Elliot Krane: The mystery of chronic pain

242,846 views ・ 2011-05-19

TED


Please double-click on the English subtitles below to play the video.

Translator: Chitmin Ng Reviewer: Ana Choi
00:15
I'm a pediatrician and an anesthesiologist,
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我係一名小兒科醫師亦係麻醉師,
00:17
so I put children to sleep for a living.
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我靠催眠D細路賺錢謀生。
00:19
(Laughter)
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(笑聲)
00:21
And I'm an academic, so I put audiences to sleep for free.
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我仲係一名學者,我可以唔使錢催眠聽眾。
00:24
(Laughter)
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(笑聲)
00:28
But what I actually mostly do
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但事實上我最做得最多嘅
00:30
is I manage the pain management service
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係喺帕洛阿爾托市斯坦福帕卡德兒童醫院
00:32
at the Packard Children's Hospital up at Stanford in Palo Alto.
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進行痛楚管理。
00:35
And it's from the experience
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喺果度嘅
00:37
from about 20 or 25 years of doing that
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有20至25年經驗
00:39
that I want to bring to you the message this morning,
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今日我想話比你地聽,
00:41
that pain is a disease.
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痛楚係一種疾病。
00:43
Now most of the time,
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大多数情况,
00:45
you think of pain as a symptom of a disease,
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你將痛楚睇成疾病嘅一種症狀。
00:47
and that's true most of the time.
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好多時候都係啱嘅。
00:49
It's the symptom of a tumor or an infection
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佢可以係腫瘤或某種感染
00:52
or an inflammation or an operation.
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或者係某種炎症亦或者係手術嘅症狀。
00:54
But about 10 percent of the time,
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但係有大概10%嘅情况,
00:57
after the patient has recovered from one of those events,
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患者從以上所講嘅情況恢復之後,
01:00
pain persists.
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痛楚仍然持續。
01:02
It persists for months
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而且持續好幾個月,
01:04
and oftentimes for years,
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好多時仲係幾年。
01:06
and when that happens,
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哩種情況發生果陣,
01:08
it is its own disease.
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佢就係疾病。
01:10
And before I tell you about how it is that we think that happens
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喺我講比你地聽佢點樣產生之前
01:13
and what we can do about it,
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以及我地可以點做之前,
01:15
I want to show you how it feels for my patients.
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我想同你地講下我D病人嘅感受。
01:18
So imagine, if you will,
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如果可以,請你地想像一吓,
01:20
that I'm stroking your arm with this feather,
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我用哩條羽毛掃你你嘅手臂,
01:22
as I'm stroking my arm right now.
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就好似兒家我就掃緊自己。
01:25
Now, I want you to imagine
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請你地兒家開​​始想像吓
01:27
that I'm stroking it with this.
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我用佢掃過哩度。
01:29
Please keep your seat.
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大家坐好D啊
01:31
(Laughter)
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(笑聲)
01:33
A very different feeling.
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好唔同嘅感覺。
01:35
Now what does it have to do with chronic pain?
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咁樣同慢性痛楚有咩關係呢?
01:37
Imagine, if you will, these two ideas together.
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想像吓,如果你將哩兩個想法混埋一齊。
01:40
Imagine what your life would be like
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想像你嘅生活會系點
01:42
if I were to stroke it with this feather,
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如果我用羽毛掃過呢度,
01:45
but your brain was telling you
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但係你嘅大腦會話比你聽
01:47
that this is what you are feeling --
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哩個就係你嘅感覺
01:49
and that is the experience of my patients with chronic pain.
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哩個就係我哥個慢性痛楚病人嘅經歷。
01:52
In fact, imagine something even worse.
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事實上,試想像某些更壞嘅事情。
01:54
Imagine I were to stroke your child's arm with this feather,
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想像我用羽毛掃過你細路嘅手臂,
01:57
and their brain [was] telling them
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佢地嘅大腦會話比佢地聽
01:59
that they were feeling this hot torch.
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佢地感覺到哩把高溫火焰。
02:02
That was the experience of my patient, Chandler,
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哩個就係我個病人Chandler嘅經歷,
02:04
whom you see in the photograph.
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哩張係佢幅相。
02:06
As you can see, she's a beautiful, young woman.
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你地見到佢係一個靚女。
02:08
She was 16 years old last year when I met her,
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我識佢果陣佢先至16歲,
02:10
and she aspired to be a professional dancer.
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佢渴望成為一位職業舞蹈員。
02:13
And during the course of one of her dance rehearsals,
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喺佢一次舞蹈排練嘅過程中,
02:15
she fell on her outstretched arm and sprained her wrist.
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佢跌親壓住咗伸出嘅手臂,跟住扭親埋手腕
02:18
Now you would probably imagine, as she did,
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兒家你地大概可以想象就好似佢感,
02:20
that a wrist sprain is a trivial event
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扭傷手腕喺人生中
02:22
in a person's life.
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只不過係件小事。
02:24
Wrap it in an ACE bandage,
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只需用ACE繃帶包紮吓,
02:26
take some ibuprofen for a week or two,
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只食一到兩個星期嘅布洛芬止痛藥,
02:28
and that's the end of the story.
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就無乜事喇。
02:30
But in Chandler's case, that was the beginning of the story.
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不過喺Chandler嘅病例中,服藥只係故事嘅開始。
02:34
This is what her arm looked like
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哩個係佢手臂嘅樣
02:36
when she came to my clinic about three months after her sprain.
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佢扭傷咗大概3個星期後先來穩我。
02:39
You can see that the arm is discolored,
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你地可以睇到佢嘅手臂,
02:41
purplish in color.
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已經褪色同埋發紫。
02:43
It was cadaverically cold to the touch.
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摸上去好似屍體咁凍。
02:45
The muscles were frozen, paralyzed --
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肌肉僵硬、麻痹、
02:47
dystonic is how we refer to that.
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張力障礙。
02:50
The pain had spread from her wrist to her hands,
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痛楚從腕部擴展到手,
02:53
to her fingertips, from her wrist up to her elbow,
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再到手指,痛楚從手腕擴展到肘部,
02:56
almost all the way to her shoulder.
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甚至幾乎到左肩部。
02:58
But the worst part was,
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最惨嘅係,
03:00
not the spontaneous pain that was there 24 hours a day.
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並唔係自發嘅整日痛楚。
03:03
The worst part was that she had allodynia,
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最慘嘅系佢掂下野就會痛,
03:06
the medical term for the phenomenon that I just illustrated
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醫學上叫觸痛
03:09
with the feather and with the torch.
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同剛才羽毛、高溫火焰一樣。
03:11
The lightest touch of her arm --
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輕輕觸摸佢嘅手臂、
03:13
the touch of a hand,
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手,
03:15
the touch even of a sleeve, of a garment, as she put it on --
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甚至係衣袖
03:18
caused excruciating, burning pain.
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都會引發劇烈的、燒灼般嘅痛苦。
03:22
How can the nervous system get this so wrong?
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神經系統系點解會錯成咁樣?
03:25
How can the nervous system
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點解神經系統
03:27
misinterpret an innocent sensation
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誤解咗一個無辜嘅知覺
03:29
like the touch of a hand
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就好似摸佢隻手
03:31
and turn it into the malevolent sensation
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會變成惡毒嘅知覺
03:34
of the touch of the flame?
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火焰燒灼般嘅觸覺。
03:36
Well you probably imagine that the nervous system in the body
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你大概可以想像機體中嘅神經系統
03:39
is hardwired like your house.
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就好似你屋企裡面嘅導​​線。
03:41
In your house, wires run in the wall,
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在屋企裡面,導線佈滿牆壁,
03:43
from the light switch to a junction box in the ceiling
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從開關制到天花板嘅連接盒
03:46
and from the junction box to the light bulb.
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從連接盒到燈泡。
03:49
And when you turn the switch on, the light goes on.
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當你開開關制,燈就著。
03:51
And when you turn the switch off, the light goes off.
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當你關閉開關制,燈就熄。
03:54
So people imagine the nervous system is just like that.
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就用咁嘅方式想像神經系統。
03:58
If you hit your thumb with a hammer,
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如果一個錘打傷你嘅手指,
04:00
these wires in your arm -- that, of course, we call nerves --
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你手臂嘅導線,當然,我地稱為神經
04:03
transmit the information into the junction box in the spinal cord
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將信息傳入脊髓裡面嘅連接盒
04:06
where new wires, new nerves,
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脊髓入面嘅新嘅線路、新嘅神經,
04:08
take the information up to the brain
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將信息上傳到大腦
04:10
where you become consciously aware that your thumb is now hurt.
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你意識到你嘅手指受咗傷。
04:14
But the situation, of course, in the human body
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不過在哩種情況下,當然,在人體內
04:16
is far more complicated than that.
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要比哩個複雜好多。
04:19
Instead of it being the case
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並唔係甘純粹
04:21
that that junction box in the spinal cord
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連接盒在脊髓入邊
04:23
is just simple where one nerve connects with the next nerve
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神經之間嘅聯繫非常簡單
04:26
by releasing these little brown packets
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通過釋放哩D棕色包裹
04:28
of chemical information called neurotransmitters
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內涵化學信息,我地叫佢做神經遞質
04:31
in a linear one-on-one fashion,
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線性一一傳導信息,
04:34
in fact, what happens
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事實上,
04:36
is the neurotransmitters spill out in three dimensions --
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神經遞質嘅釋放在三維空間裡進行
04:38
laterally, vertically, up and down in the spinal cord --
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脊髓入面:橫向,縱向,垂直
04:41
and they start interacting
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佢地開始與相連嘅細胞
04:43
with other adjacent cells.
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相互作用
04:46
These cells, called glial cells,
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哩D細胞叫做膠質細胞,
04:48
were once thought to be
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之前被認為係
04:50
unimportant structural elements of the spinal cord
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脊髓中最唔重要嘅結構元素
04:52
that did nothing more than hold all the important things together,
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除咗幫助所有重要嘅好似神經細胞甘嘅物質
04:54
like the nerves.
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聚合在一齊之外,無其他用途。
04:56
But it turns out
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不過其實
04:58
the glial cells have a vital role
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膠質細胞扮演著一個重要角色
05:00
in the modulation, amplification
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在調製,放大
05:02
and, in the case of pain, the distortion
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同埋痛楚、扭曲
05:05
of sensory experiences.
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嘅感覺體驗入邊,
05:08
These glial cells become activated.
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哩D膠質細胞被激活
05:10
Their DNA starts to synthesize new proteins,
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佢地嘅DNA開始合成
05:12
which spill out
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新蛋白跟住釋放出来。
05:14
and interact with adjacent nerves,
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同相連嘅神經相互作用,
05:16
and they start releasing their neurotransmitters,
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佢地開始釋放神經遞質
05:19
and those neurotransmitters spill out
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果D神經遞質釋放出去
05:21
and activate adjacent glial cells, and so on and so forth,
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激活相連嘅膠質細胞,一直持續向前,
05:24
until what we have
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直到找到
05:26
is a positive feedback loop.
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一個確定嘅反饋迴路。
05:28
It's almost as if somebody came into your home
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就好似有人来到你屋企
05:30
and rewired your walls
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重新在牆上拉線,
05:32
so that the next time you turned on the light switch,
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跟住下一次你開燈哥陣,
05:34
the toilet flushed three doors down,
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馬桶開始自動沖洗,
05:36
or your dishwasher went on,
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或者係你嘅洗碗機開咗,
05:38
or your computer monitor turned off.
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或者係你嘅電腦屏幕開咗。
05:40
That's crazy,
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太瘋狂了,
05:42
but that's, in fact, what happens
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但實際上就係咁 ——
05:44
with chronic pain.
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慢性痛楚嘅情况。
05:46
And that's why pain becomes its own disease.
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也就係由痛楚變成疾病嘅原因。
05:49
The nervous system has plasticity.
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神經系統有可塑性,
05:51
It changes, and it morphs
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佢會改變,會變換
05:53
in response to stimuli.
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作為刺激嘅回應。
05:55
Well, what do we do about that?
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好,咁我地打算點做呢?
05:57
What can we do in a case like Chandler's?
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Chandler嘅病例我地可以點做?
06:00
We treat these patients in a rather crude fashion
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目前我地對於哩D患者嘅治療方法
06:02
at this point in time.
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仲停留在非常粗糙嘅階段。
06:04
We treat them with symptom-modifying drugs --
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我地用可以改變症狀嘅藥物來治療佢地
06:07
painkillers --
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止痛药
06:09
which are, frankly, not very effective
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講真,對於哩類痛楚來講
06:11
for this kind of pain.
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唔係特別有效。
06:13
We take nerves that are noisy and active
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對於本來安靜但係現在
06:15
that should be quiet,
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亢奮過度嘅神經,
06:17
and we put them to sleep with local anesthetics.
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我地用局部麻醉方式令到佢地休眠。
06:19
And most importantly, what we do
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最重要嘅係,我地所做嘅
06:22
is we use a rigorous, and often uncomfortable, process
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係用一個嚴格嘅進程,通常並唔咁係舒服嘅
06:26
of physical therapy and occupational therapy
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物理治療同職業療法
06:29
to retrain the nerves in the nervous system
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喺神經系統入面重新訓練神經
06:32
to respond normally
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使到能正常應答
06:35
to the activities and sensory experiences
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尤其係果D日常生活嘅所有
06:38
that are part of everyday life.
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正常活動同感覺體驗。
06:40
And we support all of that
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我地全力支持
06:42
with an intensive psychotherapy program
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用密集嘅心裡療法計劃
06:45
to address the despondency, despair and depression
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打擊嚴重慢性痛楚所引起嘅
06:48
that always accompanies
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失望、绝望、
06:50
severe, chronic pain.
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憂慮症狀。
06:52
It's successful,
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Chandler嘅病例係成功嘅,
06:54
as you can see from this video of Chandler,
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你地睇到嘅視頻来自Chandler,
06:56
who, two months after we first met her,
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兩個月後嘅现在,
06:58
is now doings a back flip.
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正在進行後翻身跳轉。
07:00
And I had lunch with her yesterday
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我我昨天同佢一齊吃午餐,
07:02
because she's a college student studying dance at Long Beach here,
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因為佢喺在長灘市嘅大學學習舞蹈。
07:05
and she's doing absolutely fantastic.
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佢表演得太好了。
07:07
But the future is actually even brighter.
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未來會更加精彩。
07:11
The future holds the promise
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未來將承諾
07:14
that new drugs will be developed
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新藥將會發展
07:16
that are not symptom-modifying drugs
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成唔係症狀控制嘅藥物
07:19
that simply mask the problem,
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我地現在哩D藥物,
07:21
as we have now,
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太輕易地掩飾痛楚。
07:23
but that will be disease-modifying drugs
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但係改變症狀嘅藥物
07:26
that will actually go right to the root of the problem
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將會真正瞄準問題嘅本源
07:28
and attack those glial cells,
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攻擊果D會擴張神經膠質細胞
07:30
or those pernicious proteins
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產生有害蛋白
07:32
that the glial cells elaborate,
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有害嘅蛋白,
07:35
that spill over and cause this central nervous system wind-up,
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佢地嘅釋放會終結可塑嘅
07:38
or plasticity,
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樞神經系統,
07:40
that so is capable
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咁樣就可以扭曲同放大
07:42
of distorting and amplifying
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感覺體驗嘅能力
07:44
the sensory experience that we call pain.
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我地稱之為痛楚。
07:46
So I have hope
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所以我希望
07:48
that in the future,
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在未来,
07:50
the prophetic words of George Carlin will be realized,
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George Carlin嘅预言可以被咁樣理解,
07:53
who said, "My philosophy:
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佢話:我嘅哲學:
07:55
No pain, no pain."
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“唔痛,唔痛”
07:59
Thank you very much.
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多谢大家
08:01
(Applause)
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(鼓掌)
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