I'm a pediatrician and anesthesiologist who put children into sleep for a living. An I'm in academics so i put audiences to sleep for free. But what i actually and mostly do is that I mangage pain management service at the Packerd children's hospitals of Stanford in Paloalto. And it's from the experience of about 20 or 25 years of doing that. That i want to bring to you the message this morning is that pain is a disease. Now most of times you think the pain is a symptom of a disease and that's true most of time. It's the symptom of tumor or infection or inflammation or an operation. But about 10% of the time after the patient has recovered from one of those events pain persist. it persist for months and often times for years. And when that happens it is its own disease. And before i tell you about how it is that what we think that happens, and what we can do about this, I want to show how it feels for my patients. So imagine if you will, that i'm stroking your arm with feather as i'm stroking my are right now. Now i want you to imagine that i'm stroking my arm with this. A very different feeling. And now what does it have to do with chronic pain.. Imagine if you will, (with) these two ideas together, imagine what your life would be like. If i were to stroke with this feather but brain was telling you is that this is what you are feeling . And that is experience of my patients with chronic pain. In fact, imagine something even worse. Imagine if i'm stroking your child's arms with feather, and their brain were telling them that they were feeling this torch. that was experience of my patient Chandler whom you see in the photograph. As you can see she is beautiful young woman she was 16 years old last year when i met her, she spired to be a professional dancer. And during the course of one of her dance rehearsal she fell in her outstretched arm and sprained her wrist. Now you would probably imagine that she did the wrist sprain is a trivial event in one person's life. Wrap with adhesive bandage, take some ibuprofen for a week or two and that's the end of the story. This is what her arm look like when she came to my clinic about 3 months after her sprain. You can see that her arm is discolored puplish color . it was cata~ cally cold to the touch. The muscles were frozen paralyzed. Dystonic is what we refer to that. The pain has spread from her wrist to her hand to her finger tips from her wrist up to her elbow almost all the way of her shoulder. But the worst part was not the spontaneous pain that was there for 24hours a day. The worst part she had was allodynia the medical term for phenomenon that i've just illustrated with the feather and a torch. The lightest touch of her arm the touch of her hand the touch even of her sleeves of her garment that she put it on caused excruciating burning pain. How can this nerve system get this so wrong, misinterpret innocent sensation like the touch of a hand and turn it into a malevolent sensation of a touch of flame. You probably imagine that the nerve system of the body is hard wire of your house. In your house the wire run in the wall from the switch to the junction box in the ceiling and from the junction box to the light bulb. and when you turn the switch on the light goes on. So the people imagine that the nerve system is just like that. If you hit your thumb with hammer these wires in your arm that of course we call it nerve transmit information up to the junction box in the spinal cords where new wires new nerves takes the information up to the brain where you become consciously aware that your thumb is now hurt. But the situation of course in the human body is far more complicated than that. Instead of being the case that that junction box in the spinal cord is just simply one nerve communicate with next nerve by releasing these little brown packets of chemical information called neural transmitters in a linear one on one fashion. in fact what happens is the neural transmitter spill out in 3D laterally vertically up and down the spinal cord and it start interacting with other adjacent cells. This cell is called glial cells for once thought to be unimportant structure elements of spinal cord that did nothing more that hold all the important things together like the nerves. But it turns out the glial cells has vital role in the modulation and amplification in the case of pain and in the distortion of sensory experience. This glial cells become activated their DNA starts to synthesize new proteins which spill out and interact with adjacent nerve. and they starts to release their neural transmitter. and those neural transmitter spills out in activated adjacent glial cells so on and so forth. until what we have is a positive feedback loop. it's almost is as if somebody came into your hose and rewire your wall and when the next time you turn on the light switch the toilet flush three doors down or your dish washer went on or your computer monitor will turn off. That's crazy but that's infect what happens with chronic pain and that is why pain becomes its own disease. The nerve system has its plasticity. it changes and it morphs and response to stimuli . What can we do in the Chandler's case . We treat this patient in a rather crude fashion or this point and time we treat them with symptom modifying drugs,pain killers which are frankly not very effective for this kind of pain.  We takes nerves that are noisy and active that should be quiet and we put them to sleep with local anesthetics, and mostly important what we do is we use a rigorous and often uncomfortable process of physical therapy and occupational therapy to retrain the nerve system to respond normally to the activity and sensory experience that are parts of everyday life. And we support all of that with the intensive psycho therapy program to address the despondency, despair, and depression that always accompanies with severe chronic pain.  it was successful as you can see from this video of chandler who two month after we met chandler is now doing the back flip and i had lunch with her yesterday because she was college student of ~~~ here. And she is doing absolutely fantastic. But the future is actually even brighter 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 that would actually go right to the root of the problem and attack those glial cells or those pre~~tious protein that the glial cells elaborate that spill over and cause central neural system wind up wh plasticity that is so escapable of distorting and amplifying the sensory experience that we call pain . So that i have hope that in the future the prophetic words of George Carlen will be realized who said "my philosophy ?, No pain No pain " Thank you very much.

중간에 임시저장이 잘못되어 다 지워졌다.
내용은 간단하다.
만성통증은 말초신경에서 느껴진 자극이 척추에서 증폭되어, 작은 자극도 심각한 통증으로 느껴지는 것을 말한다. 원래 직선형으로 전달되어야할 신호가 방사형으로 신호가 퍼지게 되면 주위의 모든 신경들이 자극을 받아 처음 받은 신호가 몇배로 증폭이 된다. 문제의 원인은 척추의 글리올 세포에 있는데 이는 처음에 중요하지 않은 세포로 알려졌으나, 신경전달 물질은 사방에 뿌리는 만성통증의 주 원인으로 밝혀졌다. 지금은 행동 및 정신 치료를 통해 통증을 치료한다. 하지만 미래에는 만성통증을 일으키는 원인에 직접적으로 작용을는 약물이 나올 것이라고 강연자는 말학고 있다 .
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