Reaching out across the Web .. ...分享 http://blog.sciencenet.cn/u/zuojun Zuojun Yu, physical oceanographer, freelance English editor

博文

你有耳鸣?(多年不治的)慢性疼痛?

已有 1345 次阅读 2022-6-5 14:17 |个人分类:Health & Health-Care System|系统分类:科普集锦


耳鸣和慢性疼痛与大脑异常有关!


我曾经写过一篇博客

《有意识头脑与无意识头脑:心身疾病的流行》

 

开场白:如果你有背痛、腰疼、腿痛,而且多年不治。也许,你应该看看这本书。(我周围不少朋友有各种各样的病痛,我自己患有“功能性神经紊乱”。这是我推荐这本书的原因。)

 

想看到点开下面的链接。

 

https://blog.sciencenet.cn/blog-306792-1321862.html

 

前几天,不小心听了TED talk

Tinnitus: Ringing in the Brain 

by Josef Rauschecker 

at TEDxCharlottesville


我非常想把演讲稿复制下来,和大家分享。但是,我没有办法复制全文。然后,我就上网找、找、找。感觉下面的这个报道还不错。借用机器翻译成中文。


NEUROSCIENTISTS UNCOVER BRAIN ABNORMALITIES RESPONSIBLE FOR TINNITUS AND CHRONIC PAIN

神经科学家发现导致耳鸣和慢性疼痛的大脑异常

https://neuro.georgetown.edu/rauschecker-abnormalities-tinnitus/

 

SEPTEMBER 23, 2015—Neuroscientists at Georgetown University Medical Center and Germany’s Technische Universität München have uncovered the brain malady responsible for tinnitus and for chronic pain — the uncomfortable, sometimes agonizing sensations that persist long after an initial injury.

乔治城大学医学中心和德国慕尼黑工业大学的神经科学家发现了导致耳鸣和
慢性疼痛的脑部疾病——这种不舒服的、有时是痛苦的感觉在初次受伤后仍会持续
很长时间。

 

In the October issue of Trends in Cognitive Sciences, researchers say identifying the problem is the first step to developing effective therapies for these disorders, which afflict millions of people. None now exist.

 10 月份的《认知科学趋势》,研究人员表示,找出问题是为这些困扰着数百万人的疾病开发有效疗法的第一步。 现在没有任何有效治疗法。


The scientists describe how the neural mechanisms that normally “gate” or control noise and pain signals can become dysfunctional, leading to a chronic perception of these sensations. They traced the flow of these signals through the brain and showed where “circuit breakers” should be working — but aren’t.

科学家们描述了通常门控或控制噪音和疼痛信号的神经机制如何变得功能失调,导致对这些感觉的长期【过分】感知。 他们追踪了这些信号在大脑中的流动,并显示了断路器应该在哪里工作––断路器没有起作用。

 

In both disorders, the brain has been reorganized in response to an injury in its sensory apparatus, says Josef Rauschecker, PhD, DSc, director of the Laboratory for Integrative Neuroscience and Cognition at GUMC. Tinnitus can occur after the ears are damaged by loud noise, but even after the brain reorganizes itself, it continues to “hear” a constant hum or drum. Chronic pain can occur from an injury that often is healed on the outside but persists inside the brain.

GUMC 综合神经科学与认知实验室主任 Josef Rauschecker 博士说,在这两种疾病中,大脑都因感觉器官损伤而进行了重组。 耳鸣可能发生在耳朵被巨响损坏后,但即使在大脑自我重组后,它仍会继续听到持续不断的嗡嗡声或鼓声。 慢性疼痛可能是由通常在外部愈合但在大脑内部持续存在的损伤引起的。


“Some people call these phantom sensations, but they are real, produced by a brain that continues to ‘feel’ the initial injury because it cannot down-regulate the sensations enough,” he says. “Both conditions are extraordinarily common, yet no treatment gets to the root of these disorders.”

有些人将这些称为幻觉感觉,但它们是真实的,由继续感觉最初伤害的大脑产生,因为它不能足够地下调感觉,他说。 “这两种情况都非常普遍,但没有任何治疗方法可以根除这些疾病的根源。


Areas of the brain responsible for these errant sensations are the nucleus accumbens, the reward and learning center, and several areas that serve “executive” or administrative roles —the ventromedial prefrontal cortex (VNPFC) and the anterior cingulate cortex.

负责这些错误感觉的大脑区域是伏隔核,即奖励和学习中心,以及几个充当执行或行政角色的区域––腹内侧前额叶皮层 (VNPFC) 和前扣带皮层。


All of these areas are also important for evaluating and modulating emotional experiences, Rauschecker says. “These areas act as a central gatekeeping system for perceptual sensations, which evaluate the affective meaning of sensory stimuli — whether produced externally or internally — and modulates information flow in the brain. Tinnitus and chronic pain occur when this system is compromised.”

Rauschecker 说,所有这些领域对于评估和调节情绪体验也很重要。 “这些区域充当感知感觉的中央把关系统,它评估感觉刺激的情感意义––无论是外部产生还是内部产生––并调节大脑中的信息流。 当这个系统受到损害时,就会出现耳鸣和慢性疼痛。


Other issues often arise in “lockstep” with tinnitus and/or chronic pain, such as depression and anxiety, which are also modulated by the nucleus accumbens, he says. Uncontrollable or long-term stress is another important factor.

他说,其他问题通常与耳鸣和/或慢性疼痛同步出现,例如抑郁和焦虑,这些问题也受到伏隔核的调节。 无法控制的或长期的压力是另一个重要因素。


Ironically, the brain plasticity that produces some of these changes provides hope that this gatekeeping role can be restored, Rauschecker says. Because these systems rely on transmission of dopamine and serotonin between neurons, drugs that modulate dopamine may help restore sensory gating, he says.

Rauschecker 说,具有讽刺意味的是,产生其中一些变化的大脑可塑性为恢复这种把关角色提供了希望。 他说,因为这些系统依赖于神经元之间的多巴胺和血清素传递,调节多巴胺的药物可能有助于恢复感觉门控。


“Better understanding could also lead to standardized assessment of individuals’ risk to develop chronic tinnitus and chronic pain, which in turn might allow for earlier and more targeted treatment,” adds Markus Ploner, MD, PhD, a consultant neurologist and Heisenberg Professor of Human Pain Research at the Technische Universität München (TUM).

更好的理解还可以导致对个人患慢性耳鸣和慢性疼痛的风险进行标准化评估,这反过来可能允许更早和更有针对性的治疗,” 医学博士Markus Ploner医生补充道。他是顾问神经学家和慕尼黑工业大学 (TUM) 的人类学疼痛研究所的海森堡教授。


Rauschecker, an expert in tinnitus, collaborated with Ploner, who studies chronic pain, during his senior fellowship at the Institute of Advanced Study at TUM. Co-authors include Audrey Maudoux, MD, PhD, from GUMC and Elisabeth May, PhD, from TUM.

耳鸣专家 Rauschecker  TUM 高级研究所担任高级研究员期间与研究慢性疼痛的Ploner 合作。合著者包括来自 GUMC 的医学博士 Audrey Maudoux 医生和来自 TUM  Elisabeth May 博士。

 

The National Institutes of Health (RC1-DC010720), the American Tinnitus Association, the Skirball Foundation, the Tinnitus Research Initiative and the Tinnitus Research Consortium have supported tinnitus research in the Rauschecker lab.

美国国立卫生研究院 (RC1-DC010720)、美国耳鸣协会、Skirball 基金会、
耳鸣研究计划和耳鸣研究联盟支持 Rauschecker 实验室的耳鸣研究。

 

 

 

Tinnitus: Ringing in the Brain by Josef Rauschecker at TEDxCharlottesville (Transcript)

Health & Wellness / By Pangambam S / January 12, 2018 12:47 pm

Here is the full transcript of Josef Rauschecker’s TEDx Talk on  Tinnitus: Ringing in the Brain at TEDxCharlottesville conference. 

Listen to the MP3 Audio: Tinnitus_ Ringing in the Brain by Josef Rauschecker at TEDxCharlottesville


TRANSCRIPT: 

I would like to talk with you about a medical disorder that is incredibly common, and yet it gets often underestimated – misunderestimated, as one of our former presidents would have said – in its impact on our psychology and on the patients. The patients really suffer from it.

And it’s very pervasive; about 50 million Americans suffer from it. I bet many of you in the audience will have friends or family that suffer from it.

What I’m talking about is tinnitus, the ringing in the ears. It’s often depicted in this painting by Edvard Munch although we don’t know for sure whether he actually had tinnitus himself. But the person in the painting is sort of covering his or her ears, and it doesn’t help because the ringing is actually generated in the brain.

It’s not a real sound that, that a person hears; it’s a phantom sound. So we often talk about it as ringing in the brain rather than ringing in the ears.

And of those 50 million Americans that suffer from it, about 10 million of them really suffer very badly – they go to the extent that they have depression and suicidal thoughts. And I get emails every day from patients that are asking, “Is there not a cure?” There is no cure, unfortunately, at this point. And part of our research is aiming for that, of course, that we’re trying to find ways to help these patients.

And I can play some examples for you, (high-pitched tone) of what that sounds like. This is just a pure tone of a single frequency, relatively rare. Usually, tinnitus sounds more like the next one… (hissing sound). You can imagine how annoying that is. If you hear that all the time in one of your ears or both of your ears. You can’t turn it off, you can’t run away from it; it’s always there.

(cricket sound) Sometimes, you get this more sophisticated cricket sound that you hear. So, people suffer from it. There are groups that are more affected or at risk than others. Musicians get it surprisingly often because they are exposed to louder sounds than they realize. I once remember being at the Kennedy Center in Washington, DC, where we live, and went to a concert there, symphony concert by the National Symphony. They played Shostakovich’s War Symphony. Very loud, of course.

One of the violinists in the first or the second row was sitting right in front of the trombones behind her. The trombone was sort of blowing right into her ear and she was reflexively covering her ears to protect herself.

This is actually the right reaction, just to avoid loud noises in order to avoid getting hair cell damage, and then hearing loss, and ultimately tinnitus.

So, loud noise exposure is certainly one of the biggest risks. And then you take a group like construction workers. If they don’t wear hearing protection, that can be very risky. The group most at risk are our war veterans, of course. They are constantly exposed to artillery fire, to bombs, explosives and so on, you know.

In addition – this is a very important factor, which I want to stress in this presentation – stress is a very important factor. So, it’s not just the loud noise exposure that can give you tinnitus – it actually doesn’t always do that – but if it combines with a stressful situation, this is the most likely scenario where you end up getting tinnitus.

So, our veterans are much more likely to come home from the battlefield with tinnitus. In fact, the Veterans’ Administration, if you look up the statistics, they show that tinnitus is the most frequent cause for benefits paid to veterans. Hearing loss is the second most frequent one. 

Tinnitus has often been compared with other phantom sensations like phantom limb pain, which you might have heard about. In this case, somebody misses a limb because of an accident or an explosion that damaged his arm or her leg. And it’s a very similar thing. In this case again, the brain is the cause for this.

Even though the leg may be missing, the neurons in the brain that represent the brain are still there and they are firing along. On occasions, the person might get the impression that his leg is still there. And you can actually feel pain in that leg.

And animal experiments have shown – that’s shown on the right of that slide here – that this is in fact what’s happening. In monkeys that have lost a hand, for example, the hand representation gets filled in with input from the face representation, which is right next to it.

Ramachandra and then neuroscientists in California did studies on amputees, where he showed that if you touch the face of an amputee, they actually feel their phantom hand, in this case, more frequently than not. So, there’s a profound reorganization going on in the brain, both in a phantom limb and in tinnitus, which is the equivalent in the auditory domain.

People have referred to this often as maladaptive plasticity. Plasticity, by definition, should be something good, right? We are learning: this is plasticity; memory is kind of a form of plasticity, so we associate this with an adaptive function. But in this case, is it really adaptive? I would think so. It’s not necessarily maladaptive, because the brain has set out a plan how to deal with these kinds of situations.

So, if you have loud noise exposure, you kill some of your hair cells in the inner ear, and they can’t be replaced; they don’t grow back. So, what the brain does, it kind of fills in that gap. Nature doesn’t like gaps. So, the gap is filled in with neurons that normally respond to other frequencies, like on the left or right of that gap.

Another example is the blind spot in your eye. You all know we have a blind spot in our retina where there are no photoreceptors, so the blood vessels go in and out from there. The optic nerve goes in from there. We don’t see, but we don’t notice that hole because with the same mechanism the brain fills in that hole. And the same thing happens – we call this lesion-induced plasticity. The same thing happens in tinnitus.

So, it is per se an adaptive mechanism. But it has an unintended side effect, this hyperactivity that I’ve been talking about, that we can actually visualize with fMRI, for example.

And then, the next step is missing in tinnitus patients. Normally, the brain is even more clever. It realizes there is this internal noise being generated, so it puts its executive sentence in play and they would suppress that noise. So, most people actually even after extensive loud noise exposure don’t get tinnitus. You might have hearing loss but you don’t end up with tinnitus. You go to a loud noise concert, for example, loud rock concert, and you have tinnitus maybe the next day, but then it goes away after a few days. So, many people have just temporary tinnitus which gets repaired by the brain; there are mechanisms for that.


But in those unfortunate people where these mechanisms don’t work, they are the ones that are becoming the chronic tinnitus patients.

 


【我没有办法复制后面的部分】




https://wap.sciencenet.cn/blog-306792-1341665.html

上一篇:Editing made easy (关于英语写作的书)
下一篇:耳鸣实际上是脑鸣
收藏 IP: 66.91.44.*| 热度|

1 郑永军

该博文允许注册用户评论 请点击登录 评论 (0 个评论)

数据加载中...

Archiver|手机版|科学网 ( 京ICP备07017567号-12 )

GMT+8, 2022-8-19 18:43

Powered by ScienceNet.cn

Copyright © 2007- 中国科学报社

返回顶部