如何缓解疼痛

这是《隐性思维》。

This is Hidden Brain.

我是 Shankar Vedanta。

I am Shankar Vedanta.

这一切就在一瞬间发生。

It happens in an instant.

你动作太快，突然觉得后背一抽。

You move too fast and you feel a wrench in your back.

那阵剧痛之后，接着是持续的酸痛，疼得你不得不去看医生。

That first sharp pain is followed by a persistent ache, bothersome enough to send you to the doctor.

检查发现出了问题。

A scan reveals a problem.

专家建议你做手术。

A specialist recommends surgery.

你决定动手术，相信只要修好受损的组织，疼痛就会消失。

You go under the knife trusting that once the damaged tissue is repaired, the pain will disappear.

这个说法听起来很合情理。

The story makes intuitive sense.

找出问题所在，修好出问题的骨头、韧带或肌腱，疼痛自然就会消失。

Diagnose the problem, fix the bone or ligament or tendon that is not working properly and you will make the pain go away.

但对我们很多人来说，疼痛并不是这样发展的。

For many of us, that is not how pain unfolds.

即使扫描结果正常，疼痛也可能持续存在，或者没做任何治疗就自己好了。

Aches persist even when scans look normal or they vanish without any medical intervention.

那些承诺能缓解疼痛的疗法，往往收效甚微。

Treatments that promise relief fail to deliver.

我们还发现一件挺奇怪的事。

We also notice something puzzling.

我们感受到的疼痛，会随着生活中的其他事情而变化。

The pain we feel changes with other things happening in our lives.

当我们平静下来，或者专心做别的事时，疼痛就会减轻。

When we are feeling calm or absorbed in something else, the pain subsides.

当我们感到孤独或难过时，疼痛就会加重。

When we feel isolated or sad, the pain gets worse.

今天在这档节目里，以及在《隐藏的思维》的附加节目中，我们将探讨为什么我们的文化在理解疼痛的本质时会犯下这么多错误。

Today on the show and in a companion episode on Hidden Brain plus we examine why our culture gets so many things wrong when it comes to understanding the true nature of pain.

当我们感受到疼痛时，究竟发生了什么？又该如何应对？

What's really happening when we experience pain and how to address it?

本周《隐藏的思维》。

This week on Hidden Brain.

疼痛给人的感觉像是身体发出的一个简单信号。

Pain feels like a simple message from the body.

如果你的肘部疼，那一定是肘部出了问题。

If your elbow hurts, there must be something wrong with your elbow.

如果你的背部僵硬得厉害，那就得去处理一下背部。

If your back is painfully stiff, you need some work done on your back.

在这个模型里，大脑只是一个旁观者。

The brain in this model is an observer.

大脑只是接收来自身体各处神经传来的疼痛信号。

It registers signals of pain sent in by nerves from the far reaches of the body.

但事情真的就这么简单吗？

But is that really all there is to it?

在加州大学旧金山分校，心理学家蕾切尔·佐夫内斯研究疼痛的本质。

At the University of California San Francisco, psychologist Rachel Zoffness studies the nature of pain.

她发现，我们的心理在疼痛体验中所起的作用，远比大多数人想象的要大得多。

She has found that our minds play a much larger role in our experience of pain than many of us realize.

而且心理在我们应对疼痛的方式上，也同样起着关键作用。

And they also play a much larger role in how we need to deal with pain.

蕾切尔·佐夫内斯，欢迎来到《隐藏的思维》。

Rachel Zoffness, welcome to Hidden Brain.

这是我最爱的播客之一。

One of my favorite ever podcasts.

能来到这里，我感到非常荣幸。

I'm so honored to be here.

拉切尔，你在接受科研训练之初，学到的是一种单维度的生物医学疼痛模型。

Rachel, as you began your own research training, you were taught a one dimensional biomedical model of pain.

你能给我讲讲这个模型吗？

Can you describe that model for me?

当然可以。

Absolutely.

生物医学模型是一种过时的疾病和疼痛观，它主要——甚至完全——关注解剖结构、生理机能、骨骼和身体部位。

The biomedical model is an antiquated way of looking at disease and pain that focuses primarily, if not exclusively, on anatomy and physiology and bones and body parts.

在生物医学的框架下，谈到治疗疼痛时，我们讨论的也几乎全是生物医学手段，比如吃药和做手术。

And what that means in the biomedical frame of things is that when we talk about treating pain, we also talk primarily, if not exclusively about biomedical solutions, and that takes the form of pills and procedures.

作为一名临床医生和疼痛研究者，我观察到的是这样一种现象。

So here's what I observe as a clinician and pain researcher.

如果你有慢性膝关节疼痛，你会被转诊给七百六十二个膝关节专家，但从来没人提过你的大脑。

What I observe is that if you have chronic knee pain, you will be sent to seven sixty two knee specialists, but we never talk about your brain at all.

在你早期的训练中，拉切尔，你遇到过两例发表在医学文献中的临床案例，它们让你开始以不同的方式思考疼痛。

So early on in your own training Rachel, you encountered a pair of clinical cases documented in the medical literature which got you thinking about pain in a different way.

其中一个故事讲的是一位29岁的建筑工人受了伤。

One was about a 29 year old construction worker who got injured.

你能给我描述一下当时的情景吗？发生了什么事？

Can you set up the scene for me and describe what happened to this worker?

我很喜欢这两个故事，我把它们叫做‘两颗钉子的故事’，谁不喜欢押韵呢？

I love these two stories and I call them a tale of two nails because who doesn't like rhymes?

没错，第一个故事，也就是第一颗钉子的故事，讲的是一位建筑工人在工地干活时，从木板上跳下来，正好踩在一根七英寸长的钉子上。

So yes, the first story, the first tale of nails is a construction worker who was working on a job site when he jumped off a plank straight onto a seven inch nail.

那根钉子直接穿透了他的靴子，从另一侧穿了出来。

And that nail drove through his boot clear through to the other side.

天哪。

Oh my god.

对。

Yes.

那疼痛一定极其剧烈。

So the pain must have just been excruciating.

那痛苦简直难以忍受，同事们立刻把他送到了急诊室，还给他用了大量镇痛药，比如芬太尼和其他阿片类药物。

It was excruciating, and his colleagues rushed him off to the emergency department, and he was sedated with a lot of good drugs, like, you know, fentanyl and other opioids.

当医生们帮他脱下靴子时，发现竟然发生了奇迹。

And when the good doctors removed his boot, they discovered that a miracle had occurred.

那枚钉子正好从他的脚趾缝中间穿了过去。

The nail had passed between the space between his toes.

根本没有伤口。

There was no puncture wound.

没有流血，也没有任何组织损伤。

There was no blood, and there was no tissue damage.

可他怎么会疼得这么厉害呢？

Well, but why was he in such excruciating pain?

这听起来完全说不通，对吧？

It makes no sense, right?

这里头其实藏着疼痛科学的重要发现，关于疼痛的机制，真的特别有意思。

So here's what pain science tells us, which is so important and fascinating about the science of pain.

我们的大脑是身体的危险探测器。

Our brain is our body's danger detector.

大脑的职责就是保护我们的生命。

That's our brain's job is to save our lives.

疼痛是身体发出的警报系统。

And pain is our body's warning system.

它就是我们的危险预警机制。

It's our danger detection system.

所以，我们的大脑——包括这位建筑工人的大脑——会综合所有可用信息，来判断是否要产生疼痛，以及疼痛的程度。

So our brain, including this construction worker's brain, used all available information to decide whether or not to make pain and how much.

这其中也包括他对危险工作环境的认知。

And that included knowledge of his dangerous work environment.

还包括过去疼痛经历的记忆，这些记忆其实都储存在海马体里。

It included memories of past pain experiences, which by the way, are stored in our hippocampus.

大脑还整合了来自五感的数据，比如他看到靴子外戳着一根巨大的钉子的画面。

It used data from his five senses, including this visual of this giant nail sticking out of his boot.

它还结合了恐慌这类情绪。

It incorporated emotions like panic.

因为他的大脑察觉到潜在的危险，就产生了疼痛来保护他。

And because his brain perceived potential threat of danger, it made pain to protect him.

我特意用了这些词。

And I'm using those words on purpose.

他的大脑察觉到潜在危险，于是产生了疼痛来保护他。

His brain perceived potential danger, and so it made pain to protect him.

我还在想，当他看到周围人的反应时，他们一定都被吓坏了，看到钉子从他的靴子里穿出来。

I'm also imagining that when he saw the reactions of the people around him, they must have just been horrified to see this nail sticking out of his boot.

现在他又从别人那里得到了反馈。

And now he's getting feedback from other people.

我遭遇了可怕的事情。

Something terrible has happened to me.

没错。

Absolutely.

这也是另一个影响因素。

That is one of the other factors.

来自周围所有建筑工人的眼神和反应这种社会信息。

The social input, the social data from all the construction workers standing around him.

你能看到一根大钉子从他靴子顶端戳出来。

And you can see this giant nail protruding from the top of his boot.

任何人看见这一幕都会同样震惊。

Like, anybody who saw that would be equally as alarmed.

你刚才说这是关于两颗钉子的故事，另一个故事里的主角也是个建筑工人，但他是在科罗拉多工作？

Now you said that this was a tale of two nails and the other story that you tell is also about a construction worker, but he was working in Colorado?

没错。

That's right.

这位建筑工人当时在科罗拉多的工地用气动钉枪，结果枪走火了，钉子反弹回来，直接打中了他的下巴。

So this construction worker was on a job site in Colorado and he was using a nail gun And the nail gun accidentally misfired, and it ricocheted backwards, and it clocked him in the jaw.

但他眼睁睁看着那颗钉子飞过房间，深深嵌进了对面的墙里。

But he saw a nail go shooting across the room and bury in the wall across from him.

所以

So

他当时只是有点牙疼，头也隐隐作痛，但还是照常工作生活了六天。

he had like a mild toothache and a mild headache, but he continued on with work and life for six days.

这次是钉枪走火，但他眼睁睁看着那颗钉子飞出去，嵌进了对面的墙里。

So in this case, the nail gun goes off, but he sees the nail embed itself in the wall far away from him.

尽管脸上被后坐力撞了一下，他还是觉得自己没什么大碍。

And even though he has a little bit of the recoil that hits his face, he thinks he's basically okay.

没错，就是这样。

That's exactly right.

六天后，吃也吃了，睡也睡了，该干嘛干嘛，他突然跟妻子说：我觉得我该去看看牙了。

And at the end of six days, six days of eating and sleeping and continuing on with life, he turns to his wife and says, You know, I think I'm gonna get this toothache checked out.

于是他去看牙医，牙医给他做了个扫描，结果两人都惊呆了——他脸上居然卡着一颗四英寸长的钉子。

So he goes to a dentist and the dentist does a scan of his patient's jaw, and much to both men's surprise, they discover a four inch nail embedded in his face.

等等。

Wait.

我不是听说那颗钉子是飞过房间，嵌进墙里的吗？

I thought you said the nail was basically flying across the room and embedding itself in the wall.

没错。

That's right.

钉枪我平时用得不多，但其实它们有时候会一次射出好几颗钉子。

So nail guns, I don't use many nail guns, but nail guns can actually release more than one nail at a time.

它们有个快速连续发射的功能。

They have like a rapid release.

他看见一颗钉子飞过房间，但说来也怪，虽然不太懂其中的物理原理，第二颗钉子居然从钉枪里弹出来，从下颌底部穿进去，扎进了他的脸。

So he saw a nail shoot across the room and somehow, not sure the physics of this, but somehow a second nail came out of the nail gun and it went up through the bottom of his jaw and into his face.

我后来还专门联系了主刀的医生。

And I actually spoke with the surgeon that conducted the surgery.

他说，这人真是运气好到极点了。

And he said, He's the luckiest guy ever.

那颗钉子已经顶到他的前额叶皮层了。

That nail was protruding into his prefrontal cortex.

那怎么可能会有这么严重的损伤，却几乎不觉得疼呢？

Now, how is it possible that someone can have such significant damage and such little pain?

因为我们都被灌输了一个错误观念：疼痛和损伤是一回事。

Because this myth, this lie that we are all sold, is that pain and damage are one and the same.

一感到疼，我们就立刻去寻找身体哪里受损了。

When you have pain, you go looking for damage.

一看到损伤，就默认觉得肯定得疼得厉害。

When you have damage, you assume necessarily that you should have pain.

但疼痛和损伤，其实根本不是一回事。

But pain or hurt and damage or harm are not the same thing.

难受和伤害，也不是同一个东西。

Hurt and harm are not the same.

Rachel，我真有点搞不懂了。

I'm really puzzled here, Rachel.

他怎么会疼得这么轻？这到底该怎么解释？

What could possibly explain why he had such little pain?

这确实让人费解，但答案就在这里。

It is so baffling, and here's the answer.

只要真正理解疼痛的科学原理，这一切就完全说得通了。

It's only baffling until we really understand the true science of pain, and then it makes perfect sense.

事情是这样的。

Here's what happened.

我们已经知道，疼痛是身体的危险警报，而大脑则是身体的危险探测器。

We've established that pain is the body's danger alarm, and we've established that the brain is our body's danger detector.

所以他的大脑，就像第一位建筑工人一样，综合了所有可用信息，来判断是否要产生疼痛，以及疼痛的程度。

So his brain, similar to the first construction worker, his brain also used all available data to decide whether or not to make pain and how much.

他的大脑也参考了他所处的危险工作环境、过去疼痛的记忆，以及视觉信息。

So his brain also used knowledge of his dangerous work environment, memories of past pain experiences, and visual data.

但他看到那颗钉子飞过房间，钉进了对面的墙里，于是大脑误以为这位工人的身体是安全的。

But because he saw that nail shoot across the room and bury in the wall across from him, His brain was under the mistaken impression that the construction worker's body was safe.

可信的危险信号会增强疼痛警报。

Credible evidence of danger will amplify the pain alarm.

安全的迹象会降低疼痛警报。

Credible evidence of safety will lower the pain alarm.

因为他的大脑觉得他很安全，所以疼痛警报根本没有响。

So because his brain perceived that he was safe, the pain alarm did not sound.

生物医学模型认为，只要感到疼痛，身体里就一定有需要修复的问题。

The biomedical model of pain holds that if something hurts, there must be something wrong in the body that needs to be fixed.

这个模型有时候是对的，但正如我们听到的，它常常不够用。

Sometimes that model does hold up but as we have heard it often falls short.

我们回来之后，讲讲疼痛在身体和大脑里究竟是怎么运作的。

When we come back, how pain really works in the body and the mind.

你正在收听《隐藏的思维》。

You are listening to Hidden Brain.

我是尚卡尔·维达纳。

I am Shankar Vedanta.

交易往往从一个问题开始，接着是另一个，然后你的浏览器里就打开了十几个标签页。

Trading often starts with one question, then another, then a dozen tabs sit open in front of you.

一位分析师说买入，另一位说等等，新闻标题却催你马上行动。

One analyst says buy, another says wait, a headline says move now.

信息杂乱容易让人困惑。

Noise can lead to confusion.

Capital.com 的平台内新闻与分析，帮你基于清晰信息交易，而不是盲目跟风。

Capital.com's in platform news and analysis help you trade on clarity, not hype.

所以，最终的决定权始终在你手上。

So decisions always stay yours.

Capital.com。

Capital.com.

清晰交易，明智决策。

Trade with clarity.

差价合约风险较高。

CFDs involve a high level of risk.

81.31% 的散户投资者亏损。

Eighty one point three one percent of retail investors lose money.

欢迎收听《隐性思维》，我是 Shankar Vedanta。

This is Hidden Brain, I'm Shankar Vedanta.

疼痛，大概是人类最普遍的一种体验。

Pain is perhaps the most common of human experiences.

我们都以为自己懂疼痛。

We all think we understand it.

一不小心撞到脚趾，就会感到疼。

You stub your toe, you feel pain.

在厨房里不小心被烫到，那种灼烧感立马就来了。

You accidentally scald yourself in the kitchen and you feel the burn.

看起来挺简单的，对吧？

It seems straightforward.

但这种对疼痛的直觉理解，其实并不完整。

But this intuitive model of pain turns out to be incomplete.

Rachel Zoffness 是加州大学旧金山医学院的一名疼痛心理学家。

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

拉切尔，和我们通常对疼痛的理解相反，你说疼痛其实是大脑构建出来的，而不是仅仅存在于身体疼痛的那个部位。

Rachel, contrary to the way we usually think about pain, you say that pain is constructed by the brain, not located in the body part that is hurting.

你能给我详细解释一下这个观点吗？

Unpack this idea for me.

你的意思是，大脑不只是在感知疼痛，而是在主动构建疼痛？

You're saying the brain is not merely perceiving pain, but it's actually constructing it?

没错。

You got it.

人们很容易觉得，疼痛只存在于身体受伤的那个地方，对吧？

So it's very easy to believe that pain lives exclusively in the body part that hurts, right?

比如你腰不好或者膝盖疼，就自然以为是腰或膝盖自己在产生疼痛。

So if you have a bad back or you have an aching knee, it's easy to believe that that pain is being constructed exclusively by your back or your knee.

但神经科学告诉我们，事实并非如此。

But neuroscience tells us that is not true.

最终，疼痛是由大脑构建出来的。

Pain is ultimately constructed by the brain.

我们之所以知道这一点，是因为有一种叫幻肢痛的病症。

And one of the reasons we know this is because of a condition called phantom limb pain.

幻肢痛发生在有人失去四肢——比如手臂或腿——之后，却依然感到缺失的部位剧烈疼痛。

And phantom limb pain occurs when someone loses a limb, an arm or a leg, and they continue to have terrible pain in the missing body part.

如果你能在一条已经不在身上的腿上感受到剧痛，那就很清楚地说明，疼痛一定是在别的地方产生的。

Now, if you can have terrible leg pain in a leg that is no longer attached to your body, that tells us pretty definitively that pain must be constructed somewhere else.

而我们现在知道，这个‘别的地方’就是大脑。

And we now know that somewhere else is the brain.

所以，拉切尔，这里有一个核心观点，我们之前在《隐性思维》里也讨论过。

So one of the animating ideas here, Rachel, is something that we have discussed previously on Hidden Brain.

大脑是通过进化被设计出来帮助我们生存的，而生存需要我们理解过去发生了什么。

The brain was designed by evolution to help us survive, and survival involves understanding what happened to us in the past.

但更重要的是，生存其实关乎我们接下来该怎么做。

But even more, survival is really about deciding what to do next.

你认为，疼痛和大脑给我们的许多其他信号一样，真正关注的是未来该采取什么行动，而不仅仅是对过去经历的记录。

And you're arguing that pain, like many other signals that the brain gives us, is really about future action rather than merely an accounting of past events.

没错。

That's right.

疼痛的作用是保护我们。

So pain's job is to protect us.

有些人几乎感觉不到疼痛，结果活不长。

There are people who do not feel very much pain and they don't live very long.

但急性疼痛和慢性疼痛有很大区别，前者不超过三个月，后者则超过三个月。

The problem is there's a very big difference between acute pain, which is three months or fewer, and chronic pain, which is three months or longer.

它们的机制完全不同。

They are designed differently.

在大脑和神经系统中的运作方式不同，治疗方法也不一样。

They work differently in the brain and nervous system, and they are treated differently.

问题是，我们现在正面临慢性疼痛的流行问题。

And the problem is that we have a chronic pain epidemic.

全球目前有19亿人饱受慢性疼痛困扰，仅美国就有1亿人。

We have one point nine billion people around the globe currently living with chronic pain, one hundred million in The US alone.

由于很少有人真正理解疼痛，我们不仅误解它，还常常错误地治疗它。

And because very few people understand pain, we continue to not just misunderstand it, but also to mistreat it.

你刚才提到一种叫幻觉痛的现象，你的病人马泰奥就生动地展示了这一点。

You talked a second ago about this phenomenon called phantom pain, and this idea was vividly demonstrated by a patient of yours, a young man whom you called Matteo.

你能说说你是怎么第一次见到他的吗，拉切尔？

Can you describe how you first met him, Rachel?

是的。

Yes.

马泰奥是被一位外科医生介绍给我的，他打电话跟我说，有个病人正在他办公室，不管用多少止痛药，疼痛都降不下来。

Matteo was sent to me by a surgeon who called me on the phone and he told me about a patient who was currently in his office and no amount of pain medication was working to lower pain volume.

他说：我需要你的帮助。

He said, I need your help.

你能见见这个孩子吗？

Will you see this child?

我很快了解到，马泰奥才十二岁，他在父母的车库里发现了一个烟花，特别兴奋。

And I learned very quickly that Matteo was 12 years old and he had found a firework in his parents' garage and he was very excited.

就像十二岁的孩子会做的那样，他邀请朋友去公园，想一起放烟花，感受烟花带来的快乐。

And like a 12 year old would, he invited his friends to the park so they could detonate the firework, and they could all experience the joy of fireworks.

对。

Mhmm.

我猜观众现在都屏住呼吸了，因为他们知道接下来会发生什么。

And I'm sure the audience is cringing because they know what's coming.

但后来马泰奥告诉我，他说，动画片里，烟花总是带着很长的引信。

But, you know, what he told me later, Matteo, was he said, you know, in the cartoons, there's always a really long fuse attached to the firework.

所以你点着引信之后，像威利·旺卡或者跑路的快客那样，有足够时间跑开再爆炸，他以为这里也会是这样。

And so there's time you light the fuse and then, you know, Wile E.

但事实并非如此。

Coyote or the Roadrunner, they have time to run away before it detonates, and that's what he assumed would happen here too, but that's not what happened.

他带着烟花来到公园。

So he takes this firework out into the park.

身边还带着朋友们。

He's with his friends.

他们大概都兴奋地围在旁边。

Presumably, they're all standing excitedly around.

接下来发生了什么，拉切尔？

What happens next, Rachel?

他们围成一圈，马泰奥手里拿着烟花，点着了引信。

They're standing in a circle and Matteo was holding the firework in his hands and they light the fuse.

结果引信没像想象中那样慢慢烧，一点燃就立刻炸了。

And instead of taking a long time to detonate, instead it exploded right away.

他的脸被严重烧伤了。

And it seared the skin on his face.

耳膜也被炸穿了。

It blew a hole in his eardrum.

角膜烧伤了，左手也直接炸没了。

It burned his cornea, and it also took off his left hand.

这真是个惨烈的意外，拉切尔。

So this is a really terrible accident, Rachel.

马特奥肯定被紧急送去医院了吧？

Mateo must have been rushed to the hospital?

是的，他被立刻送到了医院。

Yeah, he was rushed to the hospital.

医生为了救他，不得不在他肘部以下截肢，但好歹保住了他的命。

The doctors had to amputate below the elbow to save him, but they did save him.

他们联系我，是因为马特奥说被截掉的胳膊和手还在剧烈疼痛。

And the reason they called me was because Mateo was reporting terrible pain in the arm and the hand that they had amputated.

他的手已经不在身体上了，可他却感觉那只被截掉的左手在抽筋、痉挛。

So his hand was no longer attached to his body, but he was experiencing that left hand that had been removed cramping and spasming.

这其实并不罕见。

And that's not actually very unusual.

高达百分之八十的截肢者都会经历幻肢痛。

Up to eighty percent of people who have a phantom limb experience phantom pain.

我觉得，当有些人听说幻肢痛时，会以为是原本通向马特奥手部的神经，现在在肘部被切断了，还在向大脑发送信号，说手还在疼。

So I think when some of us hear about phantom pain, we imagine that, you know, the nerves that would previously have gone out to Matteo's hand are now, you know, cut off at his elbow, and they are signaling to his brain that his hand is still hurting.

你是在说，幻肢痛其实更复杂，跟大脑里对身体的映射有关？

You're presenting a more complicated view of phantom pain, and that has more to do with the map that the brain has of the body?

没错。

That's right.

经历过严重创伤或截肢的人可能会有残肢痛，就是字面意思的那种痛。

So people who have had a traumatic injury or have had a limb amputated can have stump pain, and stump pain is what it sounds like.

这种痛是伤口部位实际产生的。

It's pain that's being generated by the injury site.

但这跟我们刚才说的幻肢痛是两种不同的情况。

And that is a different kind of pain than what we're talking about here.

幻肢痛就像马特奥经历的那样——手虽然已经被切掉了，但大脑里那个身体地图还没来得及更新。

Phantom pain is when what Matteo was experiencing, where his hand had been removed, there was no hand left, but the map of his body that lived in his brain hadn't yet updated with that information.

大脑里确实有个身体地图，叫作‘皮质同源图’。

So there's a map of the body that lives in the brain, and it is called the homunculus.

这个‘皮质同源图’就是大脑对身体感觉和运动的映射图。

And the homunculus is a sensory motor map of the human body.

现在，Shankar，你试着感受一下你的左脚，看看能不能感觉到鞋子里的脚，袜子贴在皮肤上的感觉，还有脚踩在地板上的触感。

So if I say to you right now, Shankar, sense into your left foot and see if you can feel it in your shoe and feel the sock on your skin, and feel your foot on the floor.

你能做到这一点，部分原因是你大脑里的那个身体地图在向你提供全身的信息。

You can do that, and you can do that in part because of the homunculus that lives in your brain, that's giving you data about your entire body.

当你不幸且突然失去一条肢体时，大脑里的这张地图需要一些时间才能更新。

And when you tragically and traumatically lose a limb, it can take some time for the map in your brain to update.

因为如果不像电脑那样及时更新，大脑会以为那个身体部位仍然处于危险中，于是不断发出警报来引起你的注意。

Because without this updating like a computer, the brain is under the impression that that body part is still in danger, and it's producing danger messages to get your attention.

我在想，这种疼痛对这个小男孩造成了怎样的影响，Rachel。

I'm wondering how this pain affected this little boy, Rachel.

你见到他的时候，他不只是身体疼痛，还表现出明显的心理痛苦。

When you saw him, he wasn't just in pain, but he was in psychological distress.

你说得完全对。

That's absolutely right.

我第一次见到Matteo时，他穿着一件 oversized 的连帽衫，想遮住他缺失的胳膊，整个人缩在沙发里，好像想把自己藏起来。

When I first met Matteo, he was wearing an oversized sweatshirt to hide his missing arm, and he was shrunken into the couch as if he wanted to disappear.

他和父亲一起来到我的办公室，父亲说儿子整个人都变了。

And he came to my office with his father and his father described how his son had completely changed.

他变得封闭了。

He had withdrawn.

完全不跟人来往。

He was socially isolated.

也不去上学了。

He was not going to school.

几乎不吃东西，整天跟父母睡在一起。

He was barely eating, and he was sleeping in bed with his parents.

我知道他还一直自责，觉得是自己害了自己，也害了朋友们，不知道该不该这么内疚。

I understand that he also felt guilty about what happened and wondering whether the harm that he had done to himself and to his friends, whether he should be feeling guilty about it.

他觉得自己糟透了。

He felt terrible.

他觉得整场事故都是自己的错，而且爆炸时还有其他孩子受伤了。

He felt like the entire accident was his fault, and some other children had also gotten hurt during the explosion.

他觉得确实如此。

He felt like yeah.

他感到非常内疚。

He felt extremely guilty.

疼痛的现实与我们传统上对疼痛的理解不同之处在于，疼痛所处的环境会影响我们的感受。

Another way that the reality of pain departs from what we've conventionally believed about pain is that the context around pain can change our experience of it.

这具体是怎么回事呢，蕾切尔？

How is this the case, Rachel?

没错。

Absolutely.

我们之前谈到过，大脑就像是身体的危险探测器，它会综合所有可得的信息来判断是否要产生疼痛，以及疼痛的程度。

So we talked about how our brain is our body's danger detector and how it uses all available information to decide whether or not to make pain and how much.

而在任何一个时刻，大脑都会考虑环境因素。

And among the things that our brain is using in any given moment is context.

我所说的环境，指的是什么？

What do I mean by context?

所谓情境，就是你在任何一刻所处的周围环境和内心状态。

Context means everything happening around us and inside of us in any given moment.

我的意思是，你在哪里、和谁在一起、情绪如何，甚至过去的记忆都算在内。

And by that, I mean, where we are, who we're with, how we're feeling, even our past memories.

所以，如果你在被公司开除那天撞到了脚趾，那种痛感会和你在海滩上和朋友玩时撞到脚趾完全不一样。

And, and that's why if you stub your toe on the day you get fired from work, it is going to feel completely different than that exact same injury when you're at the beach with friends.

这也是为什么，如果你喜欢带点刺激的亲密关系，当你是和信任、深爱的伴侣在一起时，被拍打、咬一口，感觉会和被抢劫时受同样的伤截然不同。

And it's also why, if you're someone who is interested in spicy sex, if you're with a partner that you trust and love and you get spanked and smacked and bitten, it will feel completely different than those exact same injuries when you are getting mugged.

大脑在决定是否制造疼痛以及痛到什么程度时，永远都会考虑情境。

Context always matters to the brain when it's deciding whether or not to make pain and how much.

我记得小时候，我们家有个我很喜欢的医生，每次我疼的时候，只要他在我身边，疼痛好像就莫名其妙地减轻了。

You know, I remember as a small kid, we had a family doctor whom I really liked, and whenever I was in pain, just being in the presence of this doctor would magically make my pain seem to go away.

某种程度上，你说的正是这个意思，对吧？

In some ways, that's what you're talking about here, isn't it?

没错。

Absolutely.

疼痛发生的背景环境至关重要。

The context in which pain is delivered matters so much.

所以才会用屏幕分散孩子的注意力，来降低疼痛感。

It's why things like distracting a child with screens will lower the pain alarm.

去一个你信任又喜欢的医生那里，也会改变你对疼痛的体验。

It's why going to a doctor that we trust and like will change the pain experience.

有些人，包括我自己，都经历过这种让人抓狂的事：某个地方疼，比如牙疼或者膝盖疼，你去了信得过的医生诊所。

I mean, some of us, including me, have had this maddening experience wherein, you know, some body part hurts your tooth or your knee, and you go to the trusted doctor's office.

可你在候诊室坐着的时候，疼痛居然就消失了，对吧？

And while you're sitting in the waiting room, the pain seems to disappear, right?

这其实挺让人无奈的，因为它提醒我们，大脑每时每刻都在综合所有可用的信息做判断。

I mean, it's maddening in a way because it's just this reminder that the brain is always using all available data in every single moment of our lives.

慢性疼痛患者最清楚这一点，他们常跟我说，自己的疼痛在一小时、一天、一个月里都会变化。

And people with chronic pain know that because people with chronic pain will tell me that their pain will change over the course of an hour, a day, a month.

因为所有这些因素一直在动态交织，不断改变着疼痛的感受。

And that's because all of these factors are always coming together to change the pain experience.

现在，有些人听到这段对话可能会想，好吧，脚踝神经末梢传来的痛感，那是真实的疼痛。

Now, think some people might hear this conversation and say, Okay, the pain signals that are coming from the nerve endings in your ankle, that is real pain.

而大脑里产生的痛感，不过是‘想多了’而已。

The pain signals that are being created within the mind are, you know, just in your head.

那为什么这种想法是错的呢，拉切尔？

Why is this the wrong way to think about pain, Rachel?

当然，人们会这么想，这听起来也很有道理。

Of course, people would think that and that makes good sense.

所以我想一次性把这个问题说清楚。

So I want to clear this up once and for all.

负责产生情绪的大脑区域，同时也负责产生疼痛。

The parts of the brain that make emotions also make pain.

我们的边缘系统、杏仁核，都是疼痛机制中至关重要的部分。

Our limbic system, our amygdala, those are critical parts of the pain machinery.

事实上，我们已经知道，身体传来的所有感觉信号，在变成我们所说的‘疼痛’之前，都必须经过大脑的情绪处理系统。

And what we actually know about pain is that 100% of the sensory messages from the body filter through our brain's emotion machinery before they become the thing we call pain.

疼痛从来都不是只存在于脑子里的。

Pain is never all in your head.

疼痛从来都不是纯粹心理作用的结果。

Pain is never purely psychological.

疼痛在任何时候都是身体和情绪的结合体。

Pain is both physical and emotional 100% of the time.

疼痛不只是身体发出的信号，而是大脑构建出的一种体验，这种观点为治疗开辟了全新的可能。

The notion that pain is not simply a signal from the body but an experience constructed by the brain opens up a world of possibility for treatment.

这意味着疼痛不是固定不变的，它会受到我们的想法和行为的影响。

It implies that pain is not fixed, that it can be influenced by how we think and what we do.

接下来我们会讲到这一点。

That's coming up next.

另外，在我们的配套节目《隐藏的大脑》Plus版中，我们会重新回到马泰奥的故事，介绍蕾切尔用来帮助他重塑大脑的一种新方法。

Also, in our companion episode on Hidden Brain plus we return to Matteo's story and describe a novel technique that Rachel used to help him rewire his brain.

这个故事还探讨了一个更深层的问题：我们该如何利用大脑的可塑性来管理疼痛。

The story also explores the larger question of how we can use the plasticity of the brain to manage pain.

如果你已经是订阅用户，这期节目现在就能在本播客的推送里收听。

If you are already a subscriber, that episode is available to you right now in this podcast feed.

这期节目的标题是《可塑的大脑，可变的大脑》。

It's titled Plastic Brain, Changeable Brain.

如果你还没订阅，请访问 support.hiddenbrain.org。

If you are not yet a subscriber, please go to support.hiddenbrain.org.

如果你用的是苹果设备，请前往 apple.co/hiddenbrain。

If you are using an Apple device, please go to apple.co/hiddenbrain.

订阅后你就能立即访问我们所有仅限订阅用户的节目内容，包括往期节目。

You will instantly have access to all our subscriber only content including past episodes.

你正在收听《隐藏大脑》。

You are listening to Hidden Brain.

我是 Shankar Vedanta。

I am Shankar Vedanta.

市场变化很快，你可能会觉得时间永远不够用。

Markets move quickly, you can feel like there's never enough time.

新闻标题一闪而过，图表一动，你就会觉得此刻才是唯一重要的时刻。

A headline flashes, a chart moves, and suddenly, it's as if now is the only moment that matters.

有了背景信息，这种急迫感就会平息下来。

Context calms that desire.

Capital.com 把新闻、图表和经济日历整合在一起，帮你更好地掌握信息。

Capital.com brings news, charts and economic calendars into one place to help you stay informed.

Capital.com。

Capital.com.

交易更清晰。

Trade with clarity.

差价合约风险很高。

CFDs involve a high level of risk.

有81.31%的散户投资者亏了钱。

Eighty one point three one percent of retail investors lose money.

这是Hidden Brain。

This is Hidden Brain.

我是尚卡尔·维丹塔。

I'm Shankar Vedanta.

这场对话有没有让你想起自己经历痛苦的经历？

Has this conversation evoked your own experience with pain?

如果你愿意和《隐藏的思维》的听众分享你如何克服痛苦的亲身故事，或者对本期节目有任何问题或想法，请找一个安静的房间，录一段语音备忘录。

If you have a personal story about how you overcame pain that you would 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.

两到三分钟就足够了。

Two or three minutes is plenty.

然后把文件发送到 feedbackhiddenbrain dot org。

Then email the file at feedbackhiddenbrain dot org.

邮件主题请写：pain。

Use the subject line pain.

再次提醒，邮箱是 feedbackhiddenbrain dot org。

Again, that's feedbackhiddenbrain dot org.

蕾切尔·佐夫内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《告诉我哪里痛：疼痛的新科学与疗愈之道》一书的作者。

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

拉切尔，你提出一个观点：当我们思考疼痛时，不应该把它当成单纯的医学问题，而应该看作一个生物、心理和社会交织的现象。

Rachel, you make the case that when we think about pain, we shouldn't think about it as a biomedical problem, but as a biopsychosocial phenomenon.

你所说的这个术语，具体是指什么？

What do you mean by this term?

没错。

Right.

如果听众今天只记住一件事，我希望是‘生物-心理-社会’这个词。

So if listeners remember nothing else from today's podcast, I hope they remember this word biopsychosocial.

我想明确地说，这并不是我杜撰出来的概念。

And I want to say clearly, this is not my pet invention.

这个说法也不是我首创的。

I did not come up with this.

六十五年来，神经科学界一直清楚：疼痛从来不是纯粹的生理问题，不是只跟骨头或身体部位有关。

Neuroscience has known for sixty five years that pain is never a purely biomedical phenomenon, something to do just with bones and body parts.

疼痛比这复杂得多，也更美妙、更细腻。

Pain is more complex and beautiful and nuanced than that.

如果你想象一个由三个重叠圆圈组成的文氏图，顶部是生物因素，也就是影响疼痛的生理层面。

So if you imagine a Venn diagram with three overlapping circles, we have bio on the top, biological factors that contribute to pain.

还有心理因素，社会因素，而疼痛就存在于所有构成你独特性的复杂交集之中。

We've got psychological factors, and we've got sociological factors, and pain lives in the messy middle of all the things that make you, you.

你能花一分钟说说这三个方面各自包含什么吗，拉切尔？

I'm wondering if you could spend a minute talking about what's in each of those circles, Rachel.

医生。

Doctor.

好的。

Yes.

关于疼痛的生物层面，大家听过的最多。

So the bio domain of pain is the one we've all heard the most about.

它涉及基因、组织损伤，以及身体系统的功能失调。

It's genetics and tissue damage, system dysfunction.

还包括饮食、运动和睡眠。

It's also diet, exercise, and sleep.

这些因素对疼痛体验来说都至关重要。

And those are all critically important when it comes to the experience of pain.

但我想请大家注意的是，如果我们只关注疼痛的生物层面——而这正是西方医学的做法——那我们实际上忽略了疼痛问题的三分之二。

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

在心理层面，我们现在知道，压力、焦虑和抑郁等负面情绪会加剧疼痛信号，而喜悦、快乐、放松和感恩等正面情绪则能降低大脑对疼痛的敏感度。

So in the psych domain of pain, we now know negative emotions like stress, anxiety, and depressed mood will amplify the pain alarm while positive emotions like joy and happiness and relaxation and gratitude will lower the brain's pain alarm.

在社会层面，涉及的是社会和环境因素，比如经济状况、医疗资源获取渠道、种族与民族背景、社会支持的有无，以及我们所处的环境，包括曾经遭受的虐待和创伤。

And in the sociological domain of pain, we have social and environmental factors, and that includes socioeconomic status, access to care, race and ethnicity, social support or lack thereof, and our environment, which includes history of abuse and trauma.

因为创伤不仅存在于大脑中，也深植于身体里，创伤与慢性疼痛简直是形影不离。

Because trauma, it turns out, doesn't just live in the brain, it also lives in the body, and trauma and chronic pain are best friends.

最让我感到震惊的是，这些科学发现其实已经存在几十年了，却始终没能真正进入临床医学和治疗实践。

And what's so fascinating and shocking to me is that we have known this science for many decades, but it hasn't yet found its way to medicine or treatment.

所以，面对这种错综复杂的多重影响，你认为在应对疼痛时，直接关注情绪健康是非常重要的。

So when it comes to trying to combat pain, given this complex interplay of forces, you see that it's important to address emotional health directly.

告诉一个有背痛的人去关注自己的焦虑或悲伤，听起来可能有点奇怪，但你的观点是，我们的情绪确实深刻影响着疼痛的体验。

Now it can seem odd to tell someone who has a back problem to pay attention to their anxiety or their sadness, but you're making the case that our emotional states very much shape the pain that we experience.

没错。

That's right.

因为我们都清楚，大脑中产生情绪的区域，同时也是产生疼痛的区域。

Because we know that the parts of the brain that make emotions also make pain.

我们每一种情绪都会引发身体内一系列生理反应，影响全身各个系统。

Every emotion we have triggers a physiological cascade of events in the human body that affects all of our systems.

比如，当我们感到压力或焦虑时，心跳会加快，嘴巴发干，手心冒汗。

So for example, when we get stressed or anxious, we might have a racing heart, maybe our mouth will get dry, our palms will get sweaty.

让我觉得不可思议的是，谈到身体健康时，我们却从不提及情绪健康。

What's crazy to me is that we don't talk about our emotional health when it comes to physical health.

情绪会深刻而持续地改变我们对疼痛的感受。

Emotions profoundly and constantly change the pain experience.

这一点，其实人人都明白。

And we all know that.

我们已经看到，人在压力和困境中身体状态会变得更糟。

We've seen how our bodies feel worse during times of stress and duress.

你还建议慢性疼痛患者想办法加强人际联系。

You also recommend that people who suffer from chronic pain should find ways to strengthen their social connections.

这怎么就能帮他们缓解疼痛呢？

How would this help them with their pain?

没错。

Right.

对一个人来说，最残酷的惩罚莫过于单独监禁。

One of the worst punishments you can give a human being is solitary confinement.

人类居然最受不了的就是被孤立，这说明了什么？

What does it say about human beings that one of the worst things you can do to us is isolate us from others.

人类天生就是社会性动物。

Humans evolved to be social.

事实上，社交行为对我们的生存至关重要，以至于我们的大脑进化出了奖励机制，鼓励我们去参与社交。

In fact, social behavior is so critical for our survival that our brains evolved a mechanism to reward us for engaging in it.