评论
打印
Let's say that it would take you ten minutes to solve this puzzle.
如果你平常能以十分钟完成这幅拼图。
How long would it take if you received constant electric shocks to your hands? Longer, right?
但如果你的手被电击了，你会用多久完成它呢？会用更长的时间是不是？
Because the pain would distract you from the task.
因为痛苦让你从工作中分神。
Well, maybe not; it depends on how you handle pain.
其实，也许不是；这取决于你如何控制疼痛。
Some people are distracted by pain.
疼痛使有些人分心。
It takes them longer to complete a task, and they do it less well.
让他们花更长的时间去完成工作，并让他们做的没有那么好。
Other people use tasks to distract themselves from pain,
另外有一些人通过工作忘记疼痛，
and those people actually do the task faster and better when they're in pain than when they're not.
并且他们在疼痛的时候比没有疼痛的时候工作得更快更好。
Some people can just send their mind wandering to distract themselves from pain.
一些人可以转换思维去转移疼痛。
How can different people be subjected to the exact same painful stimulus and yet experience the pain so differently?
为什么不同的人在受到相同的疼痛刺激时却感受的疼痛程度不同？
And why does this matter? First of all, what is pain?
并且为什么这是有意义的呢？首先，什么是疼痛？
Pain is an unpleasant sensory and emotional experience, associated with actual or potential tissue damage.
痛是一种不愉快的感觉及情绪经验，与实际或潜在的组织损伤有关。
Pain is something we experience, so it's best measured by what you say it is.
痛是我们主观的经历，所以最好的测量法是我们自己说有多痛。
Pain has an intensity; you can describe it on a scale from zero, no pain, to ten, the most pain imaginable.
痛有强度，你以量表来描述，从0不痛，到10最痛。
But pain also has a character, like sharp, dull, burning, or aching.
但是痛也有不同的种类，像是锐痛、钝痛、灼痛或疼痛。
What exactly creates these perceptions of pain?
到底是什么让我们产生对痛的知觉？
Well, when you get hurt, special tissue damage-sensing nerve cells, called nociceptors,
你受伤的时候，针对组织损伤感测的神经细胞，称为痛觉受器，
fire and send signals to the spinal cord and then up to the brain.
会激发且送出信号到脊髓，然后上传到脑部。
Processing work gets done by cells called neurons and glia. This is your Grey matter.
传输处理的过程由称为神经元及神经胶的细胞完成。这就是你的灰质。
And brain superhighways carry information as electrical impulses from one area to another. This is your white matter.
而大脑超级高速公路承载信息，以电脉冲方式从一处传到另一处，这就是你的白质。
The superhighway that carries pain information from the spinal cord to the brain is our sensing pathway that ends in the cortex,
一条超级高速公路承载痛的信息，从脊髓传到脑部，则是我们的感测路径，其终点在皮质，
a part of the brain that decides what to do with the pain signal.
它是大脑的一部分，在接受痛觉信号之后由其决定要做出什么反应。
Another system of interconnected brain cells called the salience network decides what to pay attention to.
互连脑细胞的另一种系统称做突显网络，则决定要注意什么事。
Since pain can have serious consequences, the pain signal immediately activates the salience network.
因为痛会带来非常严重的后果，痛觉信号会立刻激活突显网络。
Now, you're paying attention. The brain also responds to the pain and has to cope with these pain signals.
现在，你集中注意力了。脑部也对痛觉作出反应，也必须处理这些痛觉信号。
So, motor pathways are activated to take your hand off a hot stove, for example.
所以，运动路径因此被激活，譬如说，让你的手从火烫的炉上缩回。
But modulation networks are also activated that deliver endorphins and enkephalins,
但是调节网络也会被激活，以此来传送安多芬和脑啡肽
chemicals released when you're in pain or during extreme exercise, creating the runner's high.
在你疼痛的时候释放化学物质，或在剧烈运动时使运动员保持高水平。
These chemical systems help regulate and reduce pain.
这些化学系统帮助调节及减低痛感。
All these networks and pathways work together to create your pain experience,
这些网络及路径一同合作，产生你的痛觉体验，
to prevent further tissue damage, and help you to cope with pain.
以预防进一步的组织损伤，并帮助你处理这些疼痛。
This system is similar for everyone,
这个系统在每个人身上都很类似，
but the sensitivity and efficacy of these brain circuits determines how much you feel and cope with pain.
但是这些脑回路的敏感度及效力，将决定你到底觉得有多痛以及对痛产生什么反应。
This is why some people have greater pain than others
这就是为什么有些人比较怕痛，
and why some develop chronic pain that does not respond to treatment, while others respond well.
为什么有些人会产生慢性疼痛，对治疗毫无反应，但其他人却治疗效果良好。
Variability in pain sensitivities is not so different than all kinds of variability in responses to other stimuli.
疼痛感受的差异性，与回应其它刺激的变异性其实相差不大。
Like how some people love roller coasters, but other people suffer from terrible motion sickness.
就像为什么有人爱云霄飞车，但有些人一坐就晕的七荤八素。
Why does it matter that there is variability in our pain brain circuits?
为什么我们脑回路中有差异性是这么的重要？
Well, there are many treatments for pain, targeting different systems.
首先，对于不同的系统，有许多针对疼痛的治疗手段。
For mild pain, non-prescription medications can act on cells where the pain signals start.
对于轻微的痛苦，非处方药可以作用于导致疼痛的细胞。
Other stronger pain medicines and anesthetics work by reducing the activity in pain-sensing circuits
其他强烈的疼痛药和麻醉剂可作用于减轻疼痛感知回路活动，
or boosting our coping system, or endorphins.
或者增强处理系统，或脑内啡。
Some people can cope with pain using methods that involve distraction, relaxation, meditation, yoga,
一些人可以用一些方法应对疼痛，比如转移注意力、休息、冥想、瑜伽，
or strategies that can be taught, like cognitive behavioral therapy.
或一些可以学到的策略，如认知行为治疗。
For some people who suffer from severe chronic pain,
对于一些遭受严重慢性疼痛的人，
that is pain that doesn't go away months after their injury should have healed, none of the regular treatments work.
那种疼痛在痊愈几个月后都不会减轻，常规的治疗也都不起作用。
Traditionally, medical science has been about testing treatments on large groups
一般来说，药物研究是测试大量人群的结果，
to determine what would help a majority of patients.
来判断它是否帮助了大部分的患者。
But this has usually left out some who didn't benefit from the treatment or experienced side effects.
不过确实有些人并没有从治疗中受益，或有了副作用。
Now, new treatments that directly stimulate or block certain pain-sensing attention or modulation networks are being developed,
现在，新的治疗手段已经被研究出来了，这种手段以直接刺激或阻断某些痛感测的注意力或调节网络，
along with ways to tailor them to individual patients, using tools like magnetic resonance imaging to map brain pathways.
同时也在为个别患者，使用像磁共振成像的工具来绘制脑路。
Figuring out how your brain responds to pain is the key to finding the best treatment for you.
研究你的大脑如何对疼痛做出反应的，这是找出对你来说最佳的治疗法的关键。
That's true personalized medicine.
这才是真的个体化用药啊。
