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读过 Complications
The explanation of pain that has dominated much of medical history originated with Rene Descartes, more than three centuries ago. Descartes proposed that pain is a purely physical phenomenon - that tissue injury stimulates specific nerves that transmit an impulse to the brain, causing the mind to perceive pain. The phenomenon, is like pulling on a rope to ring a bell in the brain. It is hard to overstate how ingrained this account has become. Twentieth-century research on pain has been devoted largely to the search for and discovery of pain-specific nerve fibers and pathways. In everyday medicine, doctors see pain in Cartesian terms - as a physical process, a sign of tissue injury. We look for a ruptured disk, a fracture, an infection, or a tumor, and we try to fix what's wrong. The degree of injury ought to determine the degree of pain, rather like a dial controlling volume. Pain was becoming recoginzied as far more complext than a one-way transmission from injury to "ouch." p125 All pain is "in the head" - and further that sometimes, no physical injury of any kind is needed to make the pain system to go haywire. We should stop thinking that pain or any other sensation is a signal passively "felt" in the brain. Yes, injury produces nerve signals that travel through a spinal-cord gate, but it is the brain that generates the pain experience, and it can do even in the absence of external stimuli. Pain and other sensations are conceived as "neuromodules" in the brain - something akin to individual computer programs on a hard drive, or to tracks on a compact disc. When you feel pain, it's your brain running a neuromodule that produces the pain experience, as if someone pressed the PLAY button on a CD player. And a great many things can press the button. A pain neuromodule is not a discrete anatomical entity but a network, linking components from virtually every region of the brain. Input is gathered from sensory nerves, memory, mood, and other centers, like members of some committee in charge of whether the music will play. If the signals reach a certain threshold, they trigger the neuromodule. And then what plays is no one-note melody. Pain is a symphony - a complex response that includes not just a distinct sesation but also motor activity, a change in emotion, a focusing of attention, a brand-new memory. These drugs do: they tune brain cells to modulate their excitability. 引自 The Pain Perplex
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