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馴獸之路//重新認識頑固性疼痛

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  • TA的每日心情
    開心
    2016-6-8 01:31
  • 簽到天數: 9 天

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    [LV.3]偶爾看看II

    澳洲疼痛學家Lorimer Moseley用動畫片的形式告訴你疼痛的機制。


    馴獸之路

    Tame the Beast

    是時候重新認識頑固性疼痛了

    It’s time to rethink persistent pain

           Once upon a time, all the lands were fraught with persistent pain.So widespread was this affliction that one in four people experienced it. The pain lasted more than 3 months. It shadowed their daily lives… held them back from everyday activities … and the interventions they tried proved useless…“Hey, pain! Go away! We’ve tried it all But still you stay! Moving less, Taking pills, Knives and needles.I can't stand it any more ! But the pain remains like a loyal companion.The peoples’ hopes faded and they became resigned to living with the pain – only now, the pain was a beast! 

           在很久以前,人們就已經意識到頑固性疼痛的存在,并且有了一種說法:世界上1/4的人一生中都會經歷疼痛,這種疼痛會持續超過3個月以上,嚴重影響人們的生活,讓人無法從事日常活動。嘗試任何的治療均以無效告終。“Hey,疼痛,你離開我吧!我們嘗試了這么多方法怎么你還在?不管是吃藥、開刀還是針刺,我們還是痛。我們再也忍受不了!忍受不了了!!”但疼痛依舊在,忠誠的不離不棄。人們無法戰勝疼痛,就不得不與疼痛一起生活了,于是疼痛慢慢長成為了一只野獸。

          Then, along came a group of researchers, of which I am one. “Back off, big fella!” I’m Professor Lorimer Moseley and I’m a pain scientist.Pain scientists are starting to think differently about pain and its causes. And we’re making exciting discoveries…Like how the way you think about your pain can change the way it feels. Over the next few minutes, I’ll help you to understand your pain. Understanding is important because it can change how much things hurt and how much your body can do… And can help you to tame the beast.

           現在,許多團隊都在研究它,而我也是其中的一個。(退后,大家伙),我是Prof Lorimer Moseley,一名研究疼痛的科學家。疼痛科學家對疼痛以及它的形成有著不一樣的觀點。對疼痛的研究有了新的發現。比如,人們對待疼痛的態度不一樣能影響對疼痛的主觀感覺。在接下來的幾分鐘,我會幫助你更加了解你的疼痛,讀懂疼痛是非常重要的。因為這決定著疼痛對你的傷害有多大,伴隨疼痛,你的身體還能做多少活動。而這將會幫助您馴化疼痛這只猛獸。

               First, trust me about this.Pain is not an accurate measure of tissue health. Pain is a protector. By making unpleasant feelings, your brain changes your behaviour – so you can avoid injury or your tissues can heal. Sometimes pain is not helpful – like phantom limb pain. You don’t expect a missing limb to ache. But it does and the pain is very real.So how do we explain this? Pain is a warning signal from your brain that depends on credible evidence to say your body needs protecting. Sometimes it’s too protective and you get unnecessary warning signals. Pain scientists now understand that there are many ways our nervous system ends up producing unnecessary warning signals. Take conditioning for example.Think of Pavlov’s dog… Every time food was offered, Pavlov rang a bell. Of course, the dog would salivate seeing the food. This went on for a while. Eventually the dog was conditioned to salivate for the bell alone. 

          首先,相信我說的這一點,疼痛并不是衡量身體健康的準確指標,疼痛是一種保護機制,當遭遇不好的感覺刺激時,大腦會讓身體做出相應的保護措施,從而讓我們免受損傷,讓組織得以修復,但有時疼痛也是有害的,比如幻肢痛。雖然那條腿不在了,但是人體還是能感覺那里痛,而且痛起來非常地真實。怎么解釋這種現象呢?疼痛是來自大腦的一種警告信號,基于可靠的信息來作為判斷,來保護你的身體,但有時候疼痛又過度保護了,以至于讓你產生過多不必要的警告信號,現在疼痛科學家相信,人體的神經系統存在多種通路,讓機體產生各種不必要的警告信號,拿條件反射來說,巴普洛夫給狗做過一個實驗,每次給狗喂食物時都搖響鈴鐺,當然狗因為食物而垂涎,以這種方式維持了一段時間之后。最終,狗就條件反射地對搖響鈴鐺做出了垂涎的反應。

          Conditioning is just one of the ways your body learns pain. And the longer your nervous system produces pain, the better it gets at producing it. Your body learns pain.So what feeds this beast? Let’s look at how pain works… In your body’s tissues, there are specific neurones, which normally only respond to harmful stimuli. – whether mechanical, chemical or thermal. When they are activated, they send a warning signal to your spinal cord, which can in turn send a signal to your brain. This activity in neurones is called ‘nociception’ and it’s happening all the time. But iit only sometimes results in pain. Most of the time, the brain protects you with other things like movement. Once the warning signal reaches the brain, the brain makes sense of it based on the information arriving and the vast amount already stored. If there’s reason to think protection is required, then your brain makes pain.One of our amazing discoveries is that you can have pain without any physical stimuli. Thoughts and places might activate the warning signals. And the pain feels exactly the same. But it’s not just your brain - your spinal cord also learns how to generate unnecessary warning signals.So how do you know when your nervous system is learning pain? You may notice your pain spreads or comes on without warning. Your body feels odd and it’s hard to move properly. Your pain changes quickly with your mood and small annoyances can set it off. Old injuries start to hurt again. You’re more sensitive to stimuli. And the longer the pain goes on, the more all of this occurs.

           條件反射只是人體學習疼痛的其中一種方式,你的神經系統產生的疼痛的時間越長,就像在給電池充電一樣,你的身體正在學習疼痛,那是什么飼養了這些猛獸?讓我們看看疼痛是怎么產生的,我們的身體表面有很多特定的神經元,它們感知一切對身體有害的信號,無論是機械性的、化學性的以及溫熱的刺激,當這些神經元被刺激激活時,它們會將警告信號傳入脊髓,經過轉化再上傳至大腦,這個過程稱為痛覺感知。這種過程無時無刻不再發生,但只有在某一些時候才真正產生疼痛,而大多數時候大腦會做出其他反應,例如動作的產生。當外界刺激產生警告信號傳入大腦時,大腦會將這種信號與以往儲存的信號進行對比,當大腦認為這種信號是有害的,需要啟動保護機制時,大腦就會產生疼痛。一項令人驚訝的研究結果是人體并不需要實實在在的刺激就可以產生疼痛,內心的想法與所處的環境都可以產生警告信號,而大腦所產生的疼痛則感覺是實實在在的,不只是大腦,脊髓也會學習如何產生不必要的警告信號,那如何知道我們的神經系統在學習疼痛呢,你可能會發現你的疼痛在到處蔓延,你會感覺身體很奇怪而不能很好的活動,你的疼痛會隨著你的心情的變化而變化。再小的噪音都有可能引發癥狀,以前的舊患又重新痛起來了,對外界的刺激很敏感,而隨著疼痛持續,這些情況會出現的更頻繁。

          The old way we understood pain left many sufferers feeling like no one believed it was real. Or that for it to hurt so bad, there must be a tissue problem. But we now know how persistent pain happens.So how can you tame the beast?Pain is a very personal thing. There’s no one size fits all solution. And while you probably have well thought out coping strategies, it’s time to take a new approach to dealing with and reducing your pain – one that focuses on retraining your pain system. This might mean testing yourself physically and moving more than you normally would. Being honest about your current attitudes and beliefs can also help. As can asking your health professional new questions.How do I know if my pain system is being over protective?How can I retrain my pain system to be less protective?How do I know if I’m safe to move?So be brave and have hope! Because – it is possible to tame the beast!

          以往我們對待疼痛的看法很難理解這種現象,而且會留下嚴重后果,讓患者覺得沒有人相信自己,或者會認為這么嚴重的疼痛一定是有嚴重的組織損傷,但現在我們知道了頑固性疼痛是如何產生的了,那我們如何馴化疼痛這只猛獸呢?疼痛是一件非常私人的事情,沒有任何一種方法可以解決所有的疼痛,盡管你原來可能接受著各種各樣的治療手段,但現在是時候嘗試一種新的方式管理疼痛了,其中一項就是重新訓練你的疼痛系統,這會讓你重新認識你的身體機能,讓你活動的比平常更多,從而讓你相信自己可以做到,另外,也可以向你的醫師問不一樣的問題,比如,我怎么知道我的疼痛系統是不是過度保護了呢?我要如何訓練才能讓我的疼痛系統不那么過度保護?我如何知道我可以安全的運動?所以勇敢一點,還要充滿希望。因為我們是有希望馴化疼痛這只猛獸的。

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