放到前面的 置物袋里，留着它，

because then, I have increased control."

因为之后，我就能提升我的控制。”

And, pain , I was no longer that concerned.

我就不再那么在意我的疼痛了。

(Cheers and applause)

（欢呼声和掌声）

Although then, I realized I'm that guy,

尽管之后，我意识到，

我一只脚光着，伸在飞机过道中间，

with my bare foot sticking out in the aisle on a plane,

with a beer on it.

上面还绑着一罐啤酒。

(Laughter)

（笑声）

Power over pain isn’t always pretty, but it is possible

击败疼痛的力量并不一定光鲜亮丽， 但是是有可能的

and it is absolutely critical.

而且绝对非常重要。

Because there’s one more misconception we have not talked about.

因为我们还有一个 错误观念没有谈到。

I honestly thought that opioids turned off some pain switch.

我真心认为阿片类药物 能关闭一些疼痛开关。

They turn on our reward system.

它们也打开了我们的奖励系统。

So some people feel amazing,

因此有些人会感觉很美妙，

but most people just still feel pain, but don't care.

但是大部分人还是会感到疼痛， 却不在乎。

Now, this is a godsend for people with chronic pain diseases.

这对那些有长期疼痛疾病的人 来说是天赐之物。

We should not take them away.

我们不该全盘否定他们。

And in the trauma bay,

在创伤治疗室，

the more morphine in the first 24 hours after a burn or a wound,

针对烧伤或者外伤， 如果在头 24 小时使用吗啡量越大，

the less post-traumatic stress,

创伤后应激反应就会越小，

the less chronic pain later.

长期疼痛也会越少。

But studies show that recovery after surgery

但研究表明，术后恢复

is just as well accomplished with coaching and physiologic options.

同样也可以通过训练 和物理疗法来完成。

And if you're one of the people who feel amazing with opioids,

如果阿片类药物让你感觉很好，

it's too risky.

那风险太大了。

A study in 2019 found

2019 年的研究发现，

that one in 15 young adults who got opioids for their wisdom tooth removal

有十五分之一的年轻成年人， 如果在拔除智齿后使用阿片类药物，

had substance-use disorder within a year.

会在 1 年内产生药物滥用症。

Ibuprofen works better.

布洛芬会好一些。

So what do we do?

那我们应该怎么做？

Well, in my dream world, we have health-care systems --

在我的理想世界里， 我们的医疗系统，

paid-for options and coaching --

能负担我们的物理治疗和训练，

for Christophers everywhere.

帮助像克里斯托弗这样的人。

And we quit giving double-digit prescriptions for opioids

我们不再给家庭康复的病人

for home recovery.

开出 2 位数的阿片类药物处方。

In the real world,

但现实是，

80,000 people died in the US last year from opioid overdoses,

去年在美国就有 8 万人 死于阿片类药物过量，

and 80 percent of substance-use disorders start with a pill prescribed for pain ...

有 80% 的药物依赖 始于一片处方止痛药。

Usually taken from your friend's medicine cabinet.

通常来自于你朋友的药柜。

People can’t afford options.

人们没钱做物理治疗。

Doctors, 20 years later, still don't know them.

而医生们，在从业 20 年之后， 依然不知道怎么对付疼痛。

But you do.

但是现在你们知道了。

You all now know to throw away the opioids in your medicine cabinet.

你们明白要扔掉 药柜里的阿片类药物。

You now know that there are options you can use to decrease pain,

你们明白有哪些方法 可以减轻疼痛，

and you know that "pain-free" should be ditched

你们明白要摈弃“无痛”，

for "more comfortable."

而是追求“更舒服”。

And whether you dump scalding coffee

无论是咖啡洒了，

or pain wakes you and exhausts you every day ...

还是半夜被痛醒， 每天被折磨得精疲力尽……

Options that are in your control ...

那些你掌握的物理疗法，

can allow you to reframe pain.

能让你重塑疼痛。

Thank you.

谢谢大家。

(Cheers and applause)

（欢呼声和掌声）

Whitney Pennington Rodgers: Amy, thank you, it's amazing.

惠特尼·彭宁顿·罗杰斯： 艾米，谢谢，非常精彩。

So how do you think that pain scales have set us back

所以你认为疼痛量表在多大程度上

from this work that you're doing,

阻碍了你的工作，

美国国家卫生研究院 目前在对待疼痛和成瘾方面有哪些变化？

and how is the NIH treating pain and addiction differently now?

Amy Baxter: So in one of the 120 versions of this talk,

艾米·巴克斯特：在 90 年代的时候，

I talked about how the thing is, in the '90s,

我针对此做过 120 次演讲，

if we wanted to “disease-ify” pain,

如果我们想把疼痛看做一种疾病，

it meant we had to be able to measure it.

那就意味着我们需要能够量化它。

So that was where the FACES scales come from,

面部表情评分表就是这么产生的，

and they're actually very useful in the emergency department

实际上它在急诊还是非常有用处的，

to tell whether or not a medicine is working.

能判断一种药是否有效。

In fact, we were one of the first ones that showed, with sickle cell,

事实上，在镰状细胞病的研究中， 我们是第一批明确表示，

that the patient's report, based on those scales,

病人基于那些疼痛量表的自述反应，

是判断他们是否需要住院 最具指示意义的依据，

was what was most indicative of whether they needed to be admitted,

rather than any biologic marker.

而不是那些生物学的指标。

But what we're doing now

但我们现在使用的

is we're using something called the PROMIS scales,

是一种我们称为 PROMIS 的量表，

so it’s how intense pain is on five-point scales,

它用 1-5 分来评定疼痛强度，

how much it interferes,

以及疼痛对生活的影响程度，

so there's pain interference, pain intensity.

所以它有两个维度， 疼痛强度和对生活的影响程度。

And the way we're looking at pain is much more on the impact for the person,

我们看待疼痛的方式 更侧重于关注它对人的影响，

rather than trying to pretend

而不是试图假装

there's any kind of objective pain measurement.

有某种能客观测量疼痛的方法。

WPR: OK.

惠特尼：好的。

And you mentioned that you're working on some new applications for Buzzy,

你刚刚提到 你在研究 Buzzy 新的应用，

specifically for back pain.

专门针对背痛的。

What are some of the possibilities that we have here

目前取得了哪些进展

for what this could do for us in the future?

未来又能为我们带来哪些好处呢？

AB: On my tombstone, there's going to be a vibrating bee.

艾米：我的墓碑上 会有一只震动的蜜蜂的。

It's actually called DuoTherm, not Buzzy.

其实它叫 DuoTherm， 不是 Buzzy。

But what we've learned is that there are harmonics of interaction

我们发现某些特定频率间能和谐共振，

between the specific frequencies that cancel out the pain.

它们能消除疼痛。

So there’s one particular nerve called the Pacinian

有一条特定的神经叫帕西尼小体，

that has a very specific frequency range,

它有非常特定的频率范围，

and by causing them to interact,

通过使不同频率的刺激产生相互作用，

we're starting to explore more about the pain

我们开始进一步探索来自于

that's coming from the fascia between the skin and between the muscles,

皮下结缔组织区域的疼痛， 它位于皮肤和肌肉之间，

but that area is where we're unexplored,

是一个我们尚未完全了解的区域，

and so by interacting with different frequencies

因此，通过不同频率的相互作用，

and then layering heat or cold, pressure options,

再叠加热或冷，压力等方式，

giving people the choice of so many different ways to do it,

给人们不同的选择来应付疼痛，

it's really engaging all the different areas of the brain

这样可以真正刺激到大脑中

from which pain comes.

产生疼痛的不同区域。

WPR: Wow, OK. Well, thank you so much, Amy.

惠特尼：哇哦，好的。 非常感谢你，艾米。

AB: Welcome.

艾米：不客气。

Thank you, all.

谢谢大家。