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

譯者: Lilian Chiu 審譯者: Shelley Tsang 曾雯海

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

當你用鐵槌敲到你的拇指時，

你會認為疼痛是在拇指裡面。

Physicians have a more sophisticated understanding.

醫生對此的了解更複雜。

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

我們知道疼痛是一種警報， 透過神經傳到脊椎，

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

在哪裡被轉譯到大腦， 而疼痛實際上發生在……

somewhere.

某處。

It's a little vague.

有點模糊，我們讀醫學院的整個 過程中只受過兩天的疼痛教育，

We actually only get two days of pain education

throughout all of medical school, so ...

所以……

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

我唯一對於九○年代疼痛課的記憶

was in a dark room like this,

是在像這樣的暗房中， 已經三十小時沒睡覺又很飢餓，

after being awake for 30 hours and hungry,

and finding out our noon lecture was sponsored by OxyContin.

此時發現我們中午的課 是由疼始康定所贊助。

We got pens, we got great lasagna,

我們拿到筆，拿到很棒的千層麵，

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

他們用很酷的投影片展示 鴉片類藥物如何止痛。

And we learned that home opioids aren't addictive,

我們學到家中使用的 鴉片類藥物不會上癮，

and if you stay ahead of pain --

且如果你能一直超前疼痛——

(Laughter)

（笑聲）

you can keep your patients pain-free.

你就能讓你的病人保持無痛。

And beyond the obviously egregious marketing,

除了明顯的過份行銷之外，

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

我認為是把「無痛」塑造成目標

that has destroyed countless lives.

導致無數的生命被摧毀。

My friend's son Christopher started having severe abdominal pain

我朋友的兒子克里斯多夫

在這個「無痛」時代 開始有嚴重的腹痛。

during this "no-pain" era.

Eventually, he was diagnosed with a colon disease

最後他被診斷出一種結腸疾病， 在大四時接受手術。

and had surgery his senior year.

They sent Christopher home with 90 OxyContin,

他們讓克里斯多夫回家， 給了他九十顆疼始康定，

然後又給了九十顆，

and then 90 more,

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

接著，隨著疼痛變得越來越快……

Uncontrolled pain is terrifying.

無法控制的疼痛很讓人害怕。

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

所以當克里斯多夫的藥用完了， 他的朋友的藥櫃也空了，

Christopher tried heroin.

他就去嘗試海洛英。

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

克里斯多夫‧沃夫因物質濫用 過世，享年三十二歲。

So did we misunderstand pain?

所以，我們誤解了疼痛嗎？

如果疼痛並不是要消除的警報，

What if pain isn’t an alarm to silence

but a learning system for survival?

而是生存的學習系統呢？

TED pose.

TED 姿勢。

(Laughter)

（笑聲）

(Cheers and applause)

（歡呼及掌聲）

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

疼痛是所有生物的 主要生存學習系統。

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

就像是：「唉喲，別碰那邊。」

Or, to paraphrase "The Princess Bride,"

或者，引述《公主新娘》：

"Life is pain, Highness."

「人生就是痛苦，叞下。」

"Pain-free" was marketing,

「無痛」是行銷，讓醫生認為 一顆藥丸就能解決疼痛。

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

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

它仍然會讓大家覺得如果 你有些疼痛，就不可能快樂，

if you have some pain,

and we now know

我們現在知道

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

如果你想要超越疼痛，就需要努力。

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

把標準設在「無痛」是設得太高了。

Plenty of people could have been more comfortable,

很多人本來可以「更舒服一點」，

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

但他們放棄了， 因為達不到「無痛」。

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

我等下要分享一些很棒的新資訊，

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

所以接下來，我希望大家 用文氏圖來看待疼痛，

as a Venn diagram,

with physiology, fear and control.

三個圓分別是生理學、 恐懼，和控制。

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

我會說明這三者分別如何能 給你處理疼痛的力量。

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

現在我在做的研究，是將這些 轉化為一種下背疼痛裝置

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

來減少鴉片類藥物的使用。

But 20 years ago,

但二十年前，

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

我只希望有辦法可以快速治好 針痛、靜脈通路，和我孩子的注射。

for IV access and my kids' shots.

I was driving home one night after a graveyard shift,

有一天晚上，我在夜班 結束後開車回家，

and my hands were vibrating on the steering wheel,

我的雙手在方向盤上震動， 因為我們得讓輪胎保持平衡。

because we needed to get the tires balanced.

I was ignoring that to think about pain,

我沒在意它，只是想著疼痛，

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

當我回到家要開家門時，

my hand was numb.

我的手都麻木了。

Vibration.

震動。

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

我衝進去，我的童子軍丈夫 拿了一些冷凍豌豆，

and we had ourselves a genuine eureka moment,

我們經歷了一個真正的突破時刻，

where cold and vibration blocked pain.

冰和震動可以阻擋疼痛。

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

在接下來的十年，我找到阻擋 疼痛的正確頻率，取得補助金，

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

我創造了 Buzzy， 它結合了震動和冰，

in a bee shape.

外形是蜜蜂。

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

當你要接受注射時， 把它放在手臂上，

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

至今，有四千五百萬次的 針刺程序都減少了疼痛，

且有超過八十個獨立進行的 隨機對照試驗在世界各地發表。

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

have been published.

But ...

但……

(Cheers and applause)

（歡呼及掌聲）

At about 30 randomized controlled trials in,

在做了大約三十次隨機對照試驗時，

one of my colleagues came to me

我的一位同事來找我，向我透露 他正在戒除鴉片類藥物。

and confided that he was in opioid recovery.

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

他問我 Buzzy 有沒有可能幫他 度過全膝關節置換手術，

a total knee replacement drug-free.

不用藥物。

I'd never thought about it.

我從來沒想過這點。

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

膝蓋和針所連結的 疼痛神經是相同的。

so I said maybe.

所以我說，也許吧。

And he did it.

他就做了。

震動加上冰冷，取代疼始康定。

Vibration plus cold replaced OxyContin.

(Applause)

（掌聲）

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

那時起，我就全力投入 去搞懂為什麼。

And here is what we know.

我們所知的如下：

So the reason that vibration decreases pain

震動能減輕疼痛的原因

is because the physiology of the nerves

是因為輕觸、按壓、伸展，

of light touch, pressure, stretching and motion

和動作的神經生理學

all races pain to the spine.

都會把疼痛訊息傳遞到脊椎。

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

有人試過用電力來觸發輕觸神經，

but we now know that motion, shown in green,

但我們現在知道，綠色的動作神經

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

對於阻斷劇烈疼痛是最有效的。

This is called gate control,

這稱為門控。

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

對震動頻率可以觸發 減輕疼痛的神經。

The physiology of ice is different.

冰的生理學則不同。

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

冰冷會向上到達大腦， 在那裡，總指揮會說：

"Obnoxious, but not dangerous.

「很討厭，但不危險。 我會減低來自各處的感覺。」

I will decrease sensations coming from everywhere."

And it decreases pain everywhere.

它就會減輕各處的疼痛。

If a child was so freaked out from previous experiences

如果孩子被之前的經驗嚇壞了，

that even the swab hurt ...

怕到連擦拭都會痛……

physiology wasn't as helpful.

那生理學就不那麼有用。

So we added distraction, like a monkey poster.

所以我們加上了分心元素， 比如猴子海報。

And what we discovered

我們的發現是，

結合計數和做決策，

was combining counting plus making a decision

能讓疼痛減半。

cut pain in half.

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

比如，問：「有幾隻猴子 真正碰到了床？」

activates the decision switchboard.

就能啟動決策交換板。

我知道你們在算，是五隻。

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

(Laughter)

（笑聲）

Here is your pain hack for the day, though.

以下是今天的疼痛密技。

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

如果你手邊沒有猴子，

隨便找個句子，

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

算算看有幾個字母 是中間有洞的字母。

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

計數、決策。所以會有 g 的洞、o 的洞、

o-hole, a ... hole.

a 的洞（音近：屁眼）……。

(Laughter)

（笑聲）

(Laughter and applause)

（笑聲及掌聲）

I guarantee you and your family will use this.

我保證你和你的家人會用這招。

(Laughter)

（笑聲）

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

不過，最大的秘技， 是了解為什麼分心會有用。

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

透過功能性磁振造影， 我們可以真正看到疼痛發生。

And it's not one place.

不只發生在一處。

Pain is a symphony of connections,

疼痛是連結的交響樂，

from the sensation area to the conductor,

從感知區，到總指揮，

to the decision switchboard,

到決策交換板，

and then to fear, memory, meaning, control.

接著到恐懼、記憶、意義、控制。

So if the decision switchboard is occupied sorting monkeys,

所以如果決策交換板忙著分類猴子，

it can't notify fear and meaning,

它就注意不到恐懼和意義，

and you feel less pain.

你感受到的疼痛就減少了。

What you feel

你所感覺到的

is mostly what you expect to feel.

大部分是你預期會感覺到的。

Stay with me.

別分神。

If you're a kid,

如果你是孩子，

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

惡霸打你一拳會比好兄弟 打你同樣的一拳更痛。

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

如果你是成人，你有某種感覺，

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

一旦你認為那是癌症，

就會越來越痛，直到 你發現並不是癌症。

until you find out it's not.

And those same kids who had horrible shot experiences

而有恐怖打針經歷的那些孩子

can tolerate all kinds of needle pain ...

為了看起來很酷，卻能 忍受各種針刺的疼痛。

to look cool.

(Laughter)

（笑聲）

Because it is a different context.

因為情境不同。

These patterns, called connectomes,

這些模式叫做連結組，

are very personal,

是非常個人化的。

because experiences lay down more of the same sensation.

因為經驗會建立比較多同樣的感知。

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

我們現在知道，大腦中 某些區域有連結的人，

feel more pain than people with different areas connected.

會感覺比較多疼痛，

連結區域不同的人， 疼痛感覺就相對少。

更重要的是，未治療的 疼痛或強烈的疼痛

And more importantly,

untreated pain or intense pain can lay down heavier connections,

可能會建立比較密切的連結，

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

所以即使你的身體已經癒合了，

你仍然會感到更多疼痛。

It's this very plasticity and personalization

正是這種可塑性

以及個人化，讓這個生理學、 恐懼、控制模型如此有用。

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

Because choosing physiologic options

因為，

選擇你能建立的、 對你有效的生理學選項

that you can layer, that work for you,

decreases pain,

就能減輕疼痛。

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

比如：

熱、冷、震動、深度放鬆、

針灸、唐辛子、運動、冥想……

capsaicin, exercise, meditation ...

還有更多。

There's more.

Christopher probably had 10 of these around his house

克里斯多夫的家中 可能就有十種這類選項

and just didn't know it.

只是他不知道。

Having control over your options decreases pain.

控制你的選項就能減輕疼痛。

Deep breathing increases control.

深呼吸能增加控制。

Choosing what to focus on increases control.

選擇把焦點放在哪裡也能增加控制。

Fear and control are the volume knobs for pain.

恐懼和控制是疼痛的音量旋鈕。

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

恐懼控制很多種知覺， 這並非不尋常，

but we don't practice it for pain.

但我們沒有針對疼痛做練習。

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

如果你獨自在家，聽到哐啷一聲……

your hearing becomes hypersensitive.

你的聽覺就會變得超敏感。

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

但當你想起你的孩子從大學回家了，

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

你的恐懼就減低了，你的大腦 會推翻它，說：「別擔心。」

"Don't worry about it."

Saint Augustine called pain the greatest of evil.

聖奧古斯丁把疼痛稱為最大的邪惡。

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

但如果它是種生存系統， 就不可能全是邪惡的。

So instead,

所以，

把疼痛改想成是一位 嘮叨、過份強調安全、

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

誇大的朋友，且他有時會犯錯。

who’s sometimes wrong.

And it’s OK to ignore or override your friend

且如果你知道

你是安全的，要忽略 或推翻你的朋友都沒關係。

if you know that you're safe.

This takes practice.

這需要練習。

On a flight that was turbulent,

有回我搭飛機遇到亂流，我把一整杯

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

熱騰騰的咖啡直接灑在我的腳踝上。

Electric jolt through my scalp.

電流穿過我的頭皮。

I ripped off my sock; it was already red.

我扯掉我的襪子，腳踝已經紅了。

It was going to blister.

接著會起水泡。

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

我不可能把我的腳放到 小水槽裡去泡冷水。

to get cold water on it.

And then I remembered.

接著我想起來了。

Physiology hack.

生理學秘技。

I had an unopened cold beer.

我有一罐還沒開的冰啤酒。

(Laughter)

（笑聲）

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

馬上把醫療級的冰啤酒 敷在我的腳踝上。

(Laughter and applause)

（笑聲和掌聲）

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

我的隨身行李有個震動 按摩器，因為我會帶。

放在腳踝上，接著——

On my ankle. And then --

(Laughter and applause)

（笑聲及掌聲）

The pain kind.

是疼痛用的震動按摩器。

(Laughter)

（笑聲）

And then my fear hack.

接著用我的恐懼秘技。

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

我說：「有個嘔吐袋， 上面有神聖的文字，

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

但我要把它收到口袋裡，保留下來，

because then, I have increased control."

因為這樣我就能提升控制。」

而疼痛，我已經不那麼在乎了。

And, pain , I was no longer that concerned.

(Cheers and applause)

（歡呼及掌聲）

Although then, I realized I'm that guy,

不過，接著，我發現我就是那個 在飛機上打赤腳還把腳伸到

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

走道的傢伙，

with a beer on it.

腳上還有啤酒。

(Laughter)

（笑聲）

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

掌控疼痛的力量不見得都會很好看，

但，是有可能做到的，

and it is absolutely critical.

且絕對是非常重要的。

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

因為，還有一種誤解我們還沒談到。

I honestly thought that opioids turned off some pain switch.

我真心認為鴉片類藥物 會關閉一些疼痛開關。

They turn on our reward system.

它們會啟動我們的獎勵系統。

So some people feel amazing,

所以有些人覺得棒極了，

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

但大部分人仍然會感受到 疼痛，只是不在乎。

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

這對有慢性疼痛疾病的人 而言是天賜之物。

We should not take them away.

我們不該奪走這些。

And in the trauma bay,

且在創傷區，

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

在受到創傷或燒傷之後的 二十四小時之內用越多嗎啡

the less post-traumatic stress,

創傷後壓力就會越少，

the less chronic pain later.

後續的慢性疼痛也越少。

But studies show that recovery after surgery

但研究顯示，手術後的恢復

is just as well accomplished with coaching and physiologic options.

同樣可以透過輔導 和生理學的選項來達成。

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

如果你屬於用了鴉片類藥物 會覺得棒極了的人，

it's too risky.

風險太高了。

A study in 2019 found

2019 年有一項研究發現

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

因為拔智齒而使用鴉片類藥物的 年輕人，十五位中就有一位

had substance-use disorder within a year.

在一年內會有物質濫用障礙的問題。

Ibuprofen works better.

布洛芬的效果比較好。

So what do we do?

所以，我們該怎麼做？

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

在我夢想的世界裡， 我們有健康照護系統——

paid-for options and coaching --

付費選項和輔導——

for Christophers everywhere.

供各地的克里斯多夫使用。

And we quit giving double-digit prescriptions for opioids

我們不再開大量鴉片類藥物的 處方給在家恢復的病人。

for home recovery.

In the real world,

在真實世界裡，去年美國就有 八萬人死於鴉片類藥物過量，

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

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

且八成的物質濫用障礙 都始於疼痛處方藥……

Usually taken from your friend's medicine cabinet.

通常是直接從朋友的 藥櫃裡面拿取的。

People can’t afford options.

大家負擔不起其他選項。

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

二十年後，醫生仍然 不知道這些選項。

But you do.

但各位知道。

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

各位現在都知道要把 藥櫃裡的鴉片類毒品丟掉。

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

各位現在都知道可以用 其他選項來減輕疼痛，

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

且各位知道，應該把「無痛」扔掉，

for "more comfortable."

換成「更舒適」。

And whether you dump scalding coffee

不論你是打灑了熱咖啡，

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

或者每天你會痛醒 且因為疼痛而精疲力竭……

Options that are in your control ...

你能夠控制的選項……

can allow you to reframe pain.

可以讓你重新詮釋疼痛。

Thank you.

謝謝。

(Cheers and applause)

（歡呼及掌聲）

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

主持人：艾咪， 謝謝你，很棒的演說。

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

依你所見，疼痛分數如何 阻礙你現在在進行的工作？

from this work that you're doing,

國家衛生研究院現在對疼痛 和成癮的治療又有什麼不同？

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

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

講者：在這場演說的 一百二十個版本之一，

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

我談到在九○年代的狀況， 我們想把疼痛視為是一種疾病，

if we wanted to “disease-ify” pain,

it meant we had to be able to measure it.

那就表示得想辦法測量它。

那就是臉譜量表的由來， 在急診部其實非常有用，

So that was where the FACES scales come from,

and they're actually very useful in the emergency department

to tell whether or not a medicine is working.

可以知道藥物是否有效果。

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

事實上，我們很早就用 鐮狀細胞來說明病人回答

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

那些量表的結果最能顯示 他們是否需要住院，

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

rather than any biologic marker.

比任何生物標記都還適合當指標。

But what we're doing now

但我們現在則是在用應用個案 自陳資訊系統（PROMIS）量表，

is we're using something called the PROMIS scales,

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

量表把疼痛強度分為五級， 還有對生活的干擾程度，

how much it interferes,

so there's pain interference, pain intensity.

所以有疼痛干擾程度和強度。

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

我們看待疼痛的角度會更 著重在它對當事人的影響，

rather than trying to pretend

而不是試著假裝有某種 客觀的疼痛測量存在。

there's any kind of objective pain measurement.

WPR: OK.

主持人：好。你也提到你現在 在投入 Buzzy 的新應用，

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

specifically for back pain.

明確來說是背痛的應用。

What are some of the possibilities that we have here

有什麼樣的可能性？ 未來對我們可能有什麼幫助？

for what this could do for us in the future?

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

我的墓碑上會有一隻震動蜜蜂。

It's actually called DuoTherm, not Buzzy.

它叫 DuoTherm，不是 Buzzy。

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

但我們發現，有些特定頻率之間 交互作用的諧波可以抵消疼痛。

between the specific frequencies that cancel out the pain.

So there’s one particular nerve called the Pacinian

有種神經叫巴齊尼氏， 有非常明確的頻率範圍，

that has a very specific frequency range,

and by causing them to interact,

透過促使它們進行交互作用，

we're starting to explore more about the pain

我們開始進一步探究疼痛，

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

來自筋膜和皮膚間 以及肌肉間的疼痛，

but that area is where we're unexplored,

這個區域尚未被探索，

and so by interacting with different frequencies

用不同的頻率進行交互作用，

and then layering heat or cold, pressure options,

接著再加疊上熱或冷、壓力選項，

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

讓大家有各種不同的做法選擇，

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

會用到大腦不同的區域， 都是和疼痛有關的區域。

from which pain comes.

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

主持人：非常謝謝你，艾咪。

AB: Welcome.

講者：不客氣。

Thank you, all.

謝謝大家。