疼痛并非全在脑海中——但心理治疗能有所帮助

ABC Listen，播客、广播、新闻、音乐等一应俱全。

ABC Listen, podcasts, radio, news, music, and more.

克里斯托弗和皮克西·斯凯斯这对魅力四射、富有时尚的夫妇是八十年代的黄金搭档。

Charismatic, rich, stylish, glamorous, Christopher and Pixie Skace were the it couple of the eighties.

能收到斯凯斯派对的邀请函可是件值得炫耀的事。

Getting an invitation to a skace party was prized real estate.

但当他们的商业帝国摇摇欲坠时，付出惨痛代价的却是皮克西。

But when their business empire teeters, it's Pixie who pays a massive price.

这种镀金牢笼正是她被困住的地方。

This sort of gilded cage that she was a prisoner in.

我是马克·汉弗莱斯。

I'm Mark Humphries.

现在要追看完整剧集，请在ABC Listen应用或任何播客平台搜索ABC Rewind，查找《斯凯斯：大亨的陨落》。

To binge the full series now, search for ABC Rewind and look for Skace, Fall of a Tycoon on the ABC Listen app or wherever you get your podcasts.

诺曼·斯旺，我想你很喜欢分享自己的病痛，尤其是你的慢性需求，这已经不是秘密了。

Norman Swan, I think it's no secret that you quite enjoy sharing your ailments, particularly your chronic need.

你总是把它拖出来

You drag it out

从我这里。

of me.

从我这里拖出来。

It out of me.

我不这么认为。

Don't think I do.

我觉得你相当...什么...很快就

I think you're quite What quick to

你对疼痛的忍耐力如何？

are you like with pain?

这要看情况。

It just depends.

如果我踢到脚趾，我会大声咒骂，声音大到让人以为我要死了。

If I stub my toe, I let loose foul expletives in such a loud voice that people think I'm dying.

如果正在接受不舒服的治疗，我就咬牙忍着。

If I'm having a procedure done to me which is uncomfortable, I just grin and bear it.

当发生稍微严重的事情时，比如我做饭时经常切到手指

And when something sort of serious happens, like I slice a finger cooking as I often do

哦，天啊。

Oh, wow.

我相当冷静。

I'm fairly cool.

好吧。

Okay.

所以这取决于具体情况。

So it depends on the context.

是的。

Yeah.

我想我也一样。

I think that's the same for me.

我觉得如果我那天特别糟糕又精疲力尽，反应就会很差，但遇到像你说的那种严重情况时，我也会和自己讲很多道理。

I think if I'm having a particularly horrific day and I'm exhausted, I react quite poorly, but I do think I do a lot of reasoning with myself when things are serious like you do.

是啊。

Yeah.

你知道，那是急性疼痛，但慢性疼痛就完全是另一回事了。

And, you know, that's acute pain, but chronic pain is a different matter altogether.

不过类似的是，你的大脑确实会影响你对疼痛和处境的感知。

But it's similarly, your brain does get involved in how you perceive it and your situation.

有许多因素需要考虑，包括你的童年经历和个人历史，我认为这远比人们意识到的要复杂得多。

And there's lots of stuff that needs to be taken into account, your childhood experiences, your history, and I think it's far more complex than what people realize.

这只是健康报告即将公布内容的一部分。

That's just part of what's coming up on the health report.

我是普莉娅·亚历山大，现居伍伦杰里族领地。

I'm Priya Alexander on Wurundjeri land.

我是诺曼·斯旺，现居卡比卡比族领地。

And I'm Norman Swan on Kabi Kabi land.

本期节目中，我们将跟进过去两三周持续关注的一个关于儿童过敏的报道。

Also on the show, we're going to follow-up on a story that we've been pursuing over the last two or three weeks, which is about allergies in kids.

我们不断收到大量相关来信，家长们对于如何给孩子引入过敏原、何时引入以及频率等问题存在诸多困惑。

We keep on getting a lot of mail about it, and there's a lot of confusion amongst parents about how they should introduce allergens to their kids, when, and how frequently.

因此我们将回归基础，提供一些简明信息。

So we're going to actually get back to basics and give some simple information.

我们将化繁为简，诺曼，你还有个关于神经系统与癌症关联的报道。

We're going to simplify things, and you've also got a story, Norman, that connects the nervous system to cancer.

是的。

Yeah.

为肿瘤供应的神经可能实际促进其生长，深入研究后发现，这些化学信使与引发偏头痛疼痛的化学信使非常相似。

Nerves supplying the tumor might actually make it grow, and when they've actually got down to it, the chemical messengers are very similar to the chemical messengers talking about pain that actually create the pain of migraine.

因此偏头痛药物或许有助于治疗肠癌。

And so it might be that migraine drugs could help treat bowel cancer.

更多相关内容稍后继续。

More of that later.

新闻速递：八月是流感致死人数首次超过新冠的月份。

In the news, August is the first month that influenza has been more deadly than COVID nineteen.

这是自2020年2月以来，流感死亡人数首次超过新冠死亡人数。

So there's been more influenza deaths than COVID deaths for the first time since February 2020.

这是来自澳大利亚统计局的数据。

This comes from the Australian Bureau of Statistics.

需要说明的是，鉴于新冠疫情，他们现在开始记录三类呼吸道感染导致的死亡：流感、新冠和呼吸道合胞病毒。

And just to explain, in the light of the COVID pandemic, they are now recording deaths from respiratory infections, three inter respiratory infections, influenza, COVID, and respiratory syncytial virus.

我们之前多次讨论过呼吸道合胞病毒疫苗，他们记录了这三种病毒随时间变化的致死情况。

And we've talked a lot about respiratory syncytial virus as a vaccine for it now, and they've recorded the deaths from these three viruses over time.

今年八月是疫情暴发以来首次出现流感致死人数超过新冠的情况。

And in August, for the first time since the pandemic began, flu has overtaken COVID deaths.

值得注意的是，今年流感季相当严重，感染人数创下历史新高。

Worth pointing out that it's been a fairly significant flu season with record numbers.

实验室确诊病例已超过41万例，诺曼，考虑到很多人现在使用居家检测试剂盒，实际数字可能被低估了。

There's been more than four hundred and ten thousand lab confirmed cases, and that's likely an underestimation, Norman, given a lot of people are now doing at home test kits, so not all of them are lab documented.

非常不幸的是，今年流感季儿童再次成为高发人群。

And very unfortunately, children have been disproportionately affected by the flu season again this year.

确实如此。

They have.

总体来看，今年新冠死亡人数仍略高于流感致死人数。

And overall this year, COVID still outnumbers COVID deaths still outnumber flu deaths, but only by a little.

现在的问题是：哪些人群正在死亡？

And the question here is who's dying?

这其中有什么出人意料的情况吗？

Is are there any surprises here?

呼吸道合胞病毒的现状如何？

What's happening with respiratory syncytial virus?

这个问题值得警惕，因为这种病毒对儿童危害尤其严重，而流感疫苗接种率又在下降。

Because that's kind of a sleeper here, because it is a serious illness, particularly in kids, and influenza, because influenza immunization rates have fallen.

所以新冠主要威胁仍是老年人群体。

So COVID is still in older people.

虽然也有年轻人因此丧生，但主要还是老年人受影响。

There are younger people dying of it, but basically it's in older people still.

没错。

That's right.

关于呼吸道合胞病毒（RSV），数据显示与前两年相比，其致死率确实有所上升，而新冠死亡人数则在下降。

And when it comes to RSV, the statistics also suggest that the deaths from respiratory syncytial virus, or RSV, have actually risen compared with the previous two years, whereas the COVID deaths have been decreasing.

你认为新冠现在已呈现季节性特征了吗？

Do you think that COVID is now seasonal?

这是否暗示它可能在寒冷月份达到高峰？

Is that the implication here potentially that it peaks during the cooler months?

这正是大家一直在等待的迹象。

That's what everybody's been waiting for.

我们制作《新冠播客》时，这曾是主要讨论话题，因为它当时毫无季节性规律。

And when we were doing the corona cast podcast, it was a major topic of discussion because there was no seasonality to it.

要知道，流感病毒本是季节性的——除非处于大流行模式。

You know, flu flu is a seasonal virus unless it's in pandemic mode.

当病毒处于大流行状态时，就不存在季节性了。

And when you have a pandemic virus, there's no seasonality to it.

它全年都会爆发。

It just happens all year.

目前仅有微弱迹象表明新冠可能正变得季节性，这会是好消息——意味着它正在脱离大流行的特征，或者说大流行流行病学模式。

And there's just a little bit of a hint that COVID might be becoming seasonal, which would be good news because that means it's moving away from that pandemic feel, if you like, or that pandemic epidemiology.

就像疫情初期那样，圣诞节前后出现一个高峰，秋季到初冬又出现另一个高峰。

So there's a peak as it has been right since the beginning over Christmas peak, and another peak over autumn, early winter as well.

因此它的高峰期还不完全与寒冷天气同步。

So it's not necessarily in timing with the cold weather yet.

现在断言其具有季节性可能为时过早，但确实出现了规律性模式。

Probably too early to say that it's seasonal, but there is a regular pattern.

考虑到圣诞季即将来临，现在或许是个好时机，看看你是否有资格接种加强针，以及是否已及时接种。

And probably a nice time given we're about to hit the Christmas season to see if you're eligible for a booster and if you're up to date or not.

在我们离开这些统计数据之前，需要指出的是，根据这些数据，原住民和托雷斯海峡岛民的新冠死亡率是非原住民的1.5倍。

And just before we leave these these statistics, because the mortality rate from COVID nineteen is, according to these data, is one and a half times higher in Aboriginal and Torres Strait Islander people compared to non indigenous people.

而在原住民和托雷斯海峡岛民中，特别是原住民女性，死亡率是非原住民女性的2.3倍。

And in Aboriginal and Torres Strait Islander, you know, First Nations women, the rate of mortality is two point three times higher than for non indigenous women.

这强调了疫苗接种指南的建议——原住民群体应在更年轻时接种疫苗。

And that emphasizes the vaccine guidelines, which do suggest that Aboriginal people should be immunized at an earlier age.

继续新冠话题，妇产科领域也有新研究发表，探讨了孕期感染新冠与儿童神经发育诊断之间的潜在关联。

Staying in the COVID realm, there's also been some research published obstetrics and gynaecology, which has tried to look at maternal infection with COVID during pregnancy and the potential association with neurodevelopmental diagnoses in children.

这是一项回顾性研究。

And this is a study that is retrospective.

研究调查了美国波士顿地区超过1.8万例分娩。

It's looked at just over eighteen thousand births in The US, in Boston.

研究人员追踪了孕期经PCR检测确诊感染新冠的孕妇。

And they've looked at mums who've had confirmed COVID infection during pregnancy, so confirmed with a PCR test in the lab.

这是在疫情期间进行的吗？

And this was during the pandemic?

没错。

That's right.

疫情高峰期，2020年3月至2021年5月期间。

In the peak of the pandemic, March 2020 to May 2021.

他们研究的主要结果是这些儿童到36个月（3岁）时出现神经发育诊断的情况。

The main outcome they've looked at is the development of a neurodevelopmental diagnosis by the age of 36, so three years of age.

研究发现，母亲孕期感染新冠的儿童出现神经发育诊断的风险更高，若感染发生在妊娠晚期或为男性后代，风险会进一步增加。

They found that there is actually a higher risk of neurodevelopmental diagnosis in these children whose mums had an infection during COVID, and the risk was higher if there was exposure in the third trimester and in male offspring.

所以我认为这项回顾性研究的主要启示是：研究设计严谨，结果值得重视。

So I the main message from here is, this is a study looking back, It's been pretty well done.

可以说风险确实增加了

You can say that there is an increased risk.

可能是通过脑部炎症引发的

It could be through brain inflammation.

发生这种情况可能有各种原因

It could be all sorts of reasons why this might occur.

关键结论是无论是流感还是新冠肺炎，孕妇都需要接种疫苗

The bottom line here is for both flu and COVID nineteen, pregnant women need to be immunized.

人们可能看到美国RFK Jr的相关报道，因为当地疫苗计划已有调整，不再建议孕妇接种新冠疫苗，但在澳大利亚仍建议接种

And people might have seen stuff out of The US with RFK Jr because there have been changes to the vaccine schedule there, and COVID vaccination is no longer recommended for pregnant people, but certainly in Australia, it still is.

如果怀孕，你面临更高新冠并发症风险，因此仍建议接种疫苗

And if you're pregnant, you're at higher risk of COVID complications, so vaccination is still recommended.

我们要祝贺昆士兰科技大学的Lydia Mrowska教授，她本周获得了总理科学奖

So we need to congratulate professor Lydia Mrowska from, Queensland University of Technology who won the prime minister of science prize this week.

总有很多人值得获奖，但Lydia尤其特别，特别是我们刚讨论过新冠肺炎

There are always people who are worthy of the prize, but particularly Lydia, and in particular since we've just been talking about COVID nineteen.

Lydia在2021年被《时代》杂志评为全球最具影响力百人之一

Lydia was awarded in 2021 one of the most influential people in the world by Time Magazine, the top 100 influential people.

我记得疫情初期Norman作为基层全科医生时，关于新冠传播方式存在巨大争议，而Lydia发挥了关键作用

And I recall Norman being a GP on the ground at the start of the pandemic when there was huge debate about how COVID was transmitted, and Lydia was integral.

确实如此

She was.

因为当时给政府提供建议的团队中有人不相信气溶胶传播，他们的科学认知还停留在上世纪四十年代

Because we had advising the government a group of people who didn't believe in aerosol spread, who were out of date in terms of the science, and they were going back to nineteen forties science.

他们认为病毒通过物体表面传播，近距离接触感染，所以当时要求保持1.5米社交距离

So they believed you got it off surfaces, you caught it at close quarters, that's why we had one and a half meters distance between people.

但实际上它是通过细微气溶胶颗粒传播的

But in fact, it was spread through fine aerosol particles.

因此，如果你与某人保持一定距离但长时间呼吸相同的空气，实际上仍可能感染新冠病毒，这与所有防疫建议相悖。

So if you were quite distant from somebody and you were breathing the same air as them over a period of time, you could actually catch COVID nineteen, which went against all the advice.

莉迪亚多年来的观点一直是：我们对外部空气质量的关注远高于室内空气。

And Lydia's point for years has been we care much more about the quality of outside air than indoor air.

而我们当时并未采取预防措施，至今在室内空气管理规范方面也改变甚微。

And we weren't taking precautions, and we still haven't changed much in the way of our indoor air regulations.

但莉迪亚召集了全球200多位该领域的顶尖专家，他们发表论文用证据表明这是气溶胶传播。

But Lydia got together 200 odd of the world's experts in this area, and they published an argument saying you know, showing the evidence that this was aerosol spread.

但我听说有位政府顾问称我为'瘴气论者'，这本质上是在倒退到中世纪——尽管当时人们可能隐约知道某些疾病通过气溶胶传播，但瘴气理论认为疾病源自地面散发的有害空气。

But I heard that one of the advisers to the government called me a miasmatist, which was essentially going back to the Middle Ages where in fact they probably kinda knew that some of these were aerosol spread, and miasma was the air that came from the ground and spread disease.

说实话，能和莉迪亚一起被称为瘴气论者，我其实挺自豪的。

Well, I was actually pretty proud to be called a miasmatist along with Lydia.

必须指出，在那封信发表后的第二天，世界卫生组织就承认了空气传播途径，这对疫情期间的防控工作意义重大。

Well, have to say after that letter was published, the very next day, the World Health Organization actually accepted the airborne pathway of infection transmission, which is you know, that's a significant contribution to management during the pandemic.

在庆祝好消息的同时，我们还应注意到今年设立了首相原住民与托雷斯海峡岛民知识体系首创奖，获奖者马尔加努姆人迈克尔·威尔正在开展海参养殖、原住民主导的渔业及海草修复工作，这很棒。

I think we should also, whilst we're celebrating good news, just call out the fact that this year, there was also the prime minister's inaugural prize for Aboriginal and Torres Strait Islander knowledge systems, and it went to Malgarnum man, Michael Ware, who is doing work on sea cucumbers and indigenous led fishery and seagrass restoration, which is just nice.

好消息。

Good news.

您现在收听的是ABC国家广播电台的《健康报告》节目。

You're with the health report on ABC Radio National.

让我们回到正题——不是讨论我撞伤的脚趾，而是疼痛这个重大议题。

So let's get back to not my stubbed toe, but pain, which is an enormous issue.

我相信在日常诊疗中，你常遇到疼痛久治不愈的患者，这确实是个难题。

I'm sure in your daily practice, you see people who are just not getting better from their pain, and it's a problem.

在美国，这正是医疗用麻醉剂导致诸多死亡的原因之一。

And in The United States, that's one of the causes of all these deaths from narcotics used in medicine.

这正是我们本次访谈要探讨的内容。

Which is something that we cover in this interview.

但慢性疼痛，诺曼，我觉得我们在节目中已经讨论了很多。

But chronic pain, I feel like we cover a lot on the show, Norman.

我们经常谈论骨关节炎疼痛。

We often talk about osteoarthritis pain.

最近讨论了慢性盆腔疼痛。

Recently, talked about chronic pelvic pain.

心理干预经常被提及。

Psychological interventions are often mentioned.

但我们还没有深入探讨疼痛心理学的具体内容。

But we haven't quite explored what psychology for pain looks like.

它包含哪些方面？

What does it involve?

背后的证据是什么？大脑在疼痛中扮演什么角色？

What's the evidence behind it, what's the role of the brain when it comes to pain?

一提到心理学，人们就会说'哦，你是在说我的疼痛是想象出来的'，这其实与事实相去甚远。

And as soon as you say psychology, people say, oh, you're just saying it's in my head, I'm imagining my pain, which is in fact far from the truth.

确实与事实不符，可能是医疗人员在向患者解释时存在问题，为此我采访了一位专家。

It is far from the truth, and perhaps there is a problem with how health professionals communicate it to patients, but I spoke to an expert.

为了了解这些问题，我采访了迈克尔·尼古拉斯教授，他是一位临床心理学家，在疼痛领域有超过40年的经验。

To find out all of these things, the person I spoke with is Professor Michael Nicholas, who's a clinical psychologist with over forty years of experience in the field of pain.

他目前在悉尼大学的疼痛管理研究所工作。

He's currently at the Pain Management Research Institute at the University of Sydney.

很自然地，人们对'大脑可能与疼痛有关'这个观点很敏感，因为在世界许多地方，这有点像在说'都是你想象出来的，不是真实的'。

Naturally, people are sensitive to the idea that the brain might have something to do with pain, because in many parts of the world, that's a bit like saying it's all in your head, it's not real.

但如果你试着思考什么是疼痛，它不仅仅是'什么会痛'，因为会痛的就是疼痛，这种定义会陷入循环论证。

But if you try to think about well what is pain, and it's not just what hurts, because what hurts is pain, so that sort of definition goes around in circles.

全球疼痛科学家达成共识的一种观点是：疼痛最好被描述为一种不愉快的感觉和情感体验，与实际的或潜在的组织损伤相关或类似。

So one way of thinking about pain that has been agreed to by pain scientists around the world, is that it's better described as an unpleasant sensory and emotional experience associated with or resembling that associated with actual potential tissue damage.

疼痛定义的关键点在于它是一种感官与情感体验，而非实物。

Now the key points in that definition of pain is that it's a sensory and emotional experience, so it's not a thing.

你无法用X光检测疼痛。

You can't x-ray pain.

你可以用X光检查骨骼并看到骨折，但扫描图像上找不到疼痛。

You could x-ray bones and you can see fractures, but you can't find pain on a scan.

但所有人都知道疼痛是什么，有人将其描述为一种感觉，但它不止是感觉，因为你知道，它可能相当令人痛苦。

But everybody knows what it is, and some describe it as a sensation, but it's more than a sensation because, you know, it can be quite distressing.

这已经能看出大脑是如何参与其中的了。

And that's already areas where you can see how the brain is involved.

你刚才说无法用X光检测疼痛。

You just said before you can't x-ray pain.

所以人们可能有正常的影像检查结果，正常的CT扫描和X光片，却仍然患有顽固的腰痛或慢性疼痛。

So people might have normal imaging, normal CT scans, x rays, but still have really persistent low back pain, chronic pain.

当扫描结果可能显示正常，却仍对患者的生活质量和睡眠造成重大影响时，大脑究竟发生了什么？

What's happening there with the brain when there's nothing seen potentially on the scan, but there's still a really significant impact on someone's quality of life and their sleep?

慢性疼痛被定义为持续超过三个月的疼痛，而腰痛可能是最常见的例子。

Well, chronic pain is defined as pain that persists for more than three months, and back pain is probably the most common example.

腰痛可能极具侵扰性和致残性，但许多腰痛患者并未丧失劳动能力，他们仍能继续工作生活，这并非主要问题。

Back pain can be quite intrusive and disabling, but lots of people also have back pain who are not disabled, but who continue to work and function and manage and it's not a major problem.

所以仅仅存在疼痛本身并不能说明全部问题。

So just having pain itself is not all there is to it.

它对您产生的影响，实际上取决于它对您的重要性。

The impact it has on you, it really depends on its significance for you.

它是否干扰了您的工作？

Is it interfering with your work?

它是否阻碍了您谋生？

Is it stopping you earning a living?

它是否影响了你们的关系？

Is it interfering in your relationships?

同样地，如果你担心这是某种可怕事情的征兆，比如癌症或肿瘤的迹象，那么你很可能会感到焦虑，并寻求确认一切正常的安慰。

Equally, if you're worried that it's a sign of something terrible going on, like it's a sign of cancer or tumor, then you're likely to get anxious and want to seek reassurance that it's okay.

例如，许多背痛并没有明确的生物学发现，但它仍然是真实存在的。

A lot of back pain, for example, it doesn't have clear biological findings, but it's still real.

这种疼痛与你能够找到生物学（即生理变化）依据的疼痛一样真实。

It's just as real as pain where you can find biological, you know, physiological changes.

大脑在这里的作用并非被动地接收来自疼痛部位的信号，而是主动参与解释我们的行为和经历。

The role of the brain here is not passive, just getting signals coming in from the pain site, but it plays an active role in interpreting what we're doing, what we're experiencing.

我们的感受与过往事件之间存在关联。

There are associations between what we feel and previous events.

有些记忆会被感觉触发。

There are memories that can be triggered by sensations.

因此大脑扮演着这种主动角色。

So the brain plays this active role.

所以这很大程度上取决于个人背景和过往经历，这些因素会真正影响疼痛对生活的侵扰程度，或实际影响生活质量的程度。

So it's a lot about context of the person, and maybe previous experiences, that really can impact how much the pain kind of intrudes on someone's life, or how much it actually impacts their quality of life.

确实如此。

Definitely, yes.

所以，我正要说过去的日子，现在依然...

So, I was going say the old days, there's still

你说话像个女人。

You sound like a woman.

是的，现在仍然存在这种情况：当人们感到疼痛时，他们期望能找到身体上的问题，并认为应该能在扫描中显示出来。当找不到时，人们要么担心自己只是在想象，要么觉得医生等其他人可能也这么认为。

Yeah, still happens that when people have pain, they expect to find something physically wrong with them, and it should show up on a scan, and when it doesn't, then people either themselves worry that they're just imagining it, or they feel that other people like their doctor might think that as well.

事实上，我们现在知道组织损伤与你感受到的疼痛程度之间存在关联。

In fact, we now know there's relationship between tissue damage and the amount of pain you feel.

所以有些人可能只有轻微或无明显身体变化或损伤却感到疼痛，而另一些人可能损伤严重却几乎感觉不到疼痛。

So someone can have a minor or no clear physical changes or damage and feel pain, or they can have a lot of damage and feel very little pain.

因此两个人可能都有背痛，但对各自的影响却可能完全不同。

So two people may have back pain, but it may have a completely different impact on one compared to the other.

正如你提到的，这通常与他们的疼痛背景有关——疼痛对他们的意义、他们如何看待它、如何应对它，都会影响他们的感受。

And this is often because of the context of their pain, as you mentioned, the significance it has for them, the way they're thinking about it, the way they're reacting to it, will influence what they feel.

所以如果你想介入干预，首先必须评估是哪些因素导致了这个人的疼痛，而不是仅仅做个X光或CT扫描就说'哦，你没问题，你很健康'。

And so if you try to intervene in that, you must firstly assess what are those factors contributing to that person's pain, rather than just having an x-ray or a CT scan and saying, oh, there's nothing wrong with you, you're fine.

那么迈克尔，心理干预对慢性疼痛患者具体是如何起作用的呢？

So then how does psychology interventions, Michael, how do they work in someone with chronic pain?

首先，正如我刚才指出的，我们需要评估这些影响因素：这里发生了什么？他们的思维过程是怎样的？这种经历对当事人意味着什么？他们认为发生了什么？他们有哪些担忧？

Firstly, we've got to, as I was just indicating, try to assess what are these contributors, what is going on here, what are the thought processes, what's the significance of this experience to the person, what do they think is going on, what are their concerns.

换句话说，我们不是要做出某种精神科诊断，比如简单地说他们只是抑郁了，认为疼痛只是抑郁症的一个症状——虽然疼痛确实可能如此。

In other words, we're not trying to make a sort of psychiatric diagnosis out of this, like saying they're just depressed, this is just a symptom of depression, which pain can be actually.

可能是，但不总是。

It can be, but not always.

不是吗？

Isn't it?

因为我认为通常不是。

Because I think that's often No.

不是。

No.

因为那是

Because That's

我认为有时候当慢性疼痛患者被转诊给心理医生时，医疗专业人员可能没有充分说明'这种心理治疗其实是针对大脑疼痛机制的'。

I think sometimes people, if they're referred to a psychologist for chronic pain, either there's not enough communication from the health professional saying, you know, this psychology is really targeted to the brain for pain.

患者常常会感到被敷衍，或者被贴上了情绪障碍的标签，而他们自己可能并不觉得有这类问题。

And often people might feel dismissed or as if they're being labeled with a mood disorder when they may not feel they have one.

因此我认为有必要提醒大家，在心理健康领域，慢性疼痛可能独立存在而不伴随其他诊断。

So I think it's important to remind everyone that chronic pain can exist in the absence of other diagnoses in the mental health space.

哦，是的，是的，是的。

Oh yes, yes, yes.

这个评估过程是第一步，也是关键的一步，因为每个人都是独特的个体，我们需要理解他们的具体经历，而不是简单地把所有人都归为一类说'我有背痛'。

So that assessment process is the first step, and it's critical, because each person is an individual, and we've got to understand their experience rather than just lump them all together and say, well, I've got back pain.

所以这是针对背痛的治疗方案。

So this is the treatment for back pain.

我建议人们以背痛患者的身份来思考这个问题。

I recommend people think about this as a person with back pain.

我们看不到背痛，因为它是主观感受而非可见症状。

We're not seeing back pain because we can't see it, it's an experience.

我们看到的是一个正在经历痛苦并因此寻求帮助的人。

What we are seeing is a person who's experiencing this and it's causing them enough concern that they've sought help.

这就是我们首先需要理解的重点。

So that's what we need to understand first.

他们的具体困扰是什么？

What are their concerns?

然后我们必须在干预时解决这些问题。

And then we must address those when we intervene.

单纯使用镇痛药是没用的。

There's no use giving them just analgesics by themselves.

它们可以有一定作用，但效果非常有限。

They can have a place, but it's a very small place.

大多数镇痛药效果不佳，即便有效也持续时间很短。

Most of them are quite ineffective, and if they have any impact, they don't last long.

所以当疼痛转为慢性时，患者必须学会自我管理。

So people have to learn to manage it themselves once it becomes chronic.

要做到这一点，必须让他们理解。

And to do that, it's got to make sense to them.

所以这是我们的首要任务——无论你是心理学家、全科医生还是专科医生，都需要帮助患者理解他们的经历，而不仅仅是给他们贴标签。

So that's our first task, whether you're a psychologist or a GP or a specialist, you need to help the person make sense of what they're experiencing, and don't just label them.

迈克尔，你觉得我们在这方面做得好吗？

Do you think we're good at that, Michael?

不好。

No.

临床医生们，确实如此。

Clinicians, yeah.

那么需要改变什么呢？

So what needs to change then?

是否需要加强疼痛教育？是的。

Does there need to be more pain education in Yes.

诊疗环节

Consulting

不仅是在诊疗室里，所有医疗专业人员都需要接受培训。

Not just in consulting rooms, it needs to be for all health professionals.

所有医疗专业人员，无论是医生、护士、物理治疗师还是心理学家，都会接触到疼痛患者。

All health professionals, whether they're a doctor, nurse, a physiotherapist, psychologist, will see people in pain.

这是人们寻求帮助的最常见原因之一，然而我们在如何评估疼痛及帮助患者应对疼痛方面都缺乏专业训练。

It's one of the most common reasons people seek help, and yet we are all poorly trained in how to assess pain and how to help people with their pain.

这正是导致我们出现阿片类药物等问题根源——当所谓的弱效药物（如扑热息痛）无效时，人们就会被建议服用更强效的药物，也就是阿片类药物。

And this is why we actually developed these problems like with the opioids, because people were said if a weak, a so called weak drug like paracetamol wasn't working, they'd say take something stronger, which meant taking opioids.

这导致了我们后来遇到的所有问题，显然美国的情况更为严重。

And that's what led to all the problems that we have had, obviously The United States is even worse.

这源于医疗专业人员未能正确评估和理解患者的疼痛，未能帮助患者认识问题本质并共同制定治疗计划，而是简单将其视为抱怨疼痛的人，而非被疼痛困扰需要关怀的个体。

It comes from a failure of the health professionals to properly assess and understand a person's pain and help them understand what's going on and developing a plan with the person and not seeing them as just a pain complainer, but rather a person with pain that's causing them concern.

如果他们开始对医疗系统或所接受的治疗感到失望，这显然会让人感到无助或绝望，进而陷入抑郁，但这是管理方式导致的结果。

If they become disillusioned with the health system or with the treatment they're getting, that's obviously when you can start feeling rather helpless or hopeless and get depressed, but it's a result of the way they've been managed.

这不是问题的根源，但会形成恶性循环，让情况变得更糟。

It's not the cause of the problem, but it will have a feedback loop, and make the experience even worse.

确实会更糟。

Even worse, yeah.

关于针对慢性疼痛有实证支持的心理干预手段，具体是怎样的？

When it comes to the psychology interventions that have evidence for chronic pain, what does it look like?

首先，不存在一劳永逸的解决方案。

Well, firstly, there's no magic bullet.

你知道，以为做了某件事就能彻底解决问题。

You know, do this and it'll all go away.

这是对问题的完全误解。

That's a total failure to understand the problem.

研究最广泛的治疗类别是认知行为疗法，即通过分析患者的思维方式、反应原因、行为模式，他们与自身体验及周围人的互动方式，与患者共同制定方案。

The most studied broad treatment group comes under the heading of cognitive behavioural therapies, which means you look at the way people are thinking, why they're reacting, why they're behaving, the way they're interacting with their experience, and also with people around them, and work out with the person.

认知行为疗法不是对患者实施，而是与患者共同进行。

You can't do CBT to people, you do it with them.

什么方案可能适合他们？

What might be appropriate for them?

这可能包括放松训练、正念练习，但通常也会包含运动锻炼。因为患者常因疼痛停止活动，导致继发性机能退化，进而产生'疼痛时不能活动'的恐惧信念。而研究发现，这种'疼痛时不能活动'的信念是致残的最强预测因素之一。

And that may include relaxation, it may include mindfulness, but often it'll include exercise, because often people stop doing things because of pain, and that leads to secondary deconditioning type effects, and then people can develop some develop like a fear or belief that they can't do things in pain, when what we've found is that belief that you can't do things in pain is one of the most powerful predictors of disability.

所以如果坚信疼痛时不该活动，这种观念实际上会恶化预后。

So if you believe that pain is a bad thing if you don't move, then it can actually negatively impact your outcomes.

没错。

Yes.

我们通过国内外多项研究证实，这种'不能做事'的信念比恐惧本身更具破坏力。

And we've shown in numbers of studies in this country and internationally, that it's that belief that you can't do things that is more powerful than fear.

但你可以通过物理治疗师、心理医生或医生的指导来改变这种信念，逐步开始做那些你因为不相信自己能做而一直回避的事情。

But you can change that belief by being guided by a physiotherapist, or a psychologist, or your doctor, to gradually start doing the things you've been avoiding because you didn't believe you could do them.

不要过度活动，因为这是人们根据疼痛行事时的危险之一。

Not overdoing things because that's one of the dangers as people behave according to their pain.

所以当疼痛减轻时，他们会做更多事，而当疼痛加剧时，他们就停止活动。

So when their pain is low, they do more, and then when that stirs the pain up, they stop doing things.

这有点像所谓的'暴起暴落'行为模式。

That's sort of what's called a boom bust style of behavior.

我们试图做的是让人们学会如何在不持续加剧疼痛的情况下合理安排活动。

What we try to do is get people to learn how to pace their activities without aggravating the pain all the time.

所以这涉及到重新构建认知、再教育，并真正将整个人及其疼痛体验和既往病史纳入考量。

So it's about reframing, reeducating, and really taking the whole person into context, their experience of pain, and any kind of previous history.

是的，没错。

Yes, yes, yes.

并与患者讨论这些，我们需要把每位患者当作成年人来对待，与他们进行讨论，因为实际需要管理疼痛的是他们自己。

And discussing those with the patient, if we need to treat each person as an adult, and have a discussion with them, because they are the ones who've actually got to manage it.

我经常对医学生和疼痛管理专科培训生说，我们其实根本不管理疼痛。

I often say to medical students and specialists training in pain management that we don't manage pain at all.

管理疼痛的是患者本人。

It's the patient who manages pain.

是的，你是在给他们提供工具。

Yeah, you're giving them the tools.

是的，我们可以教他们策略、提供信息、成为倾诉对象，但非常重要的是要避免简单化的解释——好像存在某种万能解决方案。你只要谷歌搜索背痛，就能看到成千上万页的完全胡说八道的内容。

Yes, we can teach them strategies, give them information, be a sounding board, but it's very important that we avoid simple explanations as if there's one simple solution and you see, you just have to Google back pain and you'll see thousands of pages of absolute rubbish.

人们会说他们做了某件事后疼痛就完全消失了，但实际上疼痛并不一定要完全消失。

People saying that, you know, they did this and it all went away, but it doesn't actually have to go away.

这正是心理治疗的妙处——如果你能意识到这实际上不必阻碍你正常生活，你可以重返工作岗位，尽管有疼痛也能过上充实活跃的生活。

And that's the whole beauty of the psychological actually, is that if you can real if you realize that actually this doesn't have to stop you functioning, you can get back to work, You can live an active and full life despite pain.

那么疼痛对你来说将不再是那么大的问题，但一味追求彻底止痛是个严重的错误，因为这会导致你尝试各种最终无效的药物。

Then pain will be much less of a problem for you, but chasing complete pain relief is a big mistake, because that's what leads you into all these different drugs which don't work in the end.

对于正在收听的听众，迈克尔，那些可能在想，我一直在与慢性疼痛作斗争的人。

For people listening, Michael, who might be thinking, you know, I've been struggling with chronic pain.

可能是慢性盆腔疼痛、颈部疼痛、背部疼痛。

Maybe it's chronic pelvic pain, neck pain, back pain.

如何找到擅长这个领域的心理学家或临床医生？

How do you find a psychologist or a clinician who is skilled in this space?

我们能告诉人们什么来引导他们呢？

What can we tell people to help guide them potentially?

这是个好问题。

It's a good question.

我们都能来找你看病吗，迈克尔？

Can we all come and see you, Michael?

不行。

No.

我不建议这样做。

I wouldn't recommend that.

首先，我会去看我的全科医生。

Well, firstly, I would see my GP.

医疗评估非常重要。

That medical assessment is very important.

很多人会去看理疗师。

A lot of people go to a physio.

但关键是要找一个你对其有信心、能信任的人，然后开始这个过程。

But really, need to see someone you feel confident in, you have some trust in, and start that process.

现在所有公立医院都设有疼痛门诊。

Public hospitals all have a pain clinic these days.

对许多人来说存在等待名单，这是个问题。

There is a waiting list for many, which is a problem.

我的意思是，我们最近开发的一个项目是为医疗专业人员提供的在线疼痛教育网络。

I mean, one of the things we have developed this recently is an online pain education network for health professionals.

所以我会询问任何提出要帮我缓解疼痛的医疗专业人员，他们实际接受过哪些疼痛管理培训，而现实情况是很少有人接受过这类培训。

So I would ask any health professional who's offering to help with my pain, what training they've actually had in pain management, and the reality is very few have had that.

迈克尔，我很好奇，如果有人被转诊给你治疗慢性疼痛但有些抗拒，你会采取什么方法？

I'm just curious, Michael, what's your approach if someone is referred to you with chronic pain who's slightly resistant?

可能他们觉得转诊意味着自己被敷衍了，或者被告知疼痛是心理作用。

Maybe they feel as if they've been dismissed with the referral or they're being told that the pain is in their head.

你如何处理这类患者？

What is your approach with that patient?

这种情况很常见，当人们说我的疼痛在背部或脚上，不在脑子里时。

Well, it's quite common, of course, when People say, look, my pain's in my back or my foot, it's not in my head.

作为心理学家，我经常听到这种说法，我非常理解这种反应。

So as a psychologist myself, get that sort of comment, and I quite understand that.

这是社会普遍认知，认为问题要么是生理的要么是心理的。

That's the community norm, to see things are either physical or psychological.

但实际上我们认为这些问题同时涉及生理和心理层面，因此需要理解两个领域的情况。

But we actually look at these things as being both physical and psychological, and we need therefore to understand what's going on in both domains.

所以我不会一开始就向患者证明自己存在的价值，而是会说：我们为什么不先明确问题所在呢？

So what I start with is not trying to justify my existence to the person, but rather I'd start to say, well, why don't we actually try to clarify what the problems are?

通过这种方式，我们会发现疼痛确实阻碍了他们做某些事情。

And when we do that, we identify that, you know, the pain stopping them from doing things.

他们因此感到沮丧和愤怒，发现现有治疗方案效果不佳。

They're getting frustrated and angry about it, they're finding the treatments they're getting are not really working.

通过向患者展示疼痛持续发展如何引发连锁反应，他们很快就能明白问题不只出在背部。

By showing people how one thing has led to another, as their pain has gone on, they can then quite quickly see that it's not all about what's going on in their back.

事实上，一旦疼痛转为慢性，其根源很可能与你当前的感受和影响关系不大。

In fact, once it becomes chronic, the origins of pain have probably got very little to do with what you're experiencing now, what the impact is.

它更多与你的行为方式、思考模式以及情感互动相关。

It's gonna be much more to do with your behavior, the way you're thinking about it, the way you're feeling and interacting.

然后人们开始意识到，实际上有许多心理因素虽未直接导致问题，却已与之纠缠不清。

Then people start to see, well actually, there are a lot of psychological aspects that didn't cause the problem, but have become entangled with it.

是的，纠缠不清。

Yes, entangled.

关键在于，我们能够对这些方面采取行动。

And the thing is, can do something about these things.

我们可以讨论你神经系统的情况，但大多数人无法直接改变它。

We can talk about what's going on in your nervous system, but most of us have no ability to directly change that.

但我们能改变的是自己的行为。

But what we can do is change our behavior.

我们能改变思维方式。

We can change the way we think.

这位是迈克尔·尼古拉斯教授，疼痛领域经验丰富的临床心理学家。

That was Professor Michael Nicholas, who is a very experienced clinical psychologist in the field of pain.

非常精彩的访谈，普莉娅，内容极其全面。

A really great interview, Priya, and really comprehensive.

迈克尔掌握的知识不逊于——甚至超过——澳大利亚许多同行。

Michael knows as much, if not more, than a lot of people in Australia.

但他在悉尼北岸医院提供的多学科服务——涉及大量人员和专业培训——在澳大利亚其他地区并不容易获得。

But the sort of service he provides at North Shore Hospital in Sydney, which is multidisciplinary, a lot of people involved, a lot of training involved, is not available easily elsewhere in Australia.

虽然各地都有优秀的疼痛中心，但它们都超负荷运转。

I mean, you have excellent pain centers, but they're overwhelmed.

我认为必须承认：要获得迈克尔提到的慢性疼痛黄金标准治疗（包括物理治疗师、心理医生和全科医生），若不在公立疼痛管理单位体系内，成本会相当高昂——因为候诊名单太长，或你可能需要更紧急的服务。

And I think that's important to acknowledge that if you really get that gold standard of care in chronic pain, which Michael mentions with physiotherapist, psychology, a health professional like a GP, it can be quite costly if you're not in one of those public pain management units, because the wait list is so long or you might need services more acutely.

即使有全科医生管理计划或政府补贴，费用也可能相当昂贵。

It can be quite expensive, even with a GP management plan or subsidies from the government.

我们会在节目笔记中提供一些可能有帮助的关键资源链接。

And we'll have links to some key resources that might help you on our show notes.

这里是ABC国家广播电台的健康报道节目。

On ABC Radio National, you're with the health report.

过去几周我们报道了关于儿童食物过敏的故事。

Over the last few weeks, we have covered stories on food allergies in children.

几周前我们报道了美国的一项研究，显示通过更新指南并建议家长尽早让孩子接触花生等常见致敏食物，可以降低食物过敏风险，美国因此避免了大量病例。

And a couple of weeks ago, we covered research out of The US that showed with updated guidelines and advice to parents to try and get in common allergy causing foods like peanut into the diet earlier, it reduces risk of food allergies, and there have been a significant number of cases avoided in The US as a result of the updated guidelines.

接下来一周我们有来自Mimi Tang教授的澳大利亚数据，显示这里也产生了类似效果，虽然程度可能较低，因为我们可能没有严格遵循指南。

And we had Australian data the following week from Professor Mimi Tang showing that we had similar impact here, perhaps at a lower level because it's more dilute, we may be not following the guidelines quite as closely.

然后你在诊所里有个经历，给我们讲讲最新情况。

And then you had an experience in your surgery, just to bring us up to date.

是的，我有个病人对过敏入门套装产生反应，这是药房可以买到的粉末产品，用于接触这些食物，而不是直接食用完整食物。

Yes, where I had a patient have a reaction to an allergy starter pack, so something you can buy from the chemist, which is the powder that you use to try and get in these foods, as opposed to the whole food.

Memmi Tang教授帮助澄清了一些困惑，她说理想情况下应该尽量选择完整食物，并给出了一些建议。

Professor Memmi Tang helped clarify some of the confusion and said, ideally, essentially, go for the whole food if you can, and gave people some tips.

她还评论说这些入门套装本身可能因为剂量和使用方式问题而无法达到效果。

And she commented that the starter packs themselves may actually not do the job because of the dose that's in them and how you use them.

所以你知道，这些产品本身是值得怀疑的。

So, you know, they are questionable themselves.

我们收到了Kylie的邮件。

Anyway, we've had an email from Kylie.

Kylie来信说：非常感谢你们关于过敏原入门套装的报道。

And so Kylie has written in and said, thank you so much for the segment on allergen starter packs.

我们一直按照建议流程让宝宝接触过敏原，但没有使用套装产品。

We've been exposing our baby to allergens following the suggested process, not with a pack.

你说得对，考虑到持续接触和要在宝宝一岁前完成所有事项，这确实是项大工程。

And you're right that it's a big job once you factor in continued exposure and getting it all done before the baby is one.

我并不意外你提到的研究中，并非所有实验组的家庭都能完全遵循方案要求。

I'm not surprised not all families in the experimental groups in the studies to which you refer were not able to follow the protocol exactly.

因此，澳大利亚的效果较弱。

Hence, the lower effects in Australia.

是的。

Yes.

接着凯莉继续说到，鉴于现实中我们都不得不做些妥协的实际困难，我认为所有尝试这样做的父母都需要一些关于如何在方案内合理确定优先顺序的建议。

And then Kylie goes on to say, given these difficulties in the reality that we're all going to have to cut some corners, I think all parents trying to do this would be helped by some advice on how to responsibly prioritize within the protocol.

很重要。

Important.

你一直在关注澳大利亚临床免疫与过敏学会的推荐建议。

You've been having a look at what the Australian Society of Clinical Immunology and Allergy is recommending.

但在讨论这个之前，我想说生命第一年的主要目标是让宝宝在12个月时过渡到饮用牛奶，但不再以奶类为主食。

But before we do that, I mean, the main aim in the first year of life is to head to a point where by 12 you've moved to cow's milk but not relying on milk in the diet.

实际上固体食物才是饮食主体，基本就是你们家庭日常饮食的适龄版本。

Solids are actually the main part of the diet, and it's a version of what you as a family are eating.

到那时孩子应该已经接触了较全面的食物种类。

And by that time, you're getting a reasonable spectrum of foods.

但这依然不能削弱早期介入的重要性。

But that still doesn't take away from the need to get in early.

那么ASKEA学会具体怎么说？

So what does ASKEA say, the society?

你刚提到的NIP Allergies in the Bub和ASKEA都是极好的资源，我们会在节目说明里附上链接。

NIP Allergies in the Bub and ASKEA, which you just mentioned, are amazing resources, which we will link in the show notes.

NIP Allergies in the Bub有个书签，上面列出了所有推荐食物，我的每位患者都会收到。

But NIP Allergies in the Bub has a bookmark that all my patients get with the foods on them.

鱼类、贝类、坚果、花生、牛奶、鸡蛋，所有这些。

Pitches of fish, shellfish, tree nuts, peanut, cow's milk, egg, all of it.

诺曼，我所做的——因为我同意凯莉的看法——这个过程确实让人望而生畏。

What I did, Norman, because I agree with Kylie, it can feel like quite a daunting process.

你已经精疲力尽了。

You're exhausted.

而且你本来就有够多事情要考虑了。

And you get enough to think about anyway.

我是说，

I mean,

就...是的。

just Yes.

养育一个孩子。

Bringing up a child.

我把它贴在冰箱上，并告诉患者们也这样做。正如咪咪上周说的，最好一次尝试一种食物，这样出现反应时就能知道是哪种食物引起的。

I put it on the fridge, and I say to patients, put this on the fridge, and ideally do one at a time, as Mimi said last week, so you know if there's a reaction which food it is to.

一旦引入某种食物后没有不良反应，就要坚持将其纳入饮食。建议每周食用两次，但尽力而为就好。

Once you've introduced it and there's no reaction, you want to reliably keep it in the diet, and the recommendation is for two times a week, but you try your best.

就像你说的，要尝试把它融入日常饮食中。

And as you say, you try and incorporate it into the everyday foods.

金枪鱼罐头救了我的命，因为它属于鱼类，而我又超爱金枪鱼罐头。

Canned tuna saved my life because it's fish, and I love canned tuna.

谢天谢地，我的孩子们对鱼类不过敏。

So my kids are not allergic to fish, thank goodness.

但我认为人们去查阅这些资源很重要。

But I think it's important that people go and look at these resources.

ASKEA在官网上也提到，如今市面上已广泛销售含有常见致敏成分的婴儿包装食品，这正是我们上周讨论的内容。

ASKEA also do say on their website that the packaged foods for babies that contain most of the common allergy causing foods are now widely commercially available, and that's what we spoke about last week.

专家们确实指出，虽然这些方法看似便于引入常见致敏食物，但必须记住直接给婴儿喂食完整食物而非粉末状替代品有很多好处，他们推荐使用完整食材。

They actually do say whilst they appear to be convenient for introducing the common allergy causing foods, it's important to remember that there are many benefits to feeding babies, the actual food rather than powdered options, and they recommend the whole food.

那么，你有什么实用建议吗？

So, you got any practical tips?

建议一次只尝试一种。

So, do one at a time.

试着把它融入家庭餐中。

Try and introduce it in the family meal.

比如当孩子能接受贝类后，就可以在炒饭里加虾仁，不必拘泥于食谱，关键是要把这些致敏食物引入饮食。

If you can put prawns into a fried rice once you've got shellfish in, however you do it, just break the rules with recipes and get those allergy foods in.

至于坚果类，等孩子适应后可以研磨成粉。

And with nuts, once you've got them in, blitz them.

比如花生、核桃、榛子。

So peanut, walnut, hazelnut.

芝麻等所有食材引入后，可以直接撒在燕麦粥或任何早餐上，让它们成为日常饮食的一部分。

Put sesame seeds in there once it's all introduced, just pop it onto oats or whatever breakfast is happening in the morning and just keep it in the diet.

所以保持平常心。

So stay cool.

这个世界本就不完美。

The world is not a perfect place.

尽力而为就好。

Just do what you can.

是的。

Yes.