你有睡眠困难吗？

邮件主题请写“睡眠”。

Use the subject line sleep.

再说一遍，邮箱地址是feedbackhiddenbrain点org。

Again, that email address is feedbackhiddenbrain dot org.

我们通常把睡眠不足看作是个人的问题，会影响我们的感受、工作效率和一天的表现。

We often think of sleep deprivation as a personal problem something that affects how we feel, how productive we are, how well we can get through the day.

如果因为休息不够而疲惫或烦躁，我们往往会认为后果只会落在自己身上。

If we are tired or cranky from not getting enough rest, we assume the consequences will land on us.

在华盛顿大学，克里斯·巴恩斯研究睡眠科学以及睡眠不足的影响。

At the University of Washington, Chris Barnes studies the science of sleep and the effects of sleep deprivation.

他说，睡眠不足的影响远比我们想象的要严重。

He says the stakes are far higher than we imagine.

当人们长期睡眠不足时，这不仅影响他们自己的健康。

When people are chronically exhausted, that doesn't just affect their own health.

它还可能影响整个社区的安全。

It can shape the safety of entire communities.

克里斯，大多数人需要多少睡眠，实际又睡了多少呢？

Chris, how much sleep do most people require, and how much sleep do most people get?

我们大多数人需要七到九个小时的睡眠。

So most of us need between seven and nine hours.

当然，人们听到这个，就会想，哦，好吧。

Of course, people hear that, and they hear, oh, okay.

七个小时就够了。

Seven is fine.

所以你可能是需要七个小时的人，但也可能是需要九个小时的人。

So you might be one of the people who need seven, but you might be one of the people who needs nine.

所以大多数人都在七到九个小时这个范围内。

So most of us are in that range seven to nine.

对于学龄儿童来说，十个小时，甚至对于最年幼的学龄儿童来说，可能更多一些是最好的。

For school age children, 10 or maybe even more for the youngest school age children would be best.

不幸的是，无论是儿童还是成年人，通常都没有得到他们应有的睡眠量。

Unfortunately, neither children nor adults are typically getting as much sleep as they should.

几乎所有睡六个小时的人其实都需要超过六个小时的睡眠。

Almost all of those people who are sleeping six hours need more than six hours.

他们中的大多数人可能和普通人一样，需要七到九个小时。

Most of them probably need seven to nine like everyone else.

不幸的是，很多人觉得自己是睡眠超人，认为别人需要八小时睡眠，但自己睡四个小时就完全没问题，好像自己不需要那么多睡眠似的。

Unfortunately, a large number of people believe they are short sleep superheroes and that maybe it's fine for everyone else to get eight hours of sleep, but I'll be just totally fine if I get four hours of sleep because I'm somehow above the need for sleep.

这种想法很常见，但确实是个误区。

It's an unfortunately common belief.

你能谈谈不仅睡眠充足，而且深度睡眠的重要性吗？

Can you talk about the importance of not just enough sleep, but of getting deep sleep?

好的。

Yes.

我谈睡眠时，通常会同时提到睡眠时长和睡眠质量。

So when I talk about sleep, I usually talk about both sleep duration as well as sleep quality.

睡眠质量有点难理解，但核心就是能否进入真正的深度睡眠。

And sleep quality is a little bit harder to understand, but the central aspect there is getting into really deep sleep.

理解深度睡眠最简单的方法就是，如果别人很难把你从睡眠中叫醒，那至少从表面上看，说明你已经进入深度睡眠了。

The simplest way to think about deep sleep is if it's kind of difficult to wake you out of that sleep, that's a good indication at least on the surface level that you're getting to that deep sleep.

所以我们可以把睡眠状态分成三种。

So we can really divide our states into three states.

分别是清醒状态、快速眼动睡眠，也就是REM睡眠，还有非快速眼动睡眠。

So there's waking, there is REM sleep, rapid eye movement sleep, and there's non rapid eye movement sleep.

当我们进入这种深度的N3非快速眼动睡眠时，会有一些非常重要的恢复过程，这些过程在深度睡眠阶段比在REM睡眠或清醒时发生得更多。

And when we get to this deep N3 non rapid eye movement sleep, there are some very important recovery processes that happen more so during that aspect of sleep than during REM sleep or waking activity.

我确实认为REM睡眠和深度非REM睡眠都很重要，但深度非REM睡眠有时候确实比较难达到。

I do say that both REM sleep and deep non REM sleep are both quite important, but that deep non REM sleep can be kinda hard to get sometimes.

我们来谈谈一些能帮助我们改善睡眠的方法吧。

Let's talk about some interventions that can help us improve our sleep.

也许我们应该先聊聊很多人和手机的关系。

Perhaps we should start by talking about the relationship that many of us have with our phones.

好的。

Yes.

手机是很棒的设备，有很多好处，但越来越明显的是，它们也有一些坏处。

Our phones are amazing devices that have lots of beneficial effects and increasingly clearly some some harmful effects as well.

所以我和同事们做了一项研究，专门观察深夜使用手机的情况。

So my colleagues and I conducted a study in which we examined smartphone use late at night.

我们发现，深夜使用这些设备往往会牺牲睡眠。

We find that using these devices late at night tends to come at the cost of sleep.

结果就是，第二天上班时人们会感到疲惫，状态不佳，工作投入度也会降低。

And as a result, people go to work the next day tired and they're not their best selves and they tend to be less engaged at work the next day.

所以这里有点讽刺：你可能想在深夜用手机多挤一点工作，但结果第二天工作效率反而更低。

So there is sort of an ironic effect here where you might be trying to squeeze in a little bit more work late at night on your phone, but then you work less the next day as a result.

所以实际上并没有净收益，反而睡眠损失了，当然，睡眠不足还会带来各种不好的影响。

So there's not really a net gain there, but there is a net loss to your sleep and, of course, all the bad things that happen when you get less sleep.

所以你和其他人也做过关于蓝光过滤器的研究。

So you and others have also done research on the use of blue light filters.

克里斯，跟我们讲讲这项研究吧。

Talk about this work, Chris.

这对我们深夜使用手机有帮助吗？

Does it help us when it comes to using our phones late at night?

最理想的解决办法是深夜不要用手机，但有一些其他工具可以帮助减轻这些影响也是好的。

The ideal solution here is not to use our phones late at night, but that is good to have some other tools that can help to mitigate some of these effects.

蓝光会抑制褪黑素的产生，而褪黑素是一种有助于入睡的化学物质。

Blue light unfortunately suppresses the production of melatonin, which is a chemical that is useful in the process of falling asleep.

所以当我们把手机紧挨着脸，让蓝光直射眼睛时，我们实际上是在给身体发送保持清醒的信号。

So when we are using our phones right next to our face, shining that blue light into our eyes, we're essentially sending a signal to our bodies to stay awake.

所以一个解决办法是戴上能过滤蓝光的眼镜，因为蓝光对昼夜节律系统的影响最大。

So one way to deal with this is to put on glasses that filter out that blue light, which has the most powerful effect on circadian system.

如果蓝光到不了你的眼睛，那它的影响就不会那么大。

So if that blue light doesn't reach your eyeballs, then it won't have as much of an effect.

不过我要提醒一下，这些蓝光过滤眼镜并不是万能的。

So I wanna be careful to note that these blue light filtering glasses are not a magic bullet.

它们不能完全解决问题，但数据确实表明，它们可以作为一种有用的部分解决方案，来应对我们现代社会中常见的昼夜节律失调问题。

They are not gonna fully solve the problem, but the data do indicate that they can be a useful partial solution to some of these circadian dysregulation issues that we tend to face in our modern society.

我想知道你能不能谈谈这里一个显而易见的问题，克里斯。

I'm wondering if you can address an elephant in the room here, Chris.

尤其是在美国社会，有一种文化暗流，就是那些地位高的人常常声称自己需要更少的睡眠，或者他们睡得很少。

One of the cultural undercurrents, especially in American society, is that people who are high status often claim that they need less sleep or they're getting less sleep.

这在某种程度上向其他人传递了一个信息，就是睡眠不足在某种意义上代表你很重要。

And in some ways, it sends a message to everyone else that being sleep deprived is in some ways a sign of being important.

你能稍微谈谈这个吗？以及这在某种程度上与你所倡导的理念是多么背道而驰。

Can you talk a little bit about this and how in some ways that message runs very counter to the message that you are preaching?

是的。

Yes.

所以外面流传着一种想法，就是如果我真的很重要，那我就没时间睡觉。

So there is an idea floating around out there that if I'm really important, then I don't have time to sleep.

然后如果我真的很有能力，那我对睡眠的需求就更少。

And then if I am if I am especially capable, that I have less need for sleep.

现在我已经到了希望这个健身房早点开门的地步，而且我实际上也睡不了懒觉了。

Now I'm at the point where I actually wish this gym would open earlier, and I actually can't sleep in.

而且我很喜欢，因为早晨是一天中最好的时光。

And I love it because the morning is the best part of the day.

我知道有些人会说，哇。

I know there's some out there that say, woah.

哇。

Woah.

哇。

Woah.

我需要八小时。

I need eight.

那我会说，那就睡快一点。

Well, I say to sleep a little faster.

我之所以早上四点半起床，是因为那时还没有其他人醒来。

The reason I wake up at 04:30 in the morning because no one else is awake yet.

所以这给了我机会去做一些事情，

So that gives me the opportunity to do things that

我想说，

I want.

别每天睡八个小时。

Don't sleep eight hours a day.

那可是你生命的三分之一。

That's a third of your life.

一天总共才二十四小时呢。

It ain't even twenty four hours.

你几乎不睡觉，整天都这样。

Your entire day with little to no sleep.

在我找医生之前，

Now before I have doctor

所以我和同事们确实做了一些关于人们炫耀自己睡眠情况的研究。

So my colleagues and I actually conducted some research about people bragging about their sleep.

我们的问题基本上是，鉴于目前所有的证据都表明睡眠不足对工作有很坏的影响，为什么人们还会这样做呢？

And our our question was essentially, like, given all the evidence that we have so far that sleep deprivation has such bad effects on work, why would people do this?

所以，通过吹嘘自己睡眠不足来获得地位，大概有两条路径。

So there's sort of two paths to status gain by bragging about your sleep deprivation.

一条路径是，同事们可能会觉得你很强大。

So one path is that your colleagues might see you as strong.

比如，你强大到连睡眠不足都压不垮你。

Like, you're so strong that not even sleep deprivation can hold you down.

确实，我们也发现了这一点，吹嘘睡眠不足能提升别人对你力量的看法，进而提升你的地位。

And indeed, we we do find this, that bragging about your sleep deprivation can increase perceptions of your strength, which in turn increases perception of your status.

另一条路径是自我牺牲。

The other path is self sacrifice.

所以人们可能会觉得你很光荣，比如，哇。

So people might see you as sort of honorable, like, wow.

你愿意牺牲睡眠，以便为团队做更多工作。

You're you're willing to sacrifice your sleep so that you can work more on behalf of our group.

这就是获得地位的第二种方式。

And that that is the second way to gain status.

什么……

What's...

我觉得特别有意思的是，这里有个性别差异，就是“坚强”这条路对男性来说更明显。

What I find especially interesting is there's a gender wrinkle here where the strength path is most visible for men.

当男性炫耀自己睡眠不足时，他们往往被视为更坚强，并因此获得地位。

When when men men brag about their sleep deprivation, they tend to be seen as stronger and they gain status that way.

他们炫耀睡眠不足，通常不会被视为更自我牺牲。

They they don't tend to be seen as more self sacrificing by bragging about their sleep deprivation.

而女性则相反，她们往往被视为自我牺牲，并以此获得地位，但她们不会……

And it's the opposite for women where they tend to be seen as self sacrificing and gain status that way, but they don't they don't...

她们不会因为炫耀睡眠不足而被视为更坚强。

They're not perceived as stronger for for bragging about their sleep deprivation.

所以总的来说，这里似乎有一些理性成分，人们觉得炫耀睡眠不足能带来一些社交上的好处。

So big picture here, it it appears that there's some rationality here where people suspect that there are some social gains that they can get from bragging about their sleep deprivation.

我们的一些数据也在一定程度上证实了这一点，确实，如果你炫耀睡眠不足，你可能真的能获得地位，这挺不幸的，而且从长远来看，最终是自毁的。

And some of our data bear this out to some degree where, yes, if you brag about your sleep deprivation, you might actually be able to gain status, which is quite unfortunate and in the long run, ultimately self defeating.

提醒一下，你有没有因为睡眠不足而经历过严重的负面影响？

A reminder, have you experienced serious adverse consequences of sleep deprivation?

如果你有个人经历愿意和《隐藏的大脑》的听众分享，或者对这个节目有疑问或评论，请找一个非常安静的房间，用手机录一段语音备忘录。

If you have a personal story you'd be willing to share with the Hidden Brain audience or a question or comment about this episode, please find a very quiet room and record a voice memo on your phone.

两三分钟就够了。

Two or three minutes is plenty.

把音频文件通过电子邮件发给我们，地址是feedbackhiddenbrain点org。

Email the audio file to us using the address feedbackhiddenbrain dot org.

邮件主题请写“睡眠”。

Use the subject line sleep.

再说一遍，那个邮箱地址是feedbackhiddenbrain点org。

Again, that email address is feedbackhiddenbrain dot org.

克里斯，我们之前聊过，切换到夏令时和事故增加有关联。

Chris, we talked earlier about how the switch to daylight saving time is associated with an uptick in accidents.

关于是否应该因为健康危害而废除夏令时，一直有很多争论。

There's been a lot of debate about whether or not daylight saving time should be abolished because of these health hazards.

克里斯，你怎么看这个争论？

What do you make of this debate, Chris?

你倾向于哪一边？

Where do you come down on it?

科学界非常清楚，尤其是春季切换到夏令时，影响相当大，我们会看到心脏病发作和车祸增加，还有其他类似的有害影响。

So the science is is very clear that the change to daylight saving time in the spring in particular is quite disruptive, where we see an increase in heart attacks and car crashes, other harmful effects like that.

秋季的调整可能影响较小，我们多了一个小时，这似乎没什么好处，但危害也没那么大。

The fall change is perhaps less disruptive where we we gain that hour that doesn't appear to be very beneficial, but it's not quite as harmful.

而且除了过渡期之外，长期处于夏令时状态，就是连续几个月暴露在昼夜节律失调中。

And beyond just the transition periods, being in daylight saving time is a prolonged multi month exposure to a circadian misalignment.

支持这一观点最好的研究例子，有一篇非常有意思的论文，专门研究同一个时区东西两侧的差异。

And the the best example of research that that makes a strong case for this is there's a a really cool paper that studies just one side versus the other of a time zone.

基本上，就是比较时区西边缘和东边缘的人。

So basically, you're examining people who are at the Western edge of the time zone and the Eastern edge of the time zone.

证据表明，当我们处在时区中日照出现较晚的那一侧时，对健康的影响更差，包括癌症发病率更高，而处在日照出现较早的那一侧时，情况则相对较好。

And that evidence indicates that when we are in the edge of the time zone that gets daylight later in the day, that tends to be worse for our health, including higher rates of cancer than when we're at the edge of the time zone that gets daylight earlier in the day.

所以为了我们的健康，我们应该更希望天亮得早一些，而不是晚一些。

So we should, for our health's sake, we should prefer that daylight to be shifted early rather than late.

我自己的研究就是看工伤事故跟这个的关系。

My own research examines work injuries as an outcome of this.

有大量研究表明，如果我们实行永久标准时间，我们的健康状况和各方面结果通常会更好。

There's a large body of research to indicate that we are generally going to be healthier and have better outcomes when we have permanent standard time.

如果我们不改成夏令时，也不实行永久标准时间的话。

If we don't change to daylight saving time and we don't have permanent standard time.

不幸的是，我们一聊到这个话题，大家就会想到夏天的烧烤，想到他们希望夏天烧烤时是什么样的光照。

Unfortunately, when we discuss this topic, people think about their summer barbecues and what light patterns would they like for their summer barbecues.

我也喜欢夏天的烧烤。

I I like summer barbecues.

我理解。

I I get it.

但我觉得大家对于现行夏令时政策的弊端了解得还不够。

But I think people are not very well informed about the downsides of the the current daylight saving time policy.

有些人甚至说，干脆永久实行夏令时吧，这样我晚上就总能见到阳光了。

Some people even say, let's make permanent daylight saving time so that I can always have that sunlight in the evening.

那

Are

克里斯，除了个人层面，你还有没有其他关于在社层面改善睡眠质量的建议？

there other policy recommendations that you have, Chris, for improving sleep quality at a societal level, not just at the level of individuals?

有。

Yes.

所以夏令时应该是最容易改的一个。

So daylight saving time should be the easiest one to change.

另一个容易见效的方面是上学时间，这方面我们也看到了一些进展。

Another low hanging fruit that we're seeing some progress on is school start times.

我记得我上高中的时候，学校七点半就开始上课，这对青少年来说实在太早了。

So I remember when I was in high school, school started at 07:30, which is an unreasonably early time for a teenager.

这就像让一个成年人早上四点半开始上班一样。

That's if you can imagine for an adult starting their workday at like 04:30 in the morning.

这差不多就像青少年早上七点半上课的感觉。

That's kinda like what it's like to be a teenager who has school starting at 07:30 in the morning.

所以现在有一个挺大的运动，推动学校上课时间往后推迟，而且已经取得了一些进展。

So there's a pretty big movement that has had a fair amount of traction to push school start times later in the day.

所以我觉得那会是一个很大的胜利。

So I think that would be a major win.

还有一个实施起来会难一些，但同样可能很有效的办法，就是把我们在像交通运输和医学这些高风险行业中学到的睡眠调节经验应用起来。

One that would be a bit more difficult to implement but still could be quite powerful would be to apply some of the lessons learned in sleep regulation that we see in really dangerous industries like transportation and medicine.

比如飞行员、卡车司机和医生，他们的排班是有一些规定的。

So you see for pilots and truck drivers and physicians, there are some rules in how we set up their schedules.

规定包括在给定时间内最多能工作多少小时，以及如何快速地从一种班次轮换到另一种班次，比如从白班到夜班，或者从夜班到白班。

Rules for the maximum number of hours they can work in a given period, rules for how rapidly we can rotate them from one kind of shift to another kind of shift, like from day to night or night to day.

这些规定之所以存在，是因为如果不遵守这些规定，往往就会发生非常糟糕的事情。

These rules are there because if we don't follow those rules, then really bad things tend to happen.

人们会撞车。

People crash their cars.

他们会让飞机失事。

They crash their planes.

他们会犯医疗错误。

They make medical errors.

我们还有很多要学的，而且在这些危险行业里，我们还能改进那些规定。

We still have a lot to learn and we can improve those regulations in those dangerous industries.

但我觉得我们也可以把这些经验教训应用到这些行业之外。

But I think we could also take some of those lessons learned and apply them outside of those industries as well.

所以不是每个人都有那么危险的工作，犯个错就会死一堆人。

So not everyone has such a dangerous job that if they make a mistake, a bunch of people are gonna die.

但很多人仍然有重要的职责。

But a lot of people still have important jobs nevertheless.

如果他们犯了错，还是会引发一些问题。

And if they make mistakes, it's still gonna cause some sort of a problem.

所以我觉得我们可以把那些同样的理念应用到普通的日常工作中。

So I think we could apply some of those same ideas to regular everyday jobs.

而且我觉得我们可能会发现，公司比我们预期的更愿意接受这些做法。

And I think we might find that, companies are more open to this than we might expect.

我想知道，克里斯，你是否把这些想法用在了自己的生活中？

I'm wondering whether you applied any of these ideas to your own life, Chris.

当你睡不着的时候，你会怎么做？

When you have trouble sleeping, what do you do?

所以我会试着做一个自我检查。

So I will try to do a self check.

我现在感觉怎么样？

How do I feel right now?

这显然不完美，因为我们常常意识不到自己有多疲惫，但这仍然是一个有用的练习，能提供一些信息。

And this is obviously imperfect because we're often unaware of how impaired we are, but it's still a a useful exercise to engage in that's a little bit informative.

所以如果我感到困倦，不在最佳状态，不够警觉，那么我会做一些更简单的任务，比如回复一些邮件。

And so if I feel like I'm drowsy, I'm not at my best, I'm not most alert, then I will do a simpler task, maybe, answering some emails.

也许我会整理一下上课要用的幻灯片。

Maybe I'll tinker with some slides that I'm using for a class.

如果我觉得精力更充沛，我就会去做那些更棘手的事情，比如给博士生论文提反馈意见。

And if I feel more energized, that's when I'll do the more tricky things, like maybe giving a PhD student some feedback on their dissertation.

所以要做好那件事，我必须特别认真和专注。

So to do a good job in that, I had to be especially diligent and focused.

所以我可能会根据当时的感觉来调整这些任务的顺序。

And so I might, change the order of those tasks depending on how I feel in that moment.

四百多年前，莎士比亚把睡眠描述为大自然温柔的护士。

More than four hundred years ago, Shakespeare described sleep as nature's soft nurse.

我们早就知道，睡眠是治疗我们各种不适的良药，无论是心情低落还是感冒流鼻涕。

We've long known that sleep is a useful remedy for what ails us, whether we are in distress or sniffling our way through a bad cold.

睡眠也是应对另一个问题——剧烈身体疼痛——的重要工具。

Sleep is also an essential tool in confronting another problem intense physical pain.

我们最近收到了一位名叫大卫的听众关于这个话题的故事。

We recently received a story on this topic from a listener named David.

很多年前，他遭遇了一场严重的摩托车事故。

Many years ago, he was in a bad motorcycle crash.

他的左小腿不得不被截肢。

His lower left leg had to be amputated.

之后的几年里，他一直饱受幻肢痛的折磨，尽管那条腿已经不在他身上了。

For years after, he suffered from phantom pain in the limb that was no longer attached to his body.

我会突然感到一阵剧烈的刺痛，直接把我从睡梦中惊醒。

I would get this unbelievable sudden jolting pain that would hit me and just wake me from my sleep.

那真的难以置信。

It was really unbelievable.

大卫的身体需要睡眠来从车祸创伤中恢复，但疼痛却让他无法入睡。

David's body needed sleep to heal from the trauma of the crash, but the pain prevented him from getting that sleep.

这成了一个恶性循环。

It was a vicious cycle.

最终，在2019年，他接受了一项名为定向肌肉神经再支配的手术。

Finally, in 2019, he had a procedure called targeted muscle reinnervation.

这个手术就是找到那些向大脑发送幻肢痛信号的神经，把神经末端剪掉，然后重新连接到一条所谓的活跃神经上，就像完成一个电路回路，而不是让那些发送幻肢痛的神经就那么悬着，不知所措。

That's where they go in and they find the nerves that's sending the phantom limb pains to the brain, clips the end of it off, and reattach it to a, quote, active nerve, kind of completing the electrical circuit instead of the nerve that's sending the phantom limb pain just dangling there going, I don't know what I'm going to do.

我这是要往大脑发送疼痛信号。

I'm going to send pain signals to the brain.

这个手术并不是万能的，但以前那种把他惊醒的剧痛现在已经消失了。

The procedure hasn't been a cure all, but the jolting pain that used to wake him up is now gone.

取而代之的是大卫觉得有点烦人的感觉。

In its place is something David considers an annoyance.

就像手臂压麻了那种针刺感。

It's like the pins and needles sensation when your arm falls asleep.

不算真的疼，但挺烦人的，尤其是晚上躺床上安静下来的时候。

It's not really painful but it's annoying, you know, especially when I get quiet down at night when I lay in bed.

不过还能忍受。

But it's manageable.

大卫截肢后经历的疼痛，有力地提醒我们，疼痛不仅仅存在于身体里。

The pain that David experienced after his leg was amputated is a powerful reminder that pain is not just in our bodies.

疼痛，尤其是慢性疼痛，还和我们大脑里发生的事情有关。

Pain, especially chronic pain, is also about what's happening in our brains.

我们回来之后，心理学家瑞秋·佐夫尼斯将再次来到节目中，回答听众关于疼痛以及我们的大脑在管理疼痛中所起的作用的问题和故事。

When we come back, psychologist Rachel Zoffness returns to the show to respond to listener questions and stories about pain and the role that our minds play in managing it.

你正在收听《隐藏的大脑》。

You're listening to Hidden Brain.

我是尚卡尔·韦丹塔姆。

I'm Shankar Vedantam.

这里是《隐藏的大脑》。

This is Hidden Brain.

我是尚卡尔·韦丹塔姆。

I'm Shankar Vedantam.

如果你撞到了脚趾，或者不小心碰到了炉子上的热锅，你的疼痛会立刻变得强烈。

If you stub your toe or accidentally touch a hot pan on the stove, your pain will be immediate and intense.

我们都会经历这些急性疼痛的时刻。

We all experience these moments of acute pain.

但随着时间的推移，痛苦会逐渐消退。

But with time, the agony recedes.

慢性疼痛就不一样了。

Chronic pain is different.

它是那种日复一日压垮你的偏头痛。

It's the migraine that overtakes you day after day.

它是你臀部那种挥之不去的疼痛。

It's the ache in your hip that won't go away.

是每晚把你惊醒的胃痉挛。

The cramp in your gut that wakes you every night.

慢性疼痛会剥夺我们工作的能力、锻炼的冲动，甚至和朋友一起做有趣事情的欲望。

Chronic pain can rob us of the ability to work, the urge to exercise, even the desire to do fun things with friends.

我们最近和加州大学旧金山分校的心理学家瑞秋·佐夫尼斯聊了聊慢性疼痛以及如何应对它。

We talked recently about chronic pain and how to cope with it with Rachel Zoffness, a psychologist at the University of California San Francisco.

如果你错过了那一集，它的标题是《如何对抗疼痛》。

If you missed that episode, it was titled How to Combat Pain.

瑞秋是《告诉我哪里疼：疼痛的新科学及如何治愈》一书的作者。

Rachel is the author of Tell Me Where It Hurts, The New Science of Pain and How to Heal.

今天，她再次来到节目，回应听众关于她工作的提问和评论。

Today, she returns to the show to respond to listeners' questions and comments about her work.

瑞秋·佐夫尼斯，欢迎回到《隐藏的大脑》。

Rachel Zoffness, welcome back to Hidden Brain.

这是我最喜欢的播客之一。

One of my favorite ever podcasts.

能来这里我非常开心。

I'm so happy to be here.

瑞秋，在我们之前的讨论中，你提到将疼痛视为生物心理社会性质的。

Rachel, we talked in our earlier discussion about how you frame pain as being biopsychosocial in nature.

请解释一下这个术语。

Explain that term to me.

这是思考疼痛时最重要的词汇之一。

This is one of the most important words when we think about pain.

我们被灌输的最大误区之一就是，疼痛纯粹是生物医学问题，只与解剖学和生理学有关，需要纯粹的生物医学解决方案，通常就是吃药和手术。

One of the biggest myths we've been sold is that pain is a purely biomedical problem, something to do just with anatomy and physiology, that requires a purely biomedical solution, usually in the form of pills and procedures.

这个误区我们已经被灌输了几十年了。

That is the myth we have been sold for many, many decades.

但是六十五年的神经科学研究告诉我们，事实并非如此。

But sixty five years of neuroscience tells us that that isn't actually true.

疼痛是生物心理社会性的。

Pain is biopsychosocial.

想象一个维恩图，有三个重叠的圆圈，这些就是导致疼痛的因素。

So if you imagine a Venn diagram with three overlapping circles, These are the factors that contribute to pain.

一个圆圈里是导致疼痛的生物因素，另一个是心理因素，还有一个是社会因素。

We have the biological factors that contribute to pain in one of the circles, psychological factors that contribute to pain, and sociological factors that contribute to pain.

而疼痛就存在于这三个健康领域的交汇处。

And pain lives in the middle of these three domains of health.

简单来说，在疼痛的生物领域，有你的听众们最常听到的那些因素。

And to briefly say, in the biological domain of pain, we have the things that your listeners will have heard the most about.

包括遗传、组织损伤、系统功能失调、炎症、饮食、运动和睡眠。

We have genetics, tissue damage, system dysfunction, inflammation, diet, exercise, and sleep.

这些对于疼痛来说非常重要。

Those are very, very important when it comes to pain.

但我想让大家注意的是，如果我们只关注疼痛的生理层面，那我们就忽略了疼痛问题的三分之二。

But what I want us all to notice is that if we're only focusing on the bio domain of pain, we are missing two thirds of the pain problem.

我想分享一个故事，讲的是环境和心理因素如何影响我们对疼痛的感受。

I'd like to share a story that gets at how environmental and psychological factors can affect our experience of pain.

这个故事来自一位名叫布鲁斯的听众。

This story comes from a listener named Bruce.

我患有慢性背痛超过二十五年，我妻子有慢性偏头痛，我们最终离婚了。

I had chronic back pain for over twenty five years and my wife had chronic migraines and we eventually got divorced.

几年后，我们碰巧同时参加一个毕业典礼，她看到我坐在椅子上，就问：你怎么不往后靠？

A couple of years later, we happened to be together at the same time at a graduation ceremony, and she saw me sitting in a chair and she said, How come you're not leaning back?

我说：我为什么要往后靠？

And I said, Why would I lean back?

她说：你总是背痛，那是你唯一能缓解的方式。

And she said, Well, you always have back pain and that's the only way you can get out of it.

我说，我已经差不多一年半没有背痛了。

I said, I haven't had any back pain for like a year and a half.

她看着我，我问她，你的偏头痛怎么样了？

She looked at me and I said, How are your migraines?

她说，嗯，我也差不多一年半没犯偏头痛了。

And she said, Well, haven't had migraine for like also about a year and a half.

我们这才意识到，离婚已经两年了，我们所有的慢性问题都消失了。

And we realized we had been divorced for two years and all of our chronic issues had gone away.

布鲁斯的故事让你惊讶吗，瑞秋？

Does Bruce's story surprise you, Rachel?

不。

No.

我并不特别惊讶。

It doesn't particularly surprise me.

不是每个人都会这样经历疼痛，但这确实很好地说明了社会因素——也就是我们疼痛三大领域之一——在很多方面对疼痛体验至关重要。

That's not how pain works for everyone, but it certainly shows us very well that social factors, which is one of our three domains of pain, are fundamentally important to the pain experience in so many different ways.

我最早开始研究疼痛神经科学是在布朗大学读本科的时候。

So I first started studying pain neuroscience when I was an undergrad at Brown University.

当时我被安排跟一位疼痛神经科学家合作，写了关于疼痛的荣誉论文。

I was paired with a pain neuroscientist and wrote my honors thesis on pain.

我记得我当时想，我当然直觉上理解疼痛是生理性的。

And I I remember thinking, you know, I understand intuitively, of course, that pain is biological.

我甚至也理解疼痛有情感方面的成分，但我当时无法理解疼痛的社会层面。

And and I even understand that pain has emotional aspects to it, but I couldn't understand the social domain of pain.

所以当我写《告诉我哪里疼》这本书的时候，我真的深入研究了相关的研究。

So when I was writing tell me where it hurts, I really went down the rabbit hole to explore the research.

我发现了大量支持这一点的科学证据。

And I found so much science behind this.

研究考察了社会关系改变我们身体和疼痛的各种不同方式。

So research has examined all these different ways that social relationships change our bodies and change our pain.

研究人员考察的一个方面是健康关系与有毒关系对我们身体和身体健康的影响。

So one thing that researchers have examined is the impact of healthy relationships versus toxic relationships on our bodies and on our physical health.

我想稍微定义一下这些术语。

And I wanna define define those terms a little bit.

我说的健康关系，是指那种互相支持、互相尊重、充满爱意、压力小的关系，一般来说，两个人会互相鼓励、共同进步。

When I say a healthy relationship, I mean a relationship that is supportive and respectful and and loving, low stress, you know, two people, generally speaking, lift each other up.

科学上有个词专门形容这种关系。

And there's a word for this in science.

叫做亲社会关系。

Those are called prosocial relationships.

而有害关系通常是那种冲突多、压力大的关系。

And toxic relationships are relationships that are typically high conflict, high stress.

这类关系往往伴随着煤气灯效应、疏远，以及大量的冲突。

They're characterized by things like gaslighting or estrangement, a lot of conflict.

这两种关系对人体的神经生物学影响是完全不同的。

And each has a different neurobiological impact on the human body.

事实证明，健康关系能带来以下这些好处。

Healthy relationships, it turns out, do some of the following things.

它们会提升我们的血清素，血清素当然是一种与情绪有关的神经化学物质。

They boost our serotonin, which, of course, is a neurochemical involved in mood.

它们会提高我们的多巴胺水平，多巴胺是一种奖励化学物质。

It bumps our dopamine, which is a reward chemical.

它们还会增加大脑中的内啡肽水平。

It also increases brain levels of endorphins.

内啡肽是我们体内自产的天然鸦片。

Endorphins are our endogenous homemade opioids.

健康的关系还能改善我们的情绪。

Healthy relationships also lift our mood.

它们能缓解肌肉紧张。

They reduce muscle tension.

它们能增强我们的免疫系统功能。

They bump our immune functioning.

总的来说，健康积极的关系会降低大脑中的疼痛感。

And overall, healthy positive relationships turn pain volume down in the brain.

反过来也是一样的。

The opposite is also true.

事实证明，有毒的关系——同样以煤气灯操纵、疏远、冲突和压力为特征——会产生以下影响。

It turns out that toxic relationships, which again are characterized by things like gaslighting, estrangement, conflict, and stress, do the following.

它们会引发身体的炎症反应。

They trigger an inflammatory response in the body.

它们会引发持续的压力反应。

They trigger a sustained stress response.

所以时间一长，你的身体可能会一直处于战斗或逃跑的状态。

So over time, your body can be stuck in fight or flight.

它们会增加肌肉的紧张程度。

They increase muscle tension.

我们都知道，肌肉越紧张，疼痛感就越强。

We all know that the more tense our muscles are, the worse pain feels.

它们会降低大脑中阿片类物质的水平。

They reduce levels, brain levels of opioids.

它可能引发免疫抑制。

It can trigger immunosuppression.

总的来说，有毒的关系会让大脑中的疼痛感增强。

And overall, all told, toxic relationships turn pain volume up in the brain.

所以社交健康总是与我们的身体健康紧密相连。

So social health is intimately connected to our physical health always.

当然，这也会影响我们的疼痛感受。

And, of course, that affects our pain.

所以，这个故事真是让人大开眼界，还有点好笑。

So so this story was mind blowing and a little bit funny.

不知道听众们是不是在暗自偷笑。

I wonder if listeners are are chuckling to themselves.

我反正是笑了。

I certainly did.

不过，总的来说，这并不让人意外。

But but, no, overall, it isn't that surprising.

我们在《隐藏的大脑》节目里聊过心态这个概念，以及它如何深刻影响我们的身心健康。

We've talked on Hidden Brain about the idea of mindsets and how they can profoundly shape our physical and mental health.

我们收到了听众唐娜发来的消息。

We received this message from listener Donna.

她提到了一种心态，这种心态常常会影响我们对待包括疼痛在内的许多医疗问题的方式。

She had a comment about a particular mindset that can often seep into how we treat many medical conditions, including pain.

多年来我一直饱受间质性膀胱炎的折磨，这是一种膀胱疼痛综合征，目前还没有已知的病因或治愈方法。

I've been struggling for years with interstitial cystitis, which is painful bladder syndrome, and there's really no known cause for it or cure for it.

有数百万人……

And millions of...

尤其是女性深受其害。

Especially women suffer from it.

过去几年，我一直在与它抗争，经历了人生中最严重的几次发作之一。

For the last couple years, I've been really struggling with it in one of the worst flares of my life.

我试过所有方法，但都无济于事，甚至到了那种地步——如果只能忍受持续的疼痛，活得小心翼翼，不敢吃任何东西，不敢做任何可能带来压力的事情，因为那也会引发疼痛，基本上生活在持续的恐惧中，那我都不想活了。

And I've gotten to places even after trying everything, it wasn't helping at all, where I felt like I didn't wanna live if I needed to be just enduring constant pain, living extremely defensively around, like, of being afraid to eat anything, being afraid to do anything that could cause me stress because that would flare my pain too, and just basically living in constant fear.

我觉得真正触动我的是，疼痛其实是一种感知到的危险造成的。

And I think it really hit me when there's this idea that it's a perceived danger that was causing the pain.

我之前一直在跟自己的身体作斗争，简直就像打仗一样。

Here I'd been going to war to try, like, basically war against my body.

我觉得自己好像坏了。

I felt like I was broken.

我觉得我的身体背叛了我。

I felt like my body had betrayed me.

我越是努力去对抗它，感觉就越糟糕。

And the more I was doing to try to combat that, the worse I was feeling.

但当我意识到，其实只是我的大脑在害怕，我需要安抚自己时，说实话，这种心态的转变，让我从痛苦中走了出来。我之前已经痛苦了一年半。

And instead when I realized that basically my brain was just afraid and that I needed to soothe myself and honestly, that shift in mentality, I'd been in pain for a year and a half.

几个月之内，我现在又恢复正常生活了。

And within a few months, I I now am living normally again.

偶尔会有发作的日子，但大多数时候，我想吃什么就吃什么。

I have the occasional flare day, but for the most part, I can eat what I want.

我可以做我想做的事，而且我相信我没事。

I can do what I want, and I believe that I am okay.

唐娜的话里，我们反复听到一个词，瑞秋，那就是“害怕”。

There's a word we hear over and over again in Donna's message, Rachel, and that word is afraid.

说说疼痛和恐惧之间的反馈循环吧。

Talk about the feedback loop between pain and fear.

天哪，唐娜的故事真的让我感触很深。

Oh gosh, that story, Donna's story, just hit me so hard.

疼痛和恐惧之间确实存在一个非常糟糕的恶性循环。

There is a notorious and terrible feedback loop between pain and fear.

疼痛会引发恐惧。

Pain triggers fear.

恐惧会放大疼痛。

Fear amplifies pain.

疼痛越强烈，我们就越害怕。

The higher pain volume goes, the more afraid we become.

这其实是适应性的，因为疼痛是我们身体的危险检测系统。

And that actually is adaptive because pain is our body's danger detection system.

它是我们的预警系统。

It's our warning system.

它的存在是为了保护我们。

And it exists to keep us safe.

所以，如果你跑步时扭伤了脚踝，你的身体会发出危险信号，告诉你：别跑了。

So, you know, if you break your ankle while you're on a run, your body will give you danger messages and tell you, stop running.

你需要确保自己的身体没有问题。

You need to make sure that nothing is wrong with your body.

你应该休息。

You should rest.

你应该寻求帮助。

You should seek help.

你应该冰敷。

You should ice.

你不应该带着那只受伤的脚踝跑步。

You shouldn't run on that broken ankle.

如果你跑了，会对身体造成严重伤害。

If you do, you will do grievous harm to your body.

这是适应性的，也很重要。

That is adaptive and important.

恐惧确实会让我们停下脚步，迫使我们集中注意力。

And and fear is something that actually stops us in our tracks, and it forces us to pay attention.

问题在于慢性疼痛，我们知道慢性疼痛的科学与急性疼痛非常不同。

The problem is that with chronic pain, we know that the science of chronic pain is very different than acute pain.

所以我们确实知道恐惧如何放大疼痛的细节，我觉得这非常吸引人。

And so we actually know the details of how fear amplifies pain, which I think is so fascinating.

恐惧属于压力家族的一部分。

Fear is part of the stress family.

所以担忧、焦虑、恐惧，甚至灾难化思维，所有这些都被认为会改变我们的生理机能，放大大脑中的疼痛信号。

So worry, anxiety, fear, even catastrophizing, all of those things are known to change our physiology to amplify pain volume in the brain.

恐惧会激活我们的中枢神经系统。

Fear activates our central nervous system.

它会加快心率，增加肌肉紧张。

It increases our heart rate and our muscle tension.

它会激活免疫系统，还会激活杏仁核，就是我们刚才提到的那个大脑区域，它不仅负责情绪，还负责疼痛。

It activates our immune system, and it activates our amygdala, the part of the brain we just talked about that is responsible not just for emotions, but also for pain.

如果杏仁核处于威胁状态，疼痛的强度就会上升。

And if our amygdala is in a state of threat, pain volume will go up.

所以，我们真的需要留意是什么在引发恐惧，以及我们能做些什么来减少对疼痛的恐惧。

So it's really important for us to notice what are the things that are activating the fear, and what can we do to reduce our fear of pain.

我很喜欢唐娜的故事，她说，这对我来说就像天籁之音，当她了解更多关于疼痛的知识，更好地理解自己的疼痛时，疼痛的强度就开始下降了。

And what I loved about Donna's story was that she said, it's like music to my ears, that when she learned more about pain and when she understood her pain better, pain volume started going down.

她注意到了理解疼痛、理解这些信号的含义以及它们不代表什么，与疼痛强度高低之间的关系。

So she noticed this relationship between understanding pain better and what the messages mean and what they don't mean, and how high or low her pain volume got.

她读得越多，学得越多，感觉就越好。

And the more she read about pain and the more she learned about pain, the better she started to feel.

这正是我们想要的。

And that's exactly what we want.

我们回来之后，要聊聊有没有所谓的假疼痛这回事。

When we come back, is there such a thing as fake pain?

您正在收听《隐藏的大脑》。

You're listening to Hidden Brain.

我是山卡尔·维丹塔姆。

I am Shankar Vedantam.

这里是《隐藏的大脑》。

This is Hidden Brain.

我是山卡尔·维丹塔姆。

I'm Shankar Vedantam.

当你感到疼痛，去找医生帮忙时，没有什么比“这都是你脑子里想出来的”更让人沮丧的话了。

When you're in pain and looking to a doctor for help, there can be few words more frustrating than it's all in your head.

当有人这么说的时候，感觉就像是在说你的疼痛不是真的。

When someone says this, it feels like they are saying your pain isn't real.

你没有骨折，也没有肌腱撕裂，所以你的疼痛不应该存在。

You don't have a broken bone or a torn tendon, so your pain shouldn't exist.

但正如我们和心理医生瑞秋·佐夫内斯讨论过的，疼痛不仅仅是生物学的问题。

But as we have discussed with psychologist Rachel Zoffness, pain isn't just about biology.

它还根植于我们的情绪、日常生活环境以及我们所处的社会之中。

It's also rooted in our emotions, in the circumstances of our daily lives, and the societies in which we live.

瑞秋，研究人员早就注意到，女性的疼痛常常被低估，也得不到充分治疗。

Rachel, researchers have long observed that pain is underdiagnosed and undertreated in women.

我想给你播放一段听众菲伊的留言。

I'd like to play for you a message that we received from a listener named Faye.

五年前，我的右腿遭受了严重的三度烫伤。

Five years ago, I suffered a severe third degree scald on my right thigh.

对于三度烫伤，我本应得到止痛药。

For a third degree scald, I should have been given painkillers.

当我要求止痛时，医生却打发我说：你是女人，能承受分娩的痛苦。

When I asked for pain relief, the doctor dismissed me: You are a woman, you can handle childbirth.

而且骨痛的疼痛程度仅次于分娩之痛，所以就不给你止痛药了。

And bone pain is second to the pain of childbirth, So no pain killers for you.

那简直一团糟，护理水平差得令人震惊。

It was a mess and the care was shockingly unprofessional.

你能承受分娩之痛，所以就不给你止痛药了。

You can handle childbirth, so no pain killers for you.

瑞秋，从我们开始看到关于男性和女性之间以及不同种族背景人群之间疼痛治疗差异的学术研究，已经过去几十年了。

Rachel, it's been decades since we started to see academic studies about disparities in pain treatment between men and women and between people from different racial backgrounds.

黑人和拉丁裔患者被处方止痛药的比例通常低于白人患者。

Black and Latino patients are often prescribed pain medicines at lower rates than white patients.

医学界是如何解决这个问题的呢？

How is this problem being addressed by the medical community?

天哪。

Oh, god.

这真是一团糟。

It's a mess.

我们在医学领域仍然看到这些巨大的差异，无论是对有色人种还是对女性。

We continue to see these great discrepancies in medicine, both for people of color and also for women.

在文化上，男性被鼓励要坚强，要忍耐。

You know, culturally, men are encouraged to be tough and to be stoic.

想想围绕这件事的语言，你会被告知要像个男人一样，硬扛过去。

You know, if you think about even the language around it, you're told to man up and take it like a man.

但我其实想谦逊地提出，而且研究也支持这一点，女性的情况要糟糕得多。

But I actually humbly submit and research supports this that women have it much worse.

就像你一开始提到的，女性常常被忽视、被边缘化，被告知疼痛是她们自己想象出来的。

As you mentioned in the beginning, women are often dismissed and marginalized and told that pain is all in their head.

而且医学界长期以来一直存在厌女症。

And there is a long history of misogyny in medicine.

我们听到心脏病，会认为它主要影响男性。

You know, we hear about heart disease, and you think it applies primarily to men.

心脏病是女性的头号杀手，部分原因是，女性因心脏问题去急诊室时，被告知那只是情绪问题，只是压力或焦虑，然后就被打发回家了。

Heart disease is the leading killer of women in part because women who go to the emergency room with heart issues are told that it's just emotional, it's just stress or anxiety, and they are sent home.

所以我觉得现在大家对这个问题有了更多的认识，我……

So what I'm seeing is there is more awareness of this, and I'm...

这让我很高兴，但我不确定这种认识是否真正落实到了治疗和诊断上。

That makes me happy, but I'm not sure it's playing out into to treatment and diagnosis the way that it should.

大约二十年前，一位《隐藏的大脑》的听众，名叫杰西，正在人行道上走着。

So about twenty years ago, a Hidden Brain listener named Jessie was walking down the sidewalk.

她滑倒了，胫骨和腓骨断了五处。

She slipped and broke her tibia and fibula in five places.

下面就是她的讲述。

Here she is.

他们在我腿里植入了一根金属杆，脚踝和膝盖处都有钉子。

They inserted a metal rod into my leg, and there are nails at the ankle and at the knee.

等医学上算痊愈了，我却发现这条腿还是持续疼痛，慢性疼痛，拖了好多年。

And once I was technically healed, I found that I was continuing to experience pain in this leg kind of chronically over for years.

到现在还在疼。

It still continues.

第一次去检查的时候，我回到了给我做手术的那位外科医生那里，他们做了X光，看了看里面的金属装置。

And the first time I went to have it checked out, I went back to the surgeon who performed the surgery and they did an x-ray and they looked at the hardware.

然后他跟我说，看，这已经完全愈合了。

And he said to me, Look, it's perfectly healed.

而且有很多人做完这种手术后还能去跑马拉松。

And there are people who have had this surgery that go on to run marathons.

你一点问题都没有。

There is nothing wrong with you.

我当时就觉得，那这是我的问题。

And I took that to mean that this is my problem.

是我自己的错，才会有这种感觉。

It's my fault that I'm feeling this pain.

这让我对疼痛感到非常绝望。

And that, you know, has led to feelings of hopelessness around this pain.

所以再次感谢你。

So again, thank you.

我真的很感激你的节目。

I really appreciate your program.

Rachel，谈谈真实疼痛和虚假疼痛的概念，以及为什么这在当今医学界仍然如此根深蒂固。

Rachel, talk about the idea of real and fake pain and why this continues to be so persistent in medicine today.

我想把这件事说得很清楚。

I want to say this really clearly.

根本不存在所谓的虚假疼痛。

There is no such thing as fake pain.

疼痛从来都不只是我们头脑中的想象。

Pain is never all in our heads.

疼痛永远是真实的。

Pain is always real.

所以Jesse，你的疼痛是真实的。

So Jesse, your pain is real.

所有的疼痛都是真实的。

All pain is real.

所有的疼痛都是生物心理社会性的。

All pain is biopsychosocial.

当我听到这样的故事，当患者来到我的办公室，我真正听到的是，我们的医疗保健提供者没有被告知关于疼痛的真实情况。

And when I hear stories like this, when patients come to my office, what I really hear is that our health care providers aren't being told the true story about pain.

然后他们把这种缺乏信息和教育的情况传递给患者。

And then they're passing on to patients this lack of information and education.

顺便说一句，这不是我们医生的错。

And it's not our doctor's fault, by the way.

医生进入医学领域是为了帮助和治愈。

Like doctors go into medicine to help and to heal.

但我们知道，医生没有得到他们想要或应得的疼痛教育，所以他们正在精疲力尽。

But we we know that doctors aren't getting the pain education they want or deserve, and so they're burning out.

你从杰西的故事中听到的是，她被告诉她的疼痛纯粹是生物医学性质的。

And what you heard from Jesse's story is that she was told that her pain is purely biomedical in nature.

她的疼痛肯定只与解剖学和生理学有关，医生在扫描中没有看到任何异常。

Her pain must be just to do with anatomy and physiology, and the doctor didn't see anything wrong on the scan.

所以，杰西不应该感到疼痛。

Therefore, Jesse should have no pain.

疼痛是一种生物心理社会现象。

Pain is a biopsychosocial phenomenon.

我在《告诉我哪里疼》里以及平时喜欢这样讲：我们总是有一个疼痛配方。

And the way I like to talk about this in Tell Me Where It Hurts and just in general is that we always have a pain recipe.

总有一个由各种成分组成的配方，共同造就了疼痛体验。

There's always a recipe of ingredients that create the pain experience.

这个配方里有生物因素。

There's biological factors in that recipe.

还有社会和社会学方面的成分。

There's social and sociological ingredients.

也有心理成分，比如情绪，因为我们的杏仁核总是参与疼痛体验。

And there's also psychological ingredients like emotions because our amygdala is always involved in the pain experience.

所以杰西所经历和谈论的，正是疼痛的真实面貌与我们所被告知的疼痛之间的这种落差。

And so what Jesse is experiencing and talking about is this discrepancy between what pain is and what we're told pain is.

那种绝望感是真实的，但改变疼痛配方的方法有很多。

And the hopelessness is real, but there are so many ways to change the pain recipe.

所以疼痛显然是身体发出的一个重要信号。

So pain is obviously an important signal from the body.

就像你说的，它是身体的警告信号。

As you said, it's the body's warning signal.

但我们收到了一位名叫扎拉的听众的有趣来信。

But we received an interesting note from a listener named Zara.

她知道自己的身体有些不对劲，但并没有感到特别疼痛。

She knew something was going on with her body, but was not in major pain.

后来，一次常规的血液检查显示结果异常。

Then a routine blood workup showed abnormal results.

她最终被诊断出一种叫做子宫内膜异位症的疾病。

She was eventually diagnosed with a condition called endometriosis.

然而，医生们因为她没有严重疼痛而忽视了她。

Still, doctors dismissed her because she wasn't in severe pain.

我还得费劲才能争取到一次MRI。

And I had to fight just to get an MRI.

结果一扫描，发现又长回来了不少。

And when I did, it showed extensive regrowth.

最后我又做了一次手术，左卵巢没了。

And I ended up having another surgery and losing my left ovary.

现在手术过去六个月了。

So now I am six months post op.

排卵的时候我还是能感觉到左卵巢，虽然它已经不在了。

I still feel my left ovary when I ovulate, even though it's not there anymore.

我觉得这是幻肢痛，我的大脑还保留着那个已经不存在的器官的图谱。

I think it's phantom pain and my brain still has a map of something that no longer exists.

所以你们那期节目真的让我思考，疼痛和没有疼痛，是不是常常让我们误解了自己身体里发生的事。

So your episode really made me wonder about how often pain and the absence of pain leads us to misunderstand what's happening in our own bodies.

这么多年来，我的身体一直在给我信号，只是这些信号不是医学专家预期我会感受到或相信的那种。

My body was telling me something for years, even though it wasn't what medical experts expected me to feel or believe.

你觉得呢，瑞秋？

What do you think, Rachel?

扎拉分享的例子真是太棒了。

What a beautiful example from Zara.

在我们上次的对话中，我们讨论了疼痛和损伤之间的区别，或者说伤害和损害之间的不同。

In our last conversation together, we talked about the difference between pain and damage or the difference between hurt and harm.

我喜欢把这两组词放在一起，提醒大家疼痛或伤害和损伤或损害并不是一回事。

And I like putting those words together to remind everyone that hurt or pain and damage or harm are not the same thing.

在医学文献、研究以及临床研究中，有很多这样的例子，就像扎拉给我们的那个例子一样。

There are a lot of examples of this throughout the medical literature, throughout the research, and of course, in clinical studies, like the example that Zara gave us.

我能给你讲一个能说明这个道理的故事吗？

And can I tell you a story that exemplifies this?

大约三十年前，在牙买加有一个小男孩。

So about thirty years ago, there was a little boy growing up in Jamaica.

他跑得特别快，而且非常喜欢跑步。

And he was really fast, and he loved to run.

他的梦想是有朝一日能参加奥运会。

And it was his dream to one day be in the Olympics.

但随着他长大，他的脊柱发生了一些奇怪的变化。

But as he grew, something strange was happening to his spine.

脊柱开始弯成S形。

It started twisting into an s shape.

随着年龄增长，脊柱弯曲得越来越厉害，但这并没有阻止他。

And the older he got, the more his spine twisted and twisted, but it didn't stop him.

他几乎没有感到疼痛。

He had very little pain.

他继续跑步。

He kept running.

他最终被诊断出一种非常真实的疾病，叫做脊柱侧弯，当然就是脊柱弯成S形的那种情况。

He was eventually diagnosed with a very real condition called scoliosis, which of course is when your spine twists into an s shape.

这并没有阻止他。

It didn't stop him.

他继续训练，直到参加奥运会。

He continued to train until he Olympics.

等他真正站上奥运赛场时，脊柱已经严重受损，身体也严重不对称，右腿比左腿短了半英寸。

And by the time he made it to the Olympics, his spine was so damaged and so abnormal, and his body was so asymmetrical that his right leg was half an inch shorter than his left.

这并没有阻止他。

It did not stop him.

他参加了奥运会。

He competed in the Olympics.

这个人不仅赢得了一枚金牌，而是八枚。

This man won not one gold medal, but eight.

你想猜猜这位先生的名字吗？

Do you wanna guess the name of this gentleman?

不会是尤塞恩·博尔特吧？

It can't be Usain Bolt, can it?

哦，我的朋友。

Oh, my friend.

那个人就是尤塞恩·博尔特。

That man is Usain Bolt.

他是世界上跑得最快的人。

He is the fastest man alive.

那为什么这个故事这么重要呢？

Now why is this story so important?

如果扫描发现的损伤和异常就是疼痛的原因，那尤塞恩·博尔特应该已经残疾，只能躺在医院的床上了。

If damage and the abnormalities found on scans were the cause of pain, Usain Bolt should be disabled and relegated to a hospital bed.

他应该不可能比闪电还快。

He should not be faster than a bolt of lightning.

这很好地提醒了我们，受伤和疼痛、损伤和痛苦并不是一回事。

And this is a good reminder that hurt and harm, pain and damage are not the same thing.

这是……

That's part of...

这是我们都被灌输和欺骗的一个谎言。

That's one of the lies we have all been told and sold.

而且，只要你相信身体的损伤是疼痛的唯一原因，你就会一次又一次地手术，没完没了。

And as long as you believe that the damage to your body is the sole cause of pain, you will continue to have surgery after surgery after surgery.

你会永远依赖止痛药。

You will forever take pain medications.

顺便说一句，手术和药物有时确实能救命。

And by the way, surgeries and medications can be lifesaving.

这没什么可羞愧的，但它们并不是慢性疼痛的唯一解决办法，而且研究表明它们也不是最好的办法。

No shame in this game, but they are not the only solution for chronic pain, and research says they aren't the best solution.

顺便说一句，正如Zara提到的，这一点也适用于子宫内膜异位症，这是一种非常真实且重要的女性慢性疼痛疾病。

And this is also true, by the way, as Zara noted, for endometriosis, which is a very real and important women's chronic pain disease.

但关于子宫内膜异位症，如果你看看研究，就会发现子宫内膜过度生长、组织过度生长，与女性疼痛的程度无关。

But what we know about endometriosis, if you look at the research, you will see that endometrial overgrowth, tissue overgrowth, is unrelated to how much pain a woman has.

有些女性过度生长很严重，却一点不疼。

Some women have significant overgrowth and no pain.

而另一些女性生长很少，却疼得要命。

Others have very little growth and a ton of pain.

所以这里的要点是，疼痛不仅仅是组织损伤。

So the takeaway here is that pain is more than just tissue damage.

疼痛总是比这更大、更广、更深。

Pain is always bigger and wider and deeper than just that.

所以，瑞秋，听了这几个听众的故事，我感觉到治疗疼痛真的非常棘手。

So it strikes me in listening to several of these listener stories, Rachel, that treating pain is just really tricky.

在某些情况下，针对特定生物标志物的干预措施是有效的。

In some cases, interventions focused on specific biological markers work.

在其他情况下，它们却不起作用。

In others, they don't work.

有时候，倾听疼痛是有帮助的。

Sometimes it's helpful to listen to pain.

而其他时候，比如幻肢综合征，疼痛在某种程度上是在误导我们。

Other times, like with phantom limb syndrome, the pain in some ways is misleading us.

所以，我对那些正在忍受慢性疼痛的人，以及试图治疗它的医生们，都深表同情。

So I have a lot of compassion for people who are dealing with chronic pain, but also for providers trying to treat it.

疼痛治疗不足会带来非常严重的伤害，但正如我们在阿片类药物危机中看到的，过度用药也会带来严重的伤害。

There are very serious harms that come from under treating pain, but as we've all seen with the opioid epidemic, there are also serious harms that can come from over medicating pain.

这个领域真的不容易，对吧？

This whole field is just not easy, is it?

哦，你说得对。

Oh, you got it.

慢性疼痛极其复杂，这又回到了那个问题：医疗服务提供者想理解疼痛，但我们并没有得到足够或充分的疼痛教育。

Chronic pain is extremely complex, and this goes back to that thing where health care providers want to understand pain, but we aren't getting sufficient or adequate pain education.

这导致了一个连锁反应：因为我们的医疗服务提供者被灌输了一个错误观念，认为疼痛纯粹是生物医学现象，所以生活在疼痛中的人也就不理解疼痛。

And what that leads to is this trickle down effect where people living with pain then don't understand pain because our health care providers, you know, are sold this myth that pain is a purely biomedical phenomenon.

真正具有挑战性，坦白说也很吓人的是，当我们谈到所谓的“疼痛患者”时，我们说的其实是每一个人。

And what's really challenging and and frightening, frankly, about that is that when I think about, quote, unquote, pain patients, we are talking about every single one of us.

你说，有哪个人能逃过疼痛的经历呢？

Like, tell me a human being that's going to escape the experience of pain.

疼痛无处不在，总有一天会找上我们每个人，如果还没找上的话——无论是分娩、疾病，还是衰老的身体。

Pain is ubiquitous, and it is coming for all of us one day if it hasn't already, whether it's, you know, childbirth or an illness or inhabiting an aging body.

所以，对我们所有人来说，理解疼痛的科学再重要不过了。

So it couldn't be more important for all of us to understand the science of pain.

休息一下，回来之后，我们会继续聊应对慢性疼痛的方法。

When we come back, more ideas about coping with chronic aches.

您正在收听的是《隐藏的大脑》。

You're listening to Hidden Brain.

我是尚卡尔·维丹塔姆。

I'm Shankar Vedantam.

这里是《隐藏的大脑》。

This is Hidden Brain.

我是尚卡尔·维丹塔姆。

I'm Shankar Vedantam.

瑞秋·佐夫尼斯是加州大学旧金山分校医学院的心理学家。

Rachel Zoffness is a psychologist at the University of California San Francisco School of Medicine.

她是《告诉我哪里疼：疼痛的新科学及如何治愈》一书的作者。

She is the author of Tell Me Where It Hurts, The New Science of Pain and How to Heal.

瑞秋，很多经历慢性疼痛的人，很自然地会限制身体疼痛部位的活动。

Rachel, many people who experience chronic pain respond understandably by limiting movement in the part of the body that hurts.

你说过，治疗疼痛的一个重要方面，是开始温和但持续地活动身体。

You say that an important aspect of pain treatment is to begin to move the body again gently but consistently.

这为什么会有帮助呢？

Why would this help?

从慢性疼痛中恢复，最基本、最重要的工具之一，叫做“节奏控制”。

One of the most important fundamental tools for recovering from chronic pain is a tool called pacing.

疼痛的节奏控制，就像马拉松的节奏控制一样。

And pacing for pain is much like pacing for a marathon.

所以尚卡尔，如果你对我说，瑞秋，我真的想跑马拉松。

So Shankar, if you said to me, you know, Rachel, I really wanna run a marathon.

我会说，那很棒，尚卡尔。

I would say, that's cool, Shankar.

我可不想跑。

I don't want to.

但如果你真的想跑马拉松，我不建议你明天就跑26英里。

But if you if you want to, I don't recommend that you start by running 26 miles tomorrow.

你也不会这么做。

And you would not do that.

如果你想跑马拉松，你会给自己设定节奏。

If you wanted to run a marathon, you would pace yourself.

这意味着你会从走路开始，然后加入一些慢跑，再加入一些跑步。

And what that means is you would start by walking, and you would mix in some jogging, and you would mix in some running.

最终，随着时间的推移，你的大脑和身体会适应和调整，你会变得更强壮。

And eventually, over time, your brain and your body would adapt and adjust and you would get stronger.

最终，你将能够跑完26英里。

And eventually, you would be able to run 26 miles.

所以当我们为疼痛设定节奏时，我们实际上是在夺回我们的力量，因为慢性疼痛是个小偷。

So when we pace for pain, what we're actually doing is taking our power back because chronic pain is a thief.

它偷走了我们工作、锻炼、打球、和小孩或孙子在地上打闹，甚至和伴侣亲密的能力。

It steals from us our ability to work and to exercise and to play sports and, you know, to roll around with our young kids on the floor or our grandkids and even to have sex with our partners.

而疼痛管理中的节奏法就是这样一种策略，我们会选择一个你曾经热爱但被疼痛夺走的爱好或活动。

And and pacing for pain is one of these strategies where we pick a beloved hobby or activity that pain has taken from us.

这也是我常问病人的第一个问题：告诉我一个你曾经喜欢但被疼痛夺走的活动。

And that's one of the first questions I ask my patients is, you know, tell me an activity that you used to love that pain has taken from you.

你们的一些听众在提问中也提到了这些活动。

And some of your listeners in their questions have even talked about some of these activities.

比如，对有些病人来说，那是足球。

So for some of my patients, that's soccer.

对另一个人来说，是爱尔兰舞蹈。

For another, it was Irish dance.

还有一个人，是做软糖。

And for another, it was fudge making.

你明白吗？

You know?

所以，我们会挑一个我们怀念的、曾经热爱的活动，然后制定一个节奏方案，这在《告诉我哪里疼》的第三部分有详细说明，任何人都可以做到。

And and so we we pick one of the activities that we miss, that we used to love, and we put together a pacing protocol, which is in part three of tell me where it hurts so anyone can do this.