返回首页

ElliotKrane_2011U-_慢性疼痛之谜_
I'm a pediatrician and an anesthesiologist , so I put children to sleep for a living. 我是一名儿科医生和麻醉师, 我以帮孩子们入睡为生。
pediatrician:n.儿科医师(等于pediatrist); anesthesiologist:n.麻醉学者(医师);
(Laughter) （笑声）
And I'm an academic , so I put audiences to sleep for free. 我也是一名大学教师,所以我免费让听我讲课的人打瞌睡。
academic:adj.学术的;理论的;学院的;n.大学生,大学教师;学者;
(Laughter) （笑声）
But what I actually mostly do is I manage the pain management service at the Packard Children's Hospital up at Stanford in Palo Alto . 但我主要从事的 还是提供管理疼痛的服务 在帕罗奥多市 斯坦福大学的 帕卡德儿童医院。
management:n.管理;管理人员;管理部门;操纵;经营手段; Alto:n.女低音;男声最高音;中音乐器;adj.中音部的;
And it's from the experience from about 20 or 25 years of doing that that I want to bring to you the message this morning, that pain is a disease . 从经验上来讲, 根据我20或25年的执业经验 今早,我想告诉你的是, 疼痛是一种病。
disease:n.病,[医]疾病;弊病;vt.传染;使…有病;
Now most of the time, you think of pain as a symptom of a disease, and that's true most of the time. 大多数时候, 你会认为疼痛是一种症状。 大多数情况下,这种想法是正确的。
symptom:n.症状;征候;征兆;
It's the symptom of a tumor or an infection or an inflammation or an operation. 它的确是肿瘤和感染的症状 或者是发炎、手术中的症状。
tumor:n.肿瘤;肿块;赘生物; infection:n.感染;传染;(身体某部位的)感染;传染病; inflammation:n.[病理]炎症;[医]发炎;燃烧;发火;
But about 10 percent of the time, after the patient has recovered from one of those events, pain persists . 但有约10％的情况下, 病人虽然已经从上述情况下康复, 但疼痛依然继续。
patient:adj.有耐心的,能容忍的;n.病人;患者; persists:vi.存留,坚持;持续,固执;vt.坚持说,反复说;
It persists for months and oftentimes for years, and when that happens, it is its own disease. 有时候持续几个月 甚至持续几年。 当这种情况发生时, 疼痛本身就是一种疾病。
oftentimes:adv.时常地;
And before I tell you about how it is that we think that happens and what we can do about it, 在我向你讲解它是如何发生 我们可以采取何种措施之前,
I want to show you how it feels for my patients . 我想向你展示一下,病人对此的感受。
patients:n.接受治疗者,病人;(patient的复数)
So imagine, if you will, that I'm stroking your arm with this feather, as I'm stroking my arm right now. 如果可以,请你想象一下, 我用这根羽毛挠你, 就像现在我挠自己的手臂一样。
stroking:v.轻抚,抚摩;轻触;轻拭;(stroke的现在分词)
Now, I want you to imagine that I'm stroking it with this. 现在,我要你想象 如果我是用这个（喷火枪）“挠”你呢？
Please keep your seat. 请大家只管坐好！
(Laughter) （笑声）
A very different feeling. 非常迥异的感觉。
Now what does it have to do with chronic pain? 这跟慢性疼痛有什么关联呢？
have to do with:与…有关; chronic:adj.慢性的;长期的;习惯性的;
Imagine, if you will, these two ideas together. 如果这两个感觉被混淆了
Imagine what your life would be like if I were to stroke it with this feather, but your brain was telling you that this is what you are feeling -- and that is the experience of my patients with chronic pain. 想象一下你的生活将会怎样 如果我是用这根羽毛去挠你, 结果你的大脑却告诉你 你现在的感觉是灼伤-- 这就是我的患者对慢性疼痛的感受。
stroke:n.中风;笔画;钟声;抚摩;v.抚摩(动物的毛皮);轻抚;轻挪;轻触;
In fact, imagine something even worse. 事实上,想象下更糟糕的情况。
Imagine I were to stroke your child's arm with this feather, and their brain [was] telling them that they were feeling this hot torch . 想象下我用这根羽毛去挠你孩子的胳膊, 结果他们的大脑却告诉他们 他们感受到的是这个灼热的喷火枪。
torch:n.火炬;手电筒;火把;v.纵火烧(建筑物或汽车);
That was the experience of my patient, Chandler, whom you see in the photograph. 这就是我的患者,钱德勒的遭遇, 就是照片中的女孩。
As you can see , she's a beautiful, young woman. 正如你看到的,她是个漂亮的年轻姑娘。
As you can see:正如你所看到的;你是知道的;
She was 16 years old last year when I met her, and she aspired to be a professional dancer. 去年当我遇到她时,她16岁, 她渴望成为一名专业的舞者。
aspired:v.向往;热望(aspire的过去分词); professional:adj.专业的;职业的;职业性的;n.专业人员;职业运动员;
And during the course of one of her dance rehearsals , she fell on her outstretched arm and sprained her wrist . 在她的一次舞蹈排练中, 她摔倒压在了自己向外伸展的手臂上,并且扭伤了手腕。
rehearsals:n.排练;预演;演习;复述;重复;(rehearsal的复数) outstretched:adj.伸展的; v.拉(伸)长; (outstretch的过去式和过去分词) sprained:v.扭伤(关节)(sprain的过去分词和过去式) wrist:n.手腕;腕关节;v.用腕力移动[送出,抛掷等];
Now you would probably imagine, as she did, that a wrist sprain is a trivial event in a person's life. 就像当时钱德勒的想法, 你可能也认为这就是人生当中 一次普通的受伤。
trivial:adj.不重要的,琐碎的;琐细的;
Wrap it in an ACE bandage, take some ibuprofen for a week or two, and that's the end of the story. 用绷带缠起来 吃点布洛芬,一周或两周 事情就会结束。
Wrap:v.缠绕;隐藏;掩护;包起来;缠绕;穿外衣;n.外套;围巾; ibuprofen:n.布洛芬,异丁苯丙酸(抗炎,镇痛药);
But in Chandler's case, that was the beginning of the story. 但是在钱德勒这次的遭遇中,这只是故事的开始。
This is what her arm looked like when she came to my clinic about three months after her sprain. 图中是当时她手臂的情况 当她来到我的诊所时,已经是扭伤发生约三个月后
clinic:n.诊所;临床实习;(医院的)门诊部;门诊时间;
You can see that the arm is discolored , purplish in color. 你可以看到手臂已经变色 有点青紫
discolored:adj.脱色的;污染的;v.使褪色;脱色(discolor的过去分词); purplish:adj.略带紫色的;
It was cadaverically cold to the touch. 摸上去像尸体一样冷
The muscles were frozen, paralyzed -- dystonic is how we refer to that. 肌肉僵硬-- 我们通常所说的瘫痪性肌张力异常。
muscles:n.肌肉(muscle的复数); paralyzed:adj.瘫痪的;麻痹的;v.使麻痹;使无力;使失去勇气(paralyze的过去分词); dystonic:adj.张力障碍的; refer:v.参考;涉及;提到;查阅;
The pain had spread from her wrist to her hands, to her fingertips , from her wrist up to her elbow , almost all the way to her shoulder. 疼痛从她的手腕蔓延到手掌, 到手指,又从手腕蔓延到手肘, 一直到她的肩膀。
fingertips:n.指尖;(fingertip的复数) elbow:n.肘;弯头;肘状物;v.用肘推;挤进;讨价还价;
But the worst part was, not the spontaneous pain that was there 24 hours a day. 但最糟糕的 不是每天24小时的自发性疼痛。
spontaneous:adj.自发的;自然的;无意识的;
The worst part was that she had allodynia, the medical term for the phenomenon that I just illustrated with the feather and with the torch. 最糟糕的是她患上痛觉超敏症 这是一个医学术语 说的就是我刚才用羽毛和喷火枪所演示的那种情况
phenomenon:n.现象;杰出的人;非凡的人(或事物); illustrated:v.加插图于;给(书等)做图表;说明,解释;(illustrate的过去分词和过去式)
The lightest touch of her arm -- the touch of a hand, the touch even of a sleeve , of a garment , as she put it on -- caused excruciating , burning pain. 轻微的触碰她的手臂 触碰手掌, 即使是她自己穿衣服时触碰到手袖、衣物 也会造成难以忍受的烧灼痛
sleeve:n.袖子;套管;有…袖子的;唱片套;v.给…装袖子; garment:n.衣服,服装;外表,外观;vt.给…穿衣服; excruciating:adj.折磨人的;极痛苦的;极坏的;v.折磨;使受酷刑;(excruciate的现在分词)
How can the nervous system get this so wrong? 神经系统怎么会犯这样的错呢？
How can the nervous system misinterpret an innocent sensation like the touch of a hand and turn it into the malevolent sensation of the touch of the flame? 神经系统 怎么会误解一个本来无害的触觉呢？ 就像是把手的触摸 误解成 触摸火焰的恶意感觉。
misinterpret:vt.曲解,误解; innocent:adj.无辜的;无罪的;无知的;n.天真的人;笨蛋; sensation:n.感觉;轰动;感动; malevolent:adj.恶毒的;有恶意的;坏心肠的;
Well you probably imagine that the nervous system in the body is hardwired like your house. 把身体里的神经系统 想象成你家里的电线电路。
hardwired:adj.电路的;
In your house, wires run in the wall, from the light switch to a junction box in the ceiling and from the junction box to the light bulb . 在你家里,电线布满在墙壁里, 从灯的开关到天花板上的接线盒 从接线盒又到灯泡。
junction:n.连接,接合;交叉点;接合点; light bulb:n.灯泡;
And when you turn the switch on , the light goes on. 当你打开开关的时候,灯泡亮了
switch on:n.接通;
And when you turn the switch off, the light goes off. 等你关闭开关的时候,灯泡熄灭。
So people imagine the nervous system is just like that. 假设神经系统就是这样。
If you hit your thumb with a hammer , these wires in your arm -- that, of course, we call nerves -- transmit the information into the junction box in the spinal cord where new wires, new nerves, take the information up to the brain where you become consciously aware that your thumb is now hurt. 如果你用锤子敲大拇指, 你手臂里的电线——当然,我们称为神经—— 在脊髓里传递信息到接线盒 新电线,新的神经 把信息运送到大脑 因此你能自觉意识到你的大拇指受伤了。
thumb:v.翻阅;以拇指拨弄;作搭车手势;笨拙地摆弄;n.拇指; hammer:n.锤子; v.锤打; nerves:n.神经;神经紧张;勇气;v.鼓足勇气;振作精神;(nerve的第三人称单数和复数) transmit:v.传送;发射;播送;传播;传染; spinal cord:n.脊髓; consciously:adv.自觉地;有意识地;
But the situation, of course, in the human body is far more complicated than that. 这个情况,当然,是发生在身体里的 实际上更复杂一些。
complicated:adj.复杂的;难懂的;v.使复杂化;(complicate的过去分词和过去式)
Instead of it being the case that that junction box in the spinal cord is just simple where one nerve connects with the next nerve by releasing these little brown packets of chemical information called neurotransmitters in a linear one-on-one fashion, in fact, what happens 相反 脊髓里的接线盒 仅仅是一段神经联系另一段神经的地方 通过释放这些小棕色块 也就是被称为神经递质的化学信息 以一对一的线性方式 事实上
releasing:n.释放;松释动作;脱扣释放;v.释放;排放;(release的现在分词); chemical:n.化学制品,化学药品;adj.化学的; neurotransmitters:n.神经传导物质(neurotransmitter的复数形式); linear:adj.线的,线型的;直线的,线状的;长度的; one-on-one:adj.一对一的;直接对立的;adv.一对一;面对面;n.一对一的比赛;
is the neurotransmitters spill out in three dimensions -- laterally , vertically , up and down in the spinal cord -- and they start interacting with other adjacent cells. 是神经递质发散出三维空间-- 在脊髓里横向、纵向、以及上下地-- 它们和其他邻近的细胞之间 开始发生反应。
spill:v.溢出;涌出;蜂拥而出;n.跌落;洒出(量);泼出(量);溢出(量); dimensions:n.规模,大小; laterally:adv.旁边地; vertically:adv.垂直地; interacting:v.交流;沟通;合作;相互影响;(interact的现在分词) adjacent:adj.邻近的,毗连的;
These cells, called glial cells, were once thought to be unimportant structural elements of the spinal cord that did nothing more than hold all the important things together, like the nerves. 这些细胞,称为神经胶质细胞, 它们曾经被认为 是脊髓里不重要的结构构件 仅仅是把其他重要的东西连接在一起, 比如说神经。
glial:adj.神经胶质的; unimportant:adj.不重要的;琐碎的; structural:adj.结构的;建筑的; elements:n.要素;基本部分;少量;一群;(element的复数)
But it turns out the glial cells have a vital role in the modulation , amplification and, in the case of pain, the distortion of sensory experiences. 结果却发现 在疼痛的案例中,神经胶质细胞 在调节,扩大 和歪曲 感觉体验的作用中起着非常重要的作用。
vital:adj.至关重要的;生死攸关的;有活力的; modulation:n.[电子]调制;调整; amplification:n.[电子]放大(率);扩大;详述; distortion:n.变形;[物]失真;扭曲;曲解; sensory:adj.感觉的;知觉的;传递感觉的;
These glial cells become activated . 这些胶质细胞活跃起来。
activated:v.使活动;激活;使活化;(activate的过去式和过去分词)
Their DNA starts to synthesize new proteins , which spill out and interact with adjacent nerves, and they start releasing their neurotransmitters, and those neurotransmitters spill out 它们的脱氧核糖核酸开始合成新的蛋白质 同时发散出来 与邻近的神经发生反应。 释放出神经递质。 神经递质又被发散出来
synthesize:vt.合成;综合;vi.合成;综合; proteins:n.[生化]蛋白质(protein复数);
and activate adjacent glial cells, and so on and so forth, until what we have is a positive feedback loop . 激活了邻近的胶质细胞,然后如此循环往复, 直到 神经反射。
positive:adj.积极的;[数]正的,[医][化学]阳性的;确定的;n.正数;[摄]正片; feedback:n.反馈;反馈意见;回授;[电子]反馈; loop:n.循环;回路;环路;圈;v.使成环;使绕成圈;成环形移动;
It's almost as if somebody came into your home and rewired your walls so that the next time you turned on the light switch, the toilet flushed three doors down, or your dishwasher went on, or your computer monitor turned off. 几乎就像是有人到你家 重新在你墙壁里布线, 结果你下次打开灯的开关, 却意外的冲了三次马桶, 或者是启动了洗碗机, 或者是电脑显示器被关闭。
rewired:vt.给…再打电报;给…换新电线;vi.再发电报;重装电线; flushed:adj.脸红的;v.发红;脸红;(用水)冲洗净,冲洗;(flush的过去分词和过去式) dishwasher:n.洗碗工;洗碟机;
That's crazy, but that's, in fact, what happens with chronic pain. 乱套了！ 但事实上, 这就是患上慢性疼痛后,会发生的事情。
And that's why pain becomes its own disease. 也是为什么疼痛本身会变成一种疾病。
The nervous system has plasticity . 神经系统有可塑性。
plasticity:n.塑性,可塑性;适应性;柔软性;
It changes, and it morphs in response to stimuli . 对刺激做出反应 它会改变,也会变异。
morphs:n.词态;语素;变体;vt.在屏幕上变换图像;改变; in response to:响应;回答;对…有反应; stimuli:n.刺激;刺激物;促进因素(stimulus的复数);
Well, what do we do about that? 那我们该怎么办呢？
What can we do in a case like Chandler's? 针对钱德勒这样的情况我们该怎么做呢？
We treat these patients in a rather crude fashion at this point in time. 我们用相对粗糙的一种方式来治疗这些患者 目前是这样的。
treat:v.治疗;处理;招待;款待;n.款待;乐事;乐趣; crude:adj.粗略的;简略的;大概的;粗糙的;n.原油;石油;
We treat them with symptom-modifying drugs -- painkillers -- which are, frankly, not very effective for this kind of pain. 我们用控制症状的药物来治疗 也就是止疼药 坦白说,对于这种病 不是很有效。
painkillers:n.止痛药(painkiller的复数形式); effective:adj.有效的,起作用的;实际的,实在的;给人深刻印象;
We take nerves that are noisy and active that should be quiet, and we put them to sleep with local anesthetics . 我们只是让那些吵闹的神经 消停下来, 用局部麻醉来使它们进入睡眠。
anesthetics:n.麻醉药;麻醉剂(anesthetic的复数);
And most importantly , what we do is we use a rigorous , and often uncomfortable, process of physical therapy and occupational therapy to retrain the nerves in the nervous system to respond normally to the activities and sensory experiences that are part of everyday life. 最重要的是,我们所做的 只是用枯燥且常不舒服的 物理治疗和职业治疗法 来在神经系统里维持神经 使它们在日常生活的 感官活动中 做出正常的反应。
And most importantly:最主要的是…; rigorous:adj.严格的,严厉的;严密的;严酷的; process:v.处理;加工;列队行进;n.过程,进行;方法,adj.经过特殊加工(或处理)的; physical therapy:n.理疗;物理疗法; occupational therapy:n.职业疗法; retrain:vt.重新教育;再教育;vi.再训练;再教育; respond:vi.回答;作出反应;承担责任;n.应答;唱和; normally:adv.正常地;通常地,一般地;
And we support all of that with an intensive psychotherapy program to address the despondency , despair and depression that always accompanies severe , chronic pain. 对此,我们用密集的心理治疗方案 进行全力的配合 解决那些 伴随严重慢性疼痛而来的 沮丧、绝望和抑郁。
intensive:adj.加强的;集中的;透彻的;加强语气的;n.加强器; psychotherapy:n.心理疗法;精神疗法; despondency:n.泄气;意气消沉; despair:v.绝望;失去希望;丧失信心;n.绝望; depression:n.沮丧;洼地;不景气;忧愁; accompanies:v.陪同;陪伴;与…同时发生;为…伴奏;(accompany的第三人称单数) severe:adj.极为恶劣的;十分严重的;严厉的;苛刻的;
It's successful, as you can see from this video of Chandler, who, two months after we first met her, is now doings a back flip . 我们很成功！ 正如你从这个视频短片中看到的钱德勒, 在我们遇见她两个月之后, 她正做着后空翻。
doings:n.举动,行为;所做之事(doing的复数); flip:n.浏览;空翻;轻抛;捻掷;v.迅速翻动;按(开关);按(按钮);开(或关)(机器等);
And I had lunch with her yesterday because she's a college student studying dance at Long Beach here, and she's doing absolutely fantastic . 昨天我刚和她一起吃了午饭, 因为现在,她是在长滩学习舞蹈的一名大学生。 她现在简直是棒极了！
absolutely:adv.绝对地;完全地; fantastic:奇异的,空想的
But the future is actually even brighter. 未来更加美好！
The future holds the promise that new drugs will be developed that are not symptom-modifying drugs that simply mask the problem, as we have now, but that will be disease-modifying drugs 未来有希望 开发新的药物 不是那些只会控制症状的药物 它们仅仅是粉饰问题。 而是,正如我们现在看到的, 去开发那种治病的药物
that will actually go right to the root of the problem and attack those glial cells, or those pernicious proteins that the glial cells elaborate , that spill over and cause this central nervous system wind-up , or plasticity, that so is capable of distorting and amplifying the sensory experience that we call pain. 能真正从根本上解决问题 对付神经胶质细胞 或对付那些由神经胶质细胞产生的 有害的蛋白质 它们溢出后使中枢神经系统产生发条拧紧现象, 产生神经的可塑性, 因此就有可能 歪曲和扩大了 我们称为疼痛的感觉体验。
pernicious:adj.有害的;恶性的;致命的;险恶的; elaborate:adj.精心制作的;详尽的;煞费苦心的;v.精心制作;详细描述;变复杂; spill over:满溢;泛溢; central nervous system:n.中枢神经系统; wind-up:n.结局;结束;故意激怒或招惹某人;adj.要上发条才能运转的; capable:adj.能干的,能胜任的;有才华的; distorting:v.使变形;扭曲;使失真;歪曲;(distort的现在分词) amplifying:adj.放大的;
So I have hope that in the future, the prophetic words of George Carlin will be realized, who said, "My philosophy : 所以,我有一个愿望 在将来 乔治·卡林的预言会实现, 他说,“我的哲学是:
prophetic:adj.预言的,预示的;先知的; Carlin:n.老妇人;巫婆; philosophy:n.哲学;哲理;人生观;
No pain, no pain." 没痛就不痛。”
Thank you very much. 非常感谢
(Applause) （鼓掌声）