疼痛科學：你是否遇過鬼魅般的疼痛？淺談疼痛科學
小明：「我的背部好痛痛！」
小華：「可是我們檢查過後你的骨頭和肌肉都沒問題啊。」
小明：「我已經痛了兩年了，你跟我說沒問題！？你們醫院真的很爛耶」
小華：「…………………….」
好痛痛今天要來講一下關於疼痛這件事。
疼痛與傷兵名單
大部分的時候，在你受傷的當下你會感受到疼痛，所以疼痛是診斷與治療時很好的訊息來源。疼痛代表著患部的神經受到刺激，神經把訊息傳到大腦，大腦解讀訊號為「腳踝很痛！他可能受傷了！！」接著大腦會把腳踝放到傷兵名單去，試著去保護他。
你的大腦就像電腦，需要不斷更新訊息才能知道身體的最新狀況。所以如果沒有更新資訊的話，大腦其實會一直認為腳踝都傷號，還不能使用腳踝，即便他可能早就好了。
因此在一些新的治療觀念裡，除了讓受傷的組織復原外，還多了讓患部和大腦重新連線的的部分，我們稱作 Joint Mapping，也就是你大腦對身體關節的連結與認知，屬於運動治療的一部分。
通常執行的是物理治療師，他會要求你做一些活動，例如以特定的方式來運動扭傷後的腳踝，用這個方法來讓大腦更新對腳踝的資訊。
你必須不斷稍微突破你的舒適圈，或者也可以說不痛圈，讓大腦知道「那個地方已經可以進行這樣的活動了！沒問題！」
而運動員又是另一種狀況，運動員雖然也會有大腦不敢動患部的問題，但是更多狀況是「大腦相信自己可以完成所有動作」，就算肌肉有受傷、就算疲勞到不行，他還是能夠啟動一堆代償、忍受一堆疼痛，去完成超人般的動作，例如馬拉松跑者或者過人之後飛身灌籃。這就是為什麼新聞常說哪位球星身上一大堆傷，但是在場上可能看不太出來。根本94狂！！
疼痛與代償
今天假設你的A肌肉受傷或不適請病假了，但為了繼續維持日常生活動作，或者運動中的某個動作，你大腦的潛意識會叫B肌肉出來幫忙，把原本A肌肉請假沒做的部分做完，這個就叫做代償。
今天B肌肉的工作量增加了應付不來大喊「X，我也不幹了！」就拍拍屁股開始裝死，你大腦的潛意識只好叫C肌肉出來把原本A和B兩條肌肉要做的事做一做。
「真是苦命啊！！！我要開始發痛了！！！」於是C肌肉也開始發痛，而且常常C肌肉叫做….下背肌群。
看到這裡，是不是開始瞭解為什麼一堆人下背痛了。而這也是為什麼國外有醫療人員統計「大多數的時候，某地方痛的原因都在別的地方。」的原因之一；同時也是為什麼有人很推崇「把核心練好可以解決很多肌肉疼痛問題」的原因之一，因為你把代償系統練強了。(當然還有其他原因)
A、B、C肌肉分別是你身上的哪些肌肉，除了C以外其實很難找，C就是痛到讓你去找醫生或物理治療所的那個症頭，除了下背最常見的就是肩膀了。而A、B則和你如何運用身體的潛意識有關，每個人的腦袋和身體都不一樣，所以代償的方法都不太一樣。
要找出A和B是相當花時間和力氣的，尤其是罪魁禍首A，至少半小時起跳，一個半小時也不為過。通常你需要自費的治療才能去找到罪魁禍首。
另外找罪魁禍首的理論與治療方式也分成很多種，例如筋膜、肌肉平衡、生物力學等等。其實只要能夠找到罪魁禍首A肌肉的都是好方法，能夠有效治療的都是好方法。目前沒有一種方法可以治療所有的人。
另一種疼痛
還有一種惱人的疼痛，不見得和生理組織有直接關係。有些人長期疼痛，有可能會檢查出一些問題，例如骨刺、椎間盤突出之類的，或是檢查不出原因。但其實生理上的問題不見得是疼痛的來源，有時候是大腦的或心理上的。
這個是疼痛科學要探討的一個重要範疇，以及如何讓病患走出幽魂纏身般的疼痛，鼓勵他動起來，恢復正常的生活。
下面有兩個很棒的影片，睿閎物理治療所翻譯的 TED 疼痛科學影片，以及林暐閎物理治療師談疼痛科學。一定要看看唷～
疼痛從何而來，了解疼痛的本質才能有效處置疼痛
分享出去，讓更多人能了解自己的疼痛
並獲得更實際的幫助→按讚獲得更多疼痛知識←
#疼痛是大腦的產物
#疼痛處理的專家由睿閎物理治療所貼上了 2016年3月25日
訪問與合作撰寫：好痛痛、羅昌智物理治療師、林暐閎物理治療師、羅一強物理治療師
延伸閱讀：姚斯元物理治療師寫代償
註：本部落格文章是以科普、衛教為出發點，不代表任何人的生理狀況。每個人的身體皆不相同，有任何疑問請詢問自己的醫師、物理治療師、專業教練。
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