The mystery of chronic pain - Elliot Krane
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i'm<00:00:16.000> a<00:00:16.080> pediatrician<00:00:16.720> and<00:00:16.800> an
i'm a pediatrician and an
i'm a pediatrician and an
anesthesiologist<00:00:17.840> so<00:00:18.000> i<00:00:18.160> put<00:00:18.320> children<00:00:18.640> to
anesthesiologist so i put children to
anesthesiologist so i put children to
sleep<00:00:18.960> for<00:00:19.119> a<00:00:19.199> living
and<00:00:22.080> i'm<00:00:22.240> an<00:00:22.320> academic<00:00:22.880> so<00:00:23.039> i<00:00:23.119> put<00:00:23.519> audiences
and i'm an academic so i put audiences
and i'm an academic so i put audiences
to<00:00:24.160> sleep<00:00:24.400> for<00:00:24.560> free
um<00:00:29.679> but<00:00:29.840> what<00:00:30.000> i<00:00:30.160> actually<00:00:30.400> mostly<00:00:30.800> do<00:00:30.960> is<00:00:31.119> i
um but what i actually mostly do is i
um but what i actually mostly do is i
manage<00:00:31.519> the<00:00:31.679> pain<00:00:31.920> management<00:00:32.399> service<00:00:32.719> at
manage the pain management service at
manage the pain management service at
the<00:00:32.880> packard<00:00:33.280> children's<00:00:33.680> hospital<00:00:34.079> up<00:00:34.160> at
the packard children's hospital up at
the packard children's hospital up at
stanford<00:00:34.719> in<00:00:34.800> palo<00:00:35.120> alto<00:00:35.840> and<00:00:36.000> it's<00:00:36.160> from<00:00:36.399> the
stanford in palo alto and it's from the
stanford in palo alto and it's from the
experience<00:00:37.120> of<00:00:37.200> about<00:00:37.520> 20<00:00:37.840> or<00:00:38.000> 25<00:00:38.399> years<00:00:38.640> of
experience of about 20 or 25 years of
experience of about 20 or 25 years of
doing<00:00:38.960> that<00:00:39.200> that<00:00:39.440> i<00:00:39.520> want<00:00:39.680> to<00:00:39.840> bring<00:00:40.079> to<00:00:40.160> you
doing that that i want to bring to you
doing that that i want to bring to you
the<00:00:40.399> message<00:00:40.879> this<00:00:41.040> morning
the message this morning
the message this morning
that<00:00:42.239> pain<00:00:43.040> is<00:00:43.280> a<00:00:43.520> disease
that pain is a disease
that pain is a disease
now<00:00:44.960> most<00:00:45.200> of<00:00:45.360> the<00:00:45.440> time<00:00:45.600> you<00:00:45.760> think<00:00:45.920> of<00:00:46.079> pain
now most of the time you think of pain
now most of the time you think of pain
is<00:00:46.719> a<00:00:46.960> symptom<00:00:47.360> of<00:00:47.440> a<00:00:47.520> disease<00:00:48.000> and<00:00:48.239> that's
is a symptom of a disease and that's
is a symptom of a disease and that's
true<00:00:48.960> most<00:00:49.200> of<00:00:49.280> the<00:00:49.440> time<00:00:49.680> it's<00:00:49.920> the<00:00:50.079> symptom
true most of the time it's the symptom
true most of the time it's the symptom
of<00:00:51.039> a<00:00:51.199> tumor<00:00:51.760> or<00:00:51.920> an<00:00:52.079> infection<00:00:52.559> or<00:00:52.640> an
of a tumor or an infection or an
of a tumor or an infection or an
inflammation<00:00:53.440> or<00:00:53.600> an<00:00:53.760> operation
inflammation or an operation
inflammation or an operation
but<00:00:55.039> about<00:00:55.440> 10<00:00:56.000> of<00:00:56.079> the<00:00:56.239> time
but about 10 of the time
but about 10 of the time
after<00:00:57.920> the<00:00:58.079> patient<00:00:58.399> has<00:00:58.640> recovered<00:00:59.280> from<00:00:59.680> one
after the patient has recovered from one
after the patient has recovered from one
of<00:00:59.920> those<00:01:00.160> events<00:01:00.960> pain<00:01:01.280> persists<00:01:02.320> it
of those events pain persists it
of those events pain persists it
persists<00:01:03.039> for
persists for
persists for
months<00:01:04.879> and<00:01:05.119> often<00:01:05.439> times<00:01:05.760> for<00:01:06.080> years<00:01:06.880> and
months and often times for years and
months and often times for years and
when<00:01:07.200> that<00:01:07.439> happens
when that happens
when that happens
it<00:01:08.720> is<00:01:08.960> its<00:01:09.200> own<00:01:09.439> disease
it is its own disease
it is its own disease
and<00:01:10.799> before<00:01:11.119> i<00:01:11.280> tell<00:01:11.439> you<00:01:11.680> about<00:01:12.000> how<00:01:12.240> it<00:01:12.400> is
and before i tell you about how it is
and before i tell you about how it is
that<00:01:12.640> we<00:01:12.799> think<00:01:12.960> that<00:01:13.200> happens<00:01:13.600> and<00:01:13.680> what<00:01:13.840> we
that we think that happens and what we
that we think that happens and what we
can<00:01:14.080> do<00:01:14.320> about<00:01:14.640> it<00:01:15.119> i<00:01:15.280> want<00:01:15.439> to<00:01:15.600> show<00:01:15.840> you<00:01:16.400> how
can do about it i want to show you how
can do about it i want to show you how
it<00:01:16.799> feels<00:01:17.200> for<00:01:17.360> my<00:01:17.600> patients
it feels for my patients
it feels for my patients
so<00:01:18.960> imagine<00:01:19.439> if<00:01:19.520> you<00:01:19.680> will
so imagine if you will
so imagine if you will
then<00:01:20.720> i'm<00:01:20.880> stroking<00:01:21.280> your<00:01:21.439> arm<00:01:21.680> with<00:01:21.759> this
then i'm stroking your arm with this
then i'm stroking your arm with this
feather<00:01:22.640> as<00:01:22.799> i'm<00:01:22.960> stroking<00:01:23.360> my<00:01:23.600> arm<00:01:23.840> right<00:01:24.000> now
feather as i'm stroking my arm right now
feather as i'm stroking my arm right now
now<00:01:26.000> i<00:01:26.159> want<00:01:26.320> you<00:01:26.479> to<00:01:26.640> imagine
now i want you to imagine
now i want you to imagine
that<00:01:27.840> i'm<00:01:27.920> stroking<00:01:28.320> it<00:01:28.400> with<00:01:28.560> this<00:01:28.880> please
that i'm stroking it with this please
that i'm stroking it with this please
keep<00:01:30.320> your<00:01:30.479> seat
a<00:01:34.880> very<00:01:35.200> different<00:01:35.520> feeling<00:01:35.759> now<00:01:35.920> what<00:01:36.079> does
a very different feeling now what does
a very different feeling now what does
it<00:01:36.320> have<00:01:36.479> to<00:01:36.560> do<00:01:36.720> with<00:01:36.799> chronic<00:01:37.200> pain
it have to do with chronic pain
it have to do with chronic pain
imagine<00:01:38.720> if<00:01:38.880> you<00:01:38.960> will<00:01:39.280> these<00:01:39.520> two<00:01:39.840> ideas
imagine if you will these two ideas
imagine if you will these two ideas
together<00:01:40.720> imagine<00:01:41.119> what<00:01:41.360> your<00:01:41.600> life<00:01:41.840> would<00:01:42.000> be
together imagine what your life would be
together imagine what your life would be
like
like
like
if<00:01:43.280> i<00:01:43.439> were<00:01:43.600> to<00:01:43.840> stroke<00:01:44.159> it<00:01:44.240> with<00:01:44.399> this<00:01:44.720> feather
if i were to stroke it with this feather
if i were to stroke it with this feather
but<00:01:45.600> your<00:01:45.840> brain<00:01:46.159> was<00:01:46.399> telling<00:01:46.720> you<00:01:47.439> that<00:01:47.759> this
but your brain was telling you that this
but your brain was telling you that this
is<00:01:48.240> what<00:01:48.399> you<00:01:48.640> were<00:01:48.799> feeling<00:01:49.200> and<00:01:49.439> that<00:01:49.680> is<00:01:49.759> the
is what you were feeling and that is the
is what you were feeling and that is the
experience<00:01:50.399> of<00:01:50.479> my<00:01:50.720> patients<00:01:51.040> with<00:01:51.200> chronic
experience of my patients with chronic
experience of my patients with chronic
pain<00:01:52.159> in<00:01:52.320> fact<00:01:52.720> imagine<00:01:53.119> something<00:01:53.439> even
pain in fact imagine something even
pain in fact imagine something even
worse
worse
worse
imagine<00:01:54.799> i<00:01:54.960> were<00:01:55.040> to<00:01:55.200> stroke<00:01:55.520> your<00:01:55.680> child's
imagine i were to stroke your child's
imagine i were to stroke your child's
arm<00:01:56.560> with<00:01:56.799> this<00:01:56.960> feather<00:01:57.600> and<00:01:57.759> their<00:01:58.000> brain
arm with this feather and their brain
arm with this feather and their brain
were<00:01:58.479> telling<00:01:58.880> them<00:01:59.600> that<00:01:59.759> they<00:01:59.920> were<00:02:00.159> feeling
were telling them that they were feeling
were telling them that they were feeling
this<00:02:01.200> hot<00:02:01.920> torch
this hot torch
this hot torch
that<00:02:03.360> was<00:02:03.520> the<00:02:03.680> experience<00:02:04.079> of<00:02:04.240> my<00:02:04.399> patient
that was the experience of my patient
that was the experience of my patient
chandler<00:02:05.600> whom<00:02:05.759> you<00:02:05.920> see<00:02:06.079> in<00:02:06.159> the<00:02:06.240> photograph
chandler whom you see in the photograph
chandler whom you see in the photograph
as<00:02:06.960> you<00:02:07.040> can<00:02:07.119> see<00:02:07.280> she's<00:02:07.520> a<00:02:07.600> beautiful<00:02:07.920> young
as you can see she's a beautiful young
as you can see she's a beautiful young
woman<00:02:08.800> she<00:02:08.959> was<00:02:09.119> 16<00:02:09.520> years<00:02:09.679> old<00:02:09.840> last<00:02:10.080> year
woman she was 16 years old last year
woman she was 16 years old last year
when<00:02:10.399> i<00:02:10.479> met<00:02:10.640> her<00:02:10.800> and<00:02:10.959> she<00:02:11.120> aspired<00:02:11.599> to<00:02:11.760> be<00:02:12.000> a
when i met her and she aspired to be a
when i met her and she aspired to be a
professional<00:02:12.720> dancer<00:02:13.520> and<00:02:13.680> during<00:02:13.920> the
professional dancer and during the
professional dancer and during the
course<00:02:14.319> of<00:02:14.400> one<00:02:14.640> of<00:02:14.720> her<00:02:14.879> dance<00:02:15.120> rehearsals
course of one of her dance rehearsals
course of one of her dance rehearsals
she<00:02:15.840> fell<00:02:16.080> on<00:02:16.239> her<00:02:16.400> outstretched<00:02:16.879> arm<00:02:17.040> and
she fell on her outstretched arm and
she fell on her outstretched arm and
sprained<00:02:17.599> her<00:02:17.680> wrist
sprained her wrist
sprained her wrist
now<00:02:19.040> you<00:02:19.200> would<00:02:19.360> probably<00:02:19.840> imagine<00:02:20.239> as<00:02:20.400> she
now you would probably imagine as she
now you would probably imagine as she
did<00:02:20.800> that<00:02:20.959> a<00:02:21.120> wrist<00:02:21.360> sprain<00:02:21.840> is<00:02:22.080> a<00:02:22.480> trivial
did that a wrist sprain is a trivial
did that a wrist sprain is a trivial
event<00:02:23.280> in<00:02:23.440> a<00:02:23.520> person's<00:02:23.920> life
event in a person's life
event in a person's life
wrap<00:02:25.040> it<00:02:25.280> in<00:02:25.360> an<00:02:25.520> ace<00:02:25.680> bandage<00:02:26.560> take<00:02:26.800> some
wrap it in an ace bandage take some
wrap it in an ace bandage take some
ibuprofen<00:02:27.920> for<00:02:28.000> a<00:02:28.080> week<00:02:28.319> or<00:02:28.400> two<00:02:28.640> and<00:02:28.720> that's
ibuprofen for a week or two and that's
ibuprofen for a week or two and that's
the<00:02:29.120> end<00:02:29.280> of<00:02:29.360> the<00:02:29.520> story<00:02:30.319> but<00:02:30.560> in<00:02:30.720> chandler's
the end of the story but in chandler's
the end of the story but in chandler's
case<00:02:31.599> that<00:02:31.840> was<00:02:32.000> the<00:02:32.080> beginning<00:02:32.480> of<00:02:32.560> the<00:02:32.720> story
case that was the beginning of the story
case that was the beginning of the story
this<00:02:34.879> is<00:02:34.959> what<00:02:35.120> her<00:02:35.360> arm<00:02:35.519> looked<00:02:35.680> like<00:02:35.920> when
this is what her arm looked like when
this is what her arm looked like when
she<00:02:36.239> came<00:02:36.400> to<00:02:36.480> my<00:02:36.640> clinic<00:02:37.040> about<00:02:37.280> three<00:02:37.440> months
she came to my clinic about three months
she came to my clinic about three months
after<00:02:38.000> her<00:02:38.160> sprain
after her sprain
after her sprain
you<00:02:39.519> can<00:02:39.680> see<00:02:39.840> that<00:02:40.080> the<00:02:40.239> arm<00:02:40.560> is<00:02:40.720> discolored
you can see that the arm is discolored
you can see that the arm is discolored
purplish<00:02:42.480> in<00:02:42.560> color<00:02:43.120> it<00:02:43.280> was<00:02:43.440> categorically
purplish in color it was categorically
purplish in color it was categorically
cold<00:02:44.879> to<00:02:45.040> the<00:02:45.200> touch<00:02:45.920> the<00:02:46.080> muscles<00:02:46.480> were
cold to the touch the muscles were
cold to the touch the muscles were
frozen<00:02:47.200> paralyzed<00:02:48.080> dystonic<00:02:48.720> is<00:02:48.800> how<00:02:48.959> we
frozen paralyzed dystonic is how we
frozen paralyzed dystonic is how we
refer<00:02:49.440> to<00:02:49.519> that
refer to that
refer to that
the<00:02:50.879> pain<00:02:51.280> had<00:02:51.519> spread<00:02:51.920> from<00:02:52.080> her<00:02:52.239> wrist<00:02:52.560> to
the pain had spread from her wrist to
the pain had spread from her wrist to
her<00:02:52.959> hands
her hands
her hands
to<00:02:54.080> her<00:02:54.239> fingertips<00:02:54.959> from<00:02:55.120> her<00:02:55.360> wrist<00:02:55.680> up<00:02:55.760> to
to her fingertips from her wrist up to
to her fingertips from her wrist up to
her<00:02:56.080> elbow<00:02:56.480> almost<00:02:56.879> all<00:02:56.959> the<00:02:57.040> way<00:02:57.200> to<00:02:57.360> her
her elbow almost all the way to her
her elbow almost all the way to her
shoulder<00:02:58.159> but<00:02:58.319> the<00:02:58.480> worst<00:02:58.879> part<00:02:59.200> was
shoulder but the worst part was
shoulder but the worst part was
not<00:03:00.239> the<00:03:00.400> spontaneous<00:03:01.200> pain<00:03:01.440> that<00:03:01.519> was<00:03:01.680> there
not the spontaneous pain that was there
not the spontaneous pain that was there
24<00:03:02.319> hours<00:03:02.640> a<00:03:02.720> day<00:03:03.519> the<00:03:03.680> worst<00:03:04.000> part<00:03:04.319> was<00:03:04.560> that
24 hours a day the worst part was that
24 hours a day the worst part was that
she<00:03:05.040> had<00:03:05.519> allodynia<00:03:06.480> the<00:03:06.640> medical<00:03:07.040> term<00:03:07.280> for
she had allodynia the medical term for
she had allodynia the medical term for
the<00:03:07.519> phenomenon<00:03:08.159> that<00:03:08.319> i<00:03:08.400> just<00:03:08.800> illustrated
the phenomenon that i just illustrated
the phenomenon that i just illustrated
with<00:03:09.519> the<00:03:09.599> feather<00:03:10.159> and<00:03:10.400> with<00:03:10.560> the<00:03:10.720> torch<00:03:11.440> the
with the feather and with the torch the
with the feather and with the torch the
lightest<00:03:12.080> touch<00:03:12.400> of<00:03:12.480> her<00:03:12.879> arm<00:03:13.680> the<00:03:13.840> touch<00:03:14.080> of<00:03:14.239> a
lightest touch of her arm the touch of a
lightest touch of her arm the touch of a
hand<00:03:14.640> the<00:03:14.800> touch<00:03:15.200> even<00:03:15.440> of<00:03:15.599> a<00:03:15.680> sleeve<00:03:16.000> of<00:03:16.159> a
hand the touch even of a sleeve of a
hand the touch even of a sleeve of a
garment<00:03:16.720> as<00:03:16.879> she<00:03:17.040> put<00:03:17.200> it<00:03:17.360> on<00:03:18.000> caused
garment as she put it on caused
garment as she put it on caused
excruciating
excruciating
excruciating
burning<00:03:20.800> pain
burning pain
burning pain
how<00:03:23.040> can<00:03:23.200> the<00:03:23.360> nervous<00:03:23.760> system<00:03:24.159> get<00:03:24.400> this<00:03:24.959> so
how can the nervous system get this so
how can the nervous system get this so
wrong<00:03:26.000> how<00:03:26.239> can<00:03:26.400> the<00:03:26.480> nervous<00:03:26.799> system
wrong how can the nervous system
wrong how can the nervous system
misinterpret<00:03:28.480> an<00:03:28.720> innocent<00:03:29.120> sensation<00:03:29.760> like
misinterpret an innocent sensation like
misinterpret an innocent sensation like
the<00:03:30.239> touch<00:03:30.799> of<00:03:30.959> a<00:03:31.120> hand<00:03:32.000> and<00:03:32.159> turn<00:03:32.400> it<00:03:32.560> into<00:03:32.799> the
the touch of a hand and turn it into the
the touch of a hand and turn it into the
malevolent<00:03:33.519> sensation<00:03:34.480> of<00:03:34.720> the<00:03:34.879> touch<00:03:35.360> of<00:03:35.519> the
malevolent sensation of the touch of the
malevolent sensation of the touch of the
flame
flame
flame
well<00:03:37.040> you<00:03:37.280> probably<00:03:37.680> imagine<00:03:38.159> that<00:03:38.319> the
well you probably imagine that the
well you probably imagine that the
nervous<00:03:38.720> system<00:03:39.040> in<00:03:39.200> the<00:03:39.280> body<00:03:39.599> is<00:03:39.680> hard<00:03:40.000> wired
nervous system in the body is hard wired
nervous system in the body is hard wired
like<00:03:40.560> your<00:03:40.799> house
like your house
like your house
in<00:03:42.000> your<00:03:42.159> house<00:03:42.480> wires<00:03:42.879> run<00:03:43.120> in<00:03:43.200> the<00:03:43.280> wall<00:03:43.519> from
in your house wires run in the wall from
in your house wires run in the wall from
the<00:03:43.920> light<00:03:44.159> switch<00:03:44.959> to<00:03:45.200> a<00:03:45.280> junction<00:03:45.680> box<00:03:46.000> in
the light switch to a junction box in
the light switch to a junction box in
the<00:03:46.239> ceiling
the ceiling
the ceiling
and<00:03:47.360> from<00:03:47.519> the<00:03:47.680> junction<00:03:48.000> box<00:03:48.319> to<00:03:48.480> the<00:03:48.560> light
and from the junction box to the light
and from the junction box to the light
bulb
bulb
bulb
and<00:03:49.920> when<00:03:50.080> you<00:03:50.159> turn<00:03:50.400> the<00:03:50.480> switch<00:03:50.799> on<00:03:50.959> the
and when you turn the switch on the
and when you turn the switch on the
light<00:03:51.360> goes<00:03:51.599> on<00:03:51.920> and<00:03:52.000> when<00:03:52.159> you<00:03:52.319> turn<00:03:52.560> the
light goes on and when you turn the
light goes on and when you turn the
switch<00:03:52.879> off<00:03:53.120> the<00:03:53.200> light<00:03:53.439> goes<00:03:53.680> off
switch off the light goes off
switch off the light goes off
so<00:03:54.720> people<00:03:55.040> imagine<00:03:55.439> the<00:03:55.519> nervous<00:03:55.840> system<00:03:56.480> is
so people imagine the nervous system is
so people imagine the nervous system is
just<00:03:56.879> like<00:03:57.120> that
just like that
just like that
if<00:03:58.720> you<00:03:58.799> hit<00:03:58.959> your<00:03:59.120> thumb<00:03:59.360> with<00:03:59.519> a<00:03:59.599> hammer
if you hit your thumb with a hammer
if you hit your thumb with a hammer
these<00:04:00.799> wires<00:04:01.200> in<00:04:01.280> your<00:04:01.519> arm<00:04:01.760> that<00:04:01.920> of<00:04:02.000> course
these wires in your arm that of course
these wires in your arm that of course
we<00:04:02.480> call<00:04:02.799> nerves<00:04:03.519> transmit<00:04:04.000> the<00:04:04.159> information
we call nerves transmit the information
we call nerves transmit the information
up<00:04:04.799> to<00:04:04.959> the<00:04:05.120> junction<00:04:05.439> box<00:04:05.760> in<00:04:05.840> the<00:04:05.920> spinal
up to the junction box in the spinal
up to the junction box in the spinal
cord<00:04:06.959> where<00:04:07.200> new<00:04:07.439> wires<00:04:07.920> new<00:04:08.080> nerves<00:04:08.400> take<00:04:08.640> the
cord where new wires new nerves take the
cord where new wires new nerves take the
information<00:04:09.599> up<00:04:09.680> to<00:04:09.840> the<00:04:10.000> brain<00:04:10.319> where<00:04:10.480> you
information up to the brain where you
information up to the brain where you
become<00:04:11.040> consciously<00:04:11.519> aware<00:04:11.840> that<00:04:12.080> your<00:04:12.319> thumb
become consciously aware that your thumb
become consciously aware that your thumb
is<00:04:12.720> now<00:04:12.879> hurt
is now hurt
is now hurt
but<00:04:14.959> the<00:04:15.120> situation<00:04:15.680> of<00:04:15.760> course<00:04:16.079> in<00:04:16.160> the<00:04:16.239> human
but the situation of course in the human
but the situation of course in the human
body<00:04:16.799> is<00:04:16.959> far<00:04:17.199> more<00:04:17.359> complicated<00:04:17.919> than<00:04:18.079> that
body is far more complicated than that
body is far more complicated than that
instead<00:04:19.680> of<00:04:19.759> it<00:04:19.919> being<00:04:20.079> the<00:04:20.239> case<00:04:20.639> that<00:04:21.120> that
instead of it being the case that that
instead of it being the case that that
junction<00:04:21.840> box<00:04:22.079> in<00:04:22.160> the<00:04:22.320> spinal<00:04:22.720> cord<00:04:23.040> is<00:04:23.120> just
junction box in the spinal cord is just
junction box in the spinal cord is just
simply<00:04:23.680> where<00:04:23.919> one<00:04:24.240> nerve<00:04:24.560> communicates<00:04:25.120> with
simply where one nerve communicates with
simply where one nerve communicates with
the<00:04:25.440> next<00:04:25.759> nerve
the next nerve
the next nerve
by<00:04:26.880> releasing<00:04:27.440> these<00:04:27.600> little<00:04:27.919> brown<00:04:28.320> packets
by releasing these little brown packets
by releasing these little brown packets
of<00:04:28.880> chemical<00:04:29.360> information<00:04:30.000> called
of chemical information called
of chemical information called
neurotransmitters
neurotransmitters
neurotransmitters
in<00:04:32.240> a<00:04:32.400> linear<00:04:32.880> one-on-one<00:04:33.600> fashion
in a linear one-on-one fashion
in a linear one-on-one fashion
in<00:04:34.800> fact<00:04:35.040> what<00:04:35.199> happens<00:04:35.520> is<00:04:35.600> the
in fact what happens is the
in fact what happens is the
neurotransmitters<00:04:36.720> spill<00:04:37.120> out<00:04:37.360> in<00:04:37.520> three
neurotransmitters spill out in three
neurotransmitters spill out in three
dimensions<00:04:38.800> laterally<00:04:39.680> vertically<00:04:40.160> up<00:04:40.320> and
dimensions laterally vertically up and
dimensions laterally vertically up and
down<00:04:40.720> in<00:04:40.800> the<00:04:40.880> spinal<00:04:41.280> cord<00:04:41.840> and<00:04:42.000> they<00:04:42.240> start
down in the spinal cord and they start
down in the spinal cord and they start
interacting<00:04:43.280> with<00:04:43.600> other<00:04:44.080> adjacent<00:04:44.800> cells
interacting with other adjacent cells
interacting with other adjacent cells
these<00:04:46.400> cells<00:04:46.800> called<00:04:47.120> glial<00:04:47.600> cells
these cells called glial cells
these cells called glial cells
were<00:04:48.800> once<00:04:49.120> thought<00:04:49.280> to<00:04:49.440> be<00:04:49.759> unimportant
were once thought to be unimportant
were once thought to be unimportant
structural<00:04:51.040> elements<00:04:51.440> of<00:04:51.600> the<00:04:51.680> spinal<00:04:52.080> cord
structural elements of the spinal cord
structural elements of the spinal cord
that<00:04:52.720> did<00:04:52.880> nothing<00:04:53.199> more<00:04:53.360> than<00:04:53.520> hold<00:04:53.840> all<00:04:54.000> the
that did nothing more than hold all the
that did nothing more than hold all the
important<00:04:54.560> things<00:04:54.800> together<00:04:55.199> like<00:04:55.360> the
important things together like the
important things together like the
nerves
nerves
nerves
but<00:04:56.639> it<00:04:56.720> turns<00:04:57.120> out<00:04:57.520> the<00:04:57.680> glial<00:04:58.000> cells<00:04:58.320> have<00:04:58.560> a
but it turns out the glial cells have a
but it turns out the glial cells have a
vital<00:04:59.280> role
vital role
vital role
in<00:05:00.400> the
in the
in the
modulation<00:05:02.320> amplification<00:05:03.280> and<00:05:03.600> in<00:05:03.680> the<00:05:03.840> case
modulation amplification and in the case
modulation amplification and in the case
of<00:05:04.240> pain<00:05:04.639> the<00:05:04.800> distortion
of pain the distortion
of pain the distortion
of<00:05:06.320> sensory<00:05:06.880> experiences
of sensory experiences
of sensory experiences
these<00:05:08.560> glial<00:05:08.880> cells<00:05:09.199> become<00:05:09.440> activated<00:05:10.320> their
these glial cells become activated their
these glial cells become activated their
dna<00:05:11.120> starts<00:05:11.360> to<00:05:11.440> synthesize<00:05:12.000> new<00:05:12.240> proteins
dna starts to synthesize new proteins
dna starts to synthesize new proteins
which<00:05:13.039> spill<00:05:13.360> out<00:05:13.919> and
which spill out and
which spill out and
interact<00:05:15.280> with<00:05:15.440> adjacent<00:05:15.919> nerves<00:05:16.639> and<00:05:16.800> they
interact with adjacent nerves and they
interact with adjacent nerves and they
start<00:05:17.280> releasing<00:05:17.680> their<00:05:17.919> neurotransmitters
start releasing their neurotransmitters
start releasing their neurotransmitters
and<00:05:19.360> those<00:05:19.600> neurotransmitters<00:05:20.400> spill<00:05:20.720> out
and those neurotransmitters spill out
and those neurotransmitters spill out
and
and
and
activate<00:05:22.160> adjacent<00:05:22.560> glial<00:05:22.960> cells<00:05:23.280> and<00:05:23.440> so<00:05:23.600> on
activate adjacent glial cells and so on
activate adjacent glial cells and so on
and<00:05:23.919> so<00:05:24.160> forth<00:05:24.800> until<00:05:25.120> what<00:05:25.280> we<00:05:25.440> have<00:05:26.000> is<00:05:26.160> a
and so forth until what we have is a
and so forth until what we have is a
positive<00:05:26.880> feedback<00:05:27.440> loop
positive feedback loop
positive feedback loop
it's<00:05:28.560> almost<00:05:28.800> as<00:05:28.960> if<00:05:29.120> somebody<00:05:29.440> came<00:05:29.680> into
it's almost as if somebody came into
it's almost as if somebody came into
your<00:05:30.160> home<00:05:30.800> and<00:05:30.960> rewired<00:05:31.520> your<00:05:31.759> wall<00:05:32.080> so<00:05:32.240> that
your home and rewired your wall so that
your home and rewired your wall so that
the<00:05:32.479> next<00:05:32.720> time<00:05:32.960> you<00:05:33.199> turned<00:05:33.440> on<00:05:33.520> the<00:05:33.600> light
the next time you turned on the light
the next time you turned on the light
switch<00:05:34.479> the<00:05:34.639> toilet<00:05:35.039> flushed<00:05:35.440> three<00:05:35.680> doors
switch the toilet flushed three doors
switch the toilet flushed three doors
down
down
down
or<00:05:37.120> your<00:05:37.360> dishwasher<00:05:38.000> went<00:05:38.320> on<00:05:38.720> or<00:05:38.960> your
or your dishwasher went on or your
or your dishwasher went on or your
computer<00:05:39.600> monitor<00:05:40.000> turned<00:05:40.320> off
computer monitor turned off
computer monitor turned off
that's<00:05:41.680> crazy<00:05:42.479> but<00:05:42.639> that's<00:05:42.960> in<00:05:43.120> fact<00:05:43.759> what
that's crazy but that's in fact what
that's crazy but that's in fact what
happens<00:05:44.560> with<00:05:44.800> chronic<00:05:45.680> pain<00:05:46.080> and<00:05:46.240> that's<00:05:46.479> why
happens with chronic pain and that's why
happens with chronic pain and that's why
pain<00:05:47.520> becomes<00:05:48.080> its<00:05:48.400> own<00:05:48.639> disease<00:05:49.360> the<00:05:49.520> nervous
pain becomes its own disease the nervous
pain becomes its own disease the nervous
system<00:05:50.240> has<00:05:50.479> plasticity<00:05:51.520> it<00:05:51.759> changes<00:05:52.320> and<00:05:52.479> it
system has plasticity it changes and it
system has plasticity it changes and it
morphs<00:05:53.039> in<00:05:53.199> response<00:05:53.759> to<00:05:53.919> stimuli
morphs in response to stimuli
morphs in response to stimuli
well
well
well
what<00:05:56.400> do<00:05:56.560> we<00:05:56.720> do<00:05:56.960> about<00:05:57.199> that<00:05:57.360> what<00:05:57.520> can<00:05:57.680> we<00:05:57.919> do
what do we do about that what can we do
what do we do about that what can we do
in<00:05:58.240> a<00:05:58.319> case<00:05:58.560> like<00:05:58.800> chandler's
in a case like chandler's
in a case like chandler's
we<00:06:00.960> treat<00:06:01.360> these<00:06:01.600> patients<00:06:02.160> in<00:06:02.319> a<00:06:02.479> rather
we treat these patients in a rather
we treat these patients in a rather
crude<00:06:03.199> fashion<00:06:03.600> at<00:06:03.680> this<00:06:03.919> point<00:06:04.160> in<00:06:04.319> time<00:06:04.639> we
crude fashion at this point in time we
crude fashion at this point in time we
treat<00:06:05.120> them<00:06:05.280> with<00:06:06.080> symptom<00:06:06.639> modifying<00:06:07.360> drugs
treat them with symptom modifying drugs
treat them with symptom modifying drugs
painkillers<00:06:09.440> which<00:06:09.680> are<00:06:09.919> frankly<00:06:10.720> not<00:06:10.960> very
painkillers which are frankly not very
painkillers which are frankly not very
effective<00:06:11.680> for<00:06:11.840> this<00:06:12.000> kind<00:06:12.240> of<00:06:12.400> pain
effective for this kind of pain
effective for this kind of pain
we<00:06:13.600> take<00:06:13.919> nerves<00:06:14.240> that<00:06:14.400> are<00:06:14.560> noisy<00:06:14.960> and<00:06:15.120> active
we take nerves that are noisy and active
we take nerves that are noisy and active
that<00:06:15.680> should<00:06:15.840> be<00:06:16.080> quiet
that should be quiet
that should be quiet
and<00:06:17.280> we<00:06:17.440> put<00:06:17.600> them<00:06:17.759> to<00:06:17.840> sleep<00:06:18.160> with<00:06:18.319> local
and we put them to sleep with local
and we put them to sleep with local
anesthetics<00:06:20.080> and<00:06:20.240> most<00:06:20.560> importantly<00:06:21.039> what<00:06:21.280> we
anesthetics and most importantly what we
anesthetics and most importantly what we
do<00:06:22.080> is<00:06:22.319> we<00:06:22.479> use<00:06:22.880> a
do is we use a
do is we use a
rigorous<00:06:24.639> and<00:06:24.880> often<00:06:25.280> uncomfortable<00:06:25.919> process
rigorous and often uncomfortable process
rigorous and often uncomfortable process
of<00:06:26.639> physical<00:06:27.039> therapy<00:06:27.840> and<00:06:28.000> occupational
of physical therapy and occupational
of physical therapy and occupational
therapy<00:06:29.440> to<00:06:29.680> retrain<00:06:30.160> the<00:06:30.319> nerves<00:06:30.800> in<00:06:30.880> the
therapy to retrain the nerves in the
therapy to retrain the nerves in the
nervous<00:06:31.360> system<00:06:32.240> to<00:06:32.800> respond<00:06:33.520> normally
nervous system to respond normally
nervous system to respond normally
to<00:06:35.360> the<00:06:35.759> activities<00:06:36.479> and<00:06:36.800> sensory
to the activities and sensory
to the activities and sensory
experiences<00:06:38.000> that<00:06:38.240> are<00:06:38.319> part<00:06:38.560> of<00:06:38.720> everyday
experiences that are part of everyday
experiences that are part of everyday
life
life
life
and<00:06:41.039> we<00:06:41.199> support<00:06:41.680> all<00:06:41.840> of<00:06:42.000> that<00:06:42.240> with<00:06:42.560> a
and we support all of that with a
and we support all of that with a
intensive<00:06:43.600> psychotherapy<00:06:44.400> program<00:06:44.960> to
intensive psychotherapy program to
intensive psychotherapy program to
address<00:06:46.000> the<00:06:46.160> despondency<00:06:47.120> despair<00:06:47.759> and
address the despondency despair and
address the despondency despair and
depression<00:06:48.880> that<00:06:49.440> always<00:06:49.840> accompanies
depression that always accompanies
depression that always accompanies
severe<00:06:51.039> chronic<00:06:51.440> pain
severe chronic pain
severe chronic pain
it's<00:06:52.960> successful<00:06:53.599> as<00:06:53.840> you<00:06:53.919> can<00:06:54.080> see<00:06:54.240> from<00:06:54.400> this
it's successful as you can see from this
it's successful as you can see from this
video<00:06:55.120> of<00:06:55.280> chandler
video of chandler
video of chandler
who<00:06:56.720> two<00:06:56.880> months<00:06:57.199> after<00:06:57.440> we<00:06:57.680> first<00:06:57.919> met<00:06:58.080> her<00:06:58.639> is
who two months after we first met her is
who two months after we first met her is
now<00:06:59.039> doing<00:06:59.280> a<00:06:59.440> backflip<00:07:00.400> and<00:07:00.639> i<00:07:00.720> had<00:07:00.880> lunch
now doing a backflip and i had lunch
now doing a backflip and i had lunch
with<00:07:01.280> her<00:07:01.440> yesterday<00:07:01.840> because<00:07:02.080> she's<00:07:02.319> a
with her yesterday because she's a
with her yesterday because she's a
college<00:07:02.720> student<00:07:03.120> studying<00:07:03.520> dance<00:07:03.919> at<00:07:04.000> long
college student studying dance at long
college student studying dance at long
beach<00:07:04.479> here<00:07:05.039> and<00:07:05.199> she's<00:07:05.440> doing<00:07:05.840> absolutely
beach here and she's doing absolutely
beach here and she's doing absolutely
fantastic
fantastic
fantastic
but<00:07:08.080> the<00:07:08.240> future
but the future
but the future
is<00:07:09.759> actually<00:07:10.240> even<00:07:10.560> brighter
is actually even brighter
is actually even brighter
the<00:07:12.000> future<00:07:12.319> holds<00:07:12.639> the<00:07:12.800> promise
the future holds the promise
the future holds the promise
that<00:07:14.560> new<00:07:14.800> drugs<00:07:15.120> will<00:07:15.280> be<00:07:15.440> developed
that new drugs will be developed
that new drugs will be developed
that<00:07:17.199> are<00:07:17.360> not<00:07:17.919> symptom<00:07:18.400> modifying<00:07:19.039> drugs
that are not symptom modifying drugs
that are not symptom modifying drugs
that<00:07:19.840> simply<00:07:20.319> mask<00:07:20.800> the<00:07:21.039> problem<00:07:21.680> as<00:07:21.840> we<00:07:22.000> have
that simply mask the problem as we have
that simply mask the problem as we have
now
now
now
but<00:07:23.520> that<00:07:23.680> will<00:07:23.840> be<00:07:24.080> disease<00:07:24.800> modifying<00:07:25.360> drugs
but that will be disease modifying drugs
but that will be disease modifying drugs
that<00:07:26.479> will<00:07:26.639> actually<00:07:26.960> go<00:07:27.360> right<00:07:27.599> to<00:07:27.759> the<00:07:27.840> root
that will actually go right to the root
that will actually go right to the root
of<00:07:28.160> the<00:07:28.319> problem<00:07:28.960> and<00:07:29.120> attack<00:07:29.599> those<00:07:29.919> glial
of the problem and attack those glial
of the problem and attack those glial
cells<00:07:31.199> or<00:07:31.360> those<00:07:31.599> pernicious<00:07:32.160> proteins<00:07:32.720> that
cells or those pernicious proteins that
cells or those pernicious proteins that
the<00:07:32.960> glial<00:07:33.360> cells<00:07:33.680> elaborate
the glial cells elaborate
the glial cells elaborate
that<00:07:35.280> spill<00:07:35.599> over<00:07:35.919> and<00:07:36.080> cause<00:07:36.400> this<00:07:36.639> central
that spill over and cause this central
that spill over and cause this central
nervous<00:07:37.280> system<00:07:38.000> wind<00:07:38.400> up<00:07:38.880> or<00:07:39.120> plasticity
nervous system wind up or plasticity
nervous system wind up or plasticity
that<00:07:40.479> so<00:07:40.960> is<00:07:41.280> capable<00:07:41.840> of<00:07:42.080> distorting<00:07:42.880> and
that so is capable of distorting and
that so is capable of distorting and
amplifying<00:07:44.080> the<00:07:44.240> sensory<00:07:44.800> experience<00:07:45.440> that
amplifying the sensory experience that
amplifying the sensory experience that
we<00:07:45.840> call<00:07:46.080> pain
we call pain
we call pain
so<00:07:47.280> that<00:07:47.599> i<00:07:47.759> have<00:07:48.000> hope<00:07:48.720> that<00:07:48.960> in<00:07:49.039> the<00:07:49.120> future
so that i have hope that in the future
so that i have hope that in the future
the<00:07:50.160> prophetic<00:07:50.720> words<00:07:51.039> of<00:07:51.199> george<00:07:51.599> carlin
the prophetic words of george carlin
the prophetic words of george carlin
will<00:07:52.319> be<00:07:52.479> realized<00:07:53.520> who<00:07:53.759> said
will be realized who said
will be realized who said
my<00:07:54.960> philosophy<00:07:56.080> no<00:07:56.400> pain
my philosophy no pain
my philosophy no pain
no<00:07:57.919> pain
thank<00:08:00.720> you<00:08:00.879> very<00:08:01.120> much
thank you very much
thank you very much
[Music]
[Music]
[Music]
[Applause]
you
Elliot Krane, pain, chronic, pain, how, works, migraine, nervous, system, nerves, TED, TED, Talk, TED-Ed, TEDEducation, Ed
