桑杰·古普塔博士希望你重新理解疼痛

你正在收听NPR的Life Kit节目。

You're listening to Life Kit from NPR.

嗨。

Hey.

我是玛丽埃尔。

It's Marielle.

我想聊聊RICE，不是那种米。

I wanna talk about RICE, not the grain.

这个缩写帮助我们记住受伤后该做什么。

The acronym we're given to help us remember what to do after an injury.

R，休息。

R, rest.

I：冰敷；C：加压；E：抬高。

I: Ice C: Compression and E: Elevation.

目的是让身体恢复，同时减少炎症。

The idea is that you want to let your body recover while minimizing inflammation.

结果发现，疼痛科医生现在有了一个全新的缩写，提出的建议截然不同。

Turns out pain doctors have a new acronym now featuring very different advice.

他们会说M。

They would say M.

T。

T.

M代表活动，E代表锻炼，A代表止痛药，T代表治疗，比如物理治疗和按摩。

That's M, movement E, exercise A, analgesia and T, treatment like physical therapy and massage.

顺便说一下，这是桑贾伊·古普塔医生。

That by the way was Doctor.

桑贾伊·古普塔。

Sanjay Gupta.

你可能听说过他？

Maybe you've heard of him?

他是一名神经外科医生，也是CNN的医疗记者。

He's a neurosurgeon and a medical reporter for CNN.

他说，关于这一点的看法已经发生了变化，因为我们发现，受伤后的炎症实际上可能是一件好事。

He says the thinking has changed on this because we've learned that actually inflammation after an injury can be a good thing.

这真的很有趣，因为告诉受伤的人要起来走动或做点什么，这跟他们平时听到的建议完全不一样。

It's really interesting, you know, to tell people who are injured to get up and walk on it or do whatever because that's not what they're used to hearing.

但几乎就像是，如果你允许身体自行运作，让那些炎症分子迅速赶到现场并发挥作用，它们能做得很好；如果你尽早进行活动，而不是过度关注减轻炎症，你就更不容易发展成慢性疼痛。

But it's almost like if you allow the body to do its job, if you allow those inflammatory molecules to rush to the scene and do their job, they do a pretty good job and you're less likely to have chronic pain if you do that early mobilization and don't focus as much on decreasing inflammation.

桑贾伊长期以来一直在报道疼痛科学，他还写了一本书，名叫《不必疼痛：你的无痛生活智慧指南》。

Sanjay has been reporting on pain science for a while now, and he wrote a book called It Doesn't Have to Hurt Your Smart Guide to a Pain Free Life.

据估计，目前美国大约有百分之二十的人正在经历慢性疼痛。

It's estimated that about twenty percent of people in The US are currently dealing with chronic pain.

我们感到疼痛。

We hurt.

我们的世界充满痛苦。

Our our our world hurts.

与此同时，一些研究人员正在研究这一课题，他们的发现可能会挑战你对疼痛来源以及如何缓解疼痛的固有认知。

At the same time, there are researchers studying this topic, and what they've learned might challenge your understandings of pain, where it comes from, and how we can feel better.

对我来说就是这种情况。

That was the case for me.

我还发现，仅仅了解疼痛科学就能帮助缓解慢性疼痛。

Also, have found that simply learning about pain science can help with chronic pain conditions.

所以在本期《生活工具箱》节目中，我与桑贾伊讨论了疼痛科学中一些令人惊讶的进展，包括你可能不知道的非阿片类治疗方法。

So on this episode of Life Kit, I talk to Sanjay about some of the surprising developments in pain science, including non opioid treatments you may not know about.

我们还会探讨疼痛和慢性疼痛究竟是什么，以及为什么即使医生找不到明显的病因，你仍可能经历疼痛。

We'll also get into what pain and chronic pain are, and why you might have them, even when doctors can't find an obvious source.

广告结束后继续。

That's after the break.

你在书中提到，疼痛治疗领域最重要且最令人惊讶的进展之一是，大脑是任何疼痛体验的核心。

You say in the book that one of the most significant and surprising developments emerging in pain treatment is the fact that the brain is at the center of any pain experience.

你能再详细说说，为什么这一点很重要吗？

Can you tell us more about why that matters?

我认为已经越来越清楚了——我并不是第一个这么说的人——如果大脑没有判定你正在疼痛，那么你就没有疼痛。

What I think has become clear, and I'm not the first person to say this, the idea that if the brain doesn't decide you have pain, then you don't have pain.

大脑甚至可以在明明不应该有疼痛的地方制造出疼痛感。

And the brain can also create pain where it seems like it wouldn't exist.

我认为最好的例子之一就是幻肢痛，长期以来这一直让人困惑不已。

And I think one of the best examples of that is phantom limb pain, which for a long time, you know, has baffled people.

比如，肢体已经不复存在了。

Like the limb doesn't even exist anymore.

这些现象长期以来都被视为谜团，但我想我们现在已经得出结论：大脑会决定，嘿。

These have been long, you know, sort of regarded as mysteries, but I think what we've concluded is that the brain will decide, hey.

这其实不疼，或者这确实疼，而这种感觉可能完全与你预期的体验不符。

That actually doesn't hurt or that does hurt, and it may seem completely out of sorts with what you think the experience should be.

你在书中也提到了这一点。

And you talk about this in the book.

你也可以看到，两个人面临非常相似的情况，甚至做了同样的手术。

You can see that too in two people having a very similar set of circumstances and maybe the same surgery.

我想这在你为两个人做手术时就发生了。

I think this happened when you perform surgery on two people.

然后，一个人术后第二天就痛苦得无法动弹，另一个人却能坐起来聊天，一切正常。

And then one is in debilitating pain the day after, and the other one is sitting up and talking and everything's fine.

两个乔安娜的故事。

The story of of the two Joannas.

碰巧的是，我在同一天为两位女性做了手术，她们的问题基本相同，不仅在医疗状况上非常相似，就连个人情况也差不多——年龄相近、病史相同等等。

It just so happened that I ended up operating on two women on the same day that basically had the same problem and were very, very similar, not only in terms of what the medical issue was, but in terms of they themselves, around the same age, same medical history and everything.

第二天我走进乔安娜一号的病房时，你总能一眼看出病人的情况，甚至在检查之前就能感觉到。

And I walk into Joanna Number One's room the next day, and you can always tell right when you walk into a patient's room how they're doing, even before you examine them.

你知道，窗帘是拉开的。

You know, the window shades are open.

她已经涂好了口红。

She'd already put on lipstick.

她的头发也梳好了。

Her hair was combed.

她很快就出院了。

And she was discharged shortly thereafter.

乔安娜二号，同样的手术，同样的病史，但她就是痛苦不堪。

Joanna number two, same operation, same medical history, and she was just miserable.

你首先想到的是：我是不是漏掉了什么？

And first thing you think is like, did I miss something here?

到底出了什么问题？

What's going on?

为什么结果会如此不同？

Why such a different outcome?

这时你才会意识到，我认为疼痛这东西真的很神秘。

And that's when you realize, I think pain is just a it's a it's a mysterious thing.

有些人对疼痛的反应截然不同。

And some people respond very differently.

甚至同一个人在不同时间的反应也可能不一样。

And even the same person may respond differently at different times.

比如，如果我一周后才给乔安娜二号做手术，她的结果可能会完全不同，那是因为她当时压力更小、营养更好。

Like, I had done Joanna two's operation a week later, maybe she would have had a totally different outcome, and that would have been because she was less stressed, was better fed.

你知道，她还没和她妈妈进行过一次艰难的对话。

You know, she hadn't had a difficult conversation with her mom.

外面的天气更好了。

The weather was nicer outside.

这真的太不可思议了。

It's really wild.

在疼痛这种问题上，那些你认为无关紧要的事情，实际上可能至关重要。

The things that you don't think matter can matter a whole lot when it comes to something like pain.

是的。

Yeah.

我认为这正是围绕疼痛产生大量误解的地方，许多医疗专业人员会轻视患者的疼痛。

And I think that's where there's a lot of miscommunication around pain, and a lot of medical professionals can dismiss people's pain.

或者当他们试图指出疼痛有心理成分时，患者却会理解为他们在说：‘这是你编出来的’、‘这只是你脑子里想的’、‘你只需要放松一下’，但实际情况远没有这么简单。

Or if they're trying to say that there's a mental component, it ends up sounding to the patient like they're saying, you're making this up, or it's all in your head, or you just need to relax, when it's not quite as simple as that.

我认为你所提到的这一点，一直是主要的挑战之一。

The point you're hitting on, I think, has been one of the big challenges.

我认识的医生，他们的本意并不是要淡化病情，但患者必须是核心。

The doctors I know, that's not their intent to minimize, but the patient has to be the North Star.

我认为任何好医生都会告诉你这一点。

I think that's what any good doctor will tell you.

你必须倾听患者，并认识到疼痛是非常神秘的。

You have to listen to the patient and recognize that pain is pretty mysterious.

是的。

Yeah.

而且我们要对我们不了解的事情保持谦逊。

And be sort of humble I think about what we don't know.

是的。

Yeah.

第一点启示。

Takeaway one.

即使没有受伤或组织损伤，疼痛也可能存在。

Pain can exist even in the absence of injury or tissue damage.

即使在受伤愈合后，疼痛也可能持续存在。

It can also linger well after an injury has healed.

即使你已经不再拥有那个身体部位。

Even if you no longer have that body part.

当然，我在这里说的是幻肢综合征。

Of course there I'm talking about phantom limb syndrome.

此外，研究人员表示，我们的环境和情绪会影响我们的疼痛程度。

Also researchers say that our surroundings and our emotions can affect our pain levels.

当我们的身体感知到危险时，即使实际上并不存在危险，我们也会感到疼痛。

And we can feel pain when our body perceives danger, even if there isn't any.

澳大利亚一位疼痛研究者曾在一次TEDx演讲中讲述，他曾在丛林中行走时被毒蛇咬伤。

There was this TEDx talk from a pain researcher in Australia and he talked about how he'd been walking in the bush when he got bitten by a venomous snake.

他最终不得不前往医院，情况非常严重。

And he ended up having to go to the hospital, and it was really serious.

但在那之后大约六个月，当他康复后，再次在丛林中行走时，他感到一阵剧烈的疼痛。

And then after that, about six months later, when he had recovered, he was walking in the bush, and he felt this excruciating pain.

他以为自己又被咬了，但结果只是被一根树枝划了一下。

And he assumed he'd been bitten again, but it turned out he'd just been scratched by a twig.

那么，那里到底发生了什么？

So what is going on there?

也就是说，疼痛研究人员认为那里发生了什么？

Like, what do pain researchers think is going on there?

如果你想想疼痛存在的原因，它可能是身体上的疼痛。

If you think about why pain exists, it could be physical pain.

它也可能是心理上的痛苦，甚至是存在性的痛苦。

It could be mental pain, even existential pain.

它的主要作用是一种警告。

It mainly serves as a warning.

它在向你警示某种危险。

It's alerting you to some sort of danger.

而人们的预警系统可能具有不同的敏感度。

And people's warning systems can have different sensitivities.

但基本上，大脑是在决定：小心点，一定要非常小心。

But basically the brain is like deciding, Hey, be really careful here, be really careful.

我能告诉你要非常小心的最好方式，就是让你感到疼痛。

The best way I can tell you to be really careful is to give you pain.

如果我在这种情况下让你感到疼痛，你很可能会采取回避行为。

You're likely to practice avoidance behavior if I give you pain in this situation.

所以大脑正在试图做出这个决定。

So the brain's trying to make that decision.

但它并不总是能做出正确的判断。

It doesn't always get it right.

有时候，疼痛的程度远远超过了它应有的程度。

It sometimes the pain can be way out of proportion to what it should be.

但同样的现象很可能也发生在这位先生身上。

But that same sort of phenomenon likely happened with this particular gentleman.

是的。

Yeah.

我认为这在慢性疼痛中也会出现。

And I think that this can show up in chronic pain.

对吧？

Right?

在某些情况下，医生找不到潜在的原因或损伤。

The doctors can't find, in some cases, an underlying cause or an injury.

没错。

Right.

或者曾经有过损伤，但现在组织已经愈合了。

Or maybe there used to be an injury, but now the tissue has healed.

但这个人仍然经历着严重或持续的疼痛。

And this person still has severe or consistent pain.

或者疼痛时有时无，反复出现又消失。

Or it just it comes back and it it goes away, and then it comes back again.

是的。

Yes.

慢性疼痛是指持续至少三个月的疼痛。

Chronic pain is is pain that's occurring for at least three months.

好的。

Okay.

所以他们试图为它设定一个时间标准。

So they they've tried to put a timetable on it.

但有些人疼痛持续了几十年，所以你知道，它可能持续非常长的时间。

But there are people who have pain for decades, so, you know, it can last a really long time.

为什么会这样，这仍然是一个非常有趣且基本上未被解答的问题。

Why that happens, it's still a really interesting and I think mostly unanswered question.

比如，从进化角度来看，我们理解疼痛的存在是为了让你吸取教训。

Like, we understand why pain exists from an evolutionary standpoint to teach you a lesson.

摸一下热炉子。

Touch a hot stove.

很疼。

Hurts.

别再这样做了。

Don't do that again.

这些教训看起来很明显。

Those lessons seem obvious.

组织修复后，没有持续的组织损伤，但疼痛依然存在。

After the repair of the tissue, no ongoing tissue injury, and yet the pain persists.

这就涉及到了疼痛中更加神秘的方面。

This gets into the much more mysterious aspects of pain.

有时候你能找到明显的病因。

Sometimes you can find obvious causes.

我是神经外科医生。

I mean, I'm a neurosurgeon.

我治疗很多脊柱损伤的患者，但有时候你找不到原因。

I take care of a lot of patients with spine injuries, but sometimes you don't.

我认为对很多疼痛科医生来说，问题变成了：那接下来该怎么办？

And I think the question becomes for a lot of pain doctors, so what do you do then?

你会开始探究情感创伤吗？

Do you start to probe for the emotional trauma?

你会开始探寻其他可能加剧或放大这一问题的因素吗？

Do you start to probe for other things that could be potentially worsening this or amplifying the underlying issue?

任何因素都可能与疼痛有关，尤其是当疼痛变成慢性的时候，没有任何禁忌。

There's nothing off limits in terms of possibly contributing to pain, especially when that pain becomes chronic.

第二个要点：慢性疼痛是指持续至少三个月的疼痛。

Takeaway two, chronic pain is pain that's occurred for at least three months.

有时它发生在已知的损伤或创伤之后，组织愈合了但疼痛依然存在；另一些时候则没有明显的诱因。

Sometimes it happens after a known injury or trauma, the tissue heals but the pain remains, And other times there's no obvious cause.

桑贾伊说，关于疼痛为何从急性转为慢性，仍然有很多未解之谜。

Sanjay says there are still a lot of unanswered questions about why a pain turns from acute to chronic.

我想告诉你一件让我着迷的事，那就是疼痛慢性化过程中，炎症在受伤时所起的作用。

I tell you one of the things that fascinated me just with regard to that chronification of the pain, just the role of inflammation, for example, at the time of injury.

比如说，你扭伤了脚踝，脚踝会肿胀、发红、疼痛。

Let's say you get a sprained ankle, for example, your ankle is swollen, it is red, it's painful.

你需要采取措施来减轻炎症。

You want to do things to minimize inflammation.

我们长期以来一直被这样告知。

That's what we had long been told.

你可能听过一个缩写词：RICE，即休息、冰敷、加压和抬高。

One of the acronyms you probably heard, RICE, Rest, Ice, Compression, Elevate.

所有这些方法本质上都是为了减少炎症。

All those things fundamentally decrease inflammation.

但几年前有一篇论文彻底颠覆了我们对这个问题的看法。

But there was a paper that came out a couple of years ago that kind of really upended the thinking on this.

这些研究人员试图回答一个问题：谁更有可能患上慢性疼痛？

It was these researchers who were trying to answer the question, who is more likely to have chronic pain?

比如，哪些人群更容易患病？他们的病史是怎样的？

Like what demographic of people, what is their medical history?

他们的血液检查结果如何？

What does their blood work look like?

他们发现的令人惊讶的是，也是让所有人都感到意外的是，在受伤时炎症水平最高的人，反而最不可能出现慢性疼痛。

And the thing that they found that surprised them, and I think surprised everybody, was the people who had the highest levels of inflammation at the time of injury were the least likely to have chronic pain.

因此，受伤时炎症越多，出现慢性疼痛的可能性就越低，这几乎与所有人之前的认知相反。

So more inflammation at the time of injury, less likely to have chronic pain, which is almost the opposite of what everyone thought.

我们该如何理解这一点呢？

What are we to do with that?

我的意思是，当有人受伤了，比如脚踝扭伤之类的，我想你现在从疼痛科医生那里听到的建议是，他们会说：嘿。

I mean, when someone's injured, sprained ankle, whatever, I think what you're hearing now from pain doctors, they'll basically say, hey.

看。

Look.

正视疼痛。

Lean into the pain.

活动关节。

Mobilize the joint.

甚至进行锻炼。

Exercise even.

如果需要，可以使用止痛药，但不要使用抗炎药。

Use analgesia, pain medication, if necessary, but don't use anti inflammatories.

还有治疗。

And treatment.

告诉受伤的人要起来走动或做点什么，这其实挺有意思的，因为这并不是他们平时听到的建议。

It's really interesting, you know, to tell people who are injured to get up and walk on it or do whatever because that's not what they're used to hearing.

但几乎就像是，如果你让身体自己发挥作用，让那些炎症分子迅速赶到现场并完成它们的工作，它们的表现其实相当不错。

But it's almost like if you allow the body to do its job, if you allow those inflammatory molecules to rush to the scene and do their job, they do a pretty good job.

如果你尽早进行活动，并不那么专注于减轻炎症，你就更不容易出现慢性疼痛。

And you're less likely to have chronic pain if you do that early mobilization and don't focus as much on decreasing inflammation.

广告后我们将继续听桑贾伊·古普塔的分享。

We'll hear more from Sanjay Gupta after the break.

让我们聊聊研究人员说的一些有助于康复的方法。

Let's talk about some of the things that researchers say can help.

我曾经有一段时间坐骨神经痛。

So I had sciatic pain for a while.

有时候疼痛会突然加剧，简直剧烈搏动。

Sometimes it would flare up, and it would be absolutely, like, throbbing.

我曾和一位治疗师交谈，她让我尝试这个练习。

And I was speaking to a therapist who had me try this exercise.

她说要集中注意力在疼痛的部位，我记得是这样。

She said to focus on I believe it was focus on the area that had pain.

就是全神贯注地感受它，持续多久我也不太记得了。

Like, focus intently on it for I don't know.

可能是二十秒左右吧。

Maybe it was, like, twenty seconds or something.

然后把注意力转移到身体其他完全不痛的地方。

And then toggle my focus to something else on my body that didn't feel painful at all.

我选了耳垂，因为平时碰它也没感觉。

So I chose my earlobe because it feels like nothing unless I touch it.

然后专注在耳垂上大约二十秒，再把注意力转回疼痛的部位。

And then focus on that for, like, twenty seconds, and then toggle back to the part that hurt.

我发誓，这就像把疼痛的旋钮调低了。

And I swear, it's like it turned the dial down on the pain.

疼痛从剧烈的七分左右降到了二三分。

It went from throbbing, like, maybe at a seven to a two or a three.

当时我觉得这简直像魔法一样。

It felt like magic at the time.

是的。

Yeah.

这太不可思议了。

That's pretty incredible.

对于大量患有这种慢性疼痛但没有明显解剖学问题的人——听起来你就是这种情况——这种方法往往非常有效。

And for a significant percentage of people who have that sort of chronic pain with, again, without an underlying anatomical problem, which sounds like the case for you, it can be really effective.

我要说的是，当我查阅相关数据和类似疗法的研究时，有一种特别的疗法叫MORE，即正念导向的康复增强疗法，他们也会做类似的事情。

I will say, when I looked at the data and I looked at data around similar protocols, there was one protocol in particular called MORE, which is Mindfulness Oriented Recovery Enhancement, and they would do similar things.

他们会说，不仅要正视疼痛，还要想象一个愉快的场景。

They would say, Hey, not only lean into the pain, but then also think of a pleasant scene.

这种想法认为，疼痛的负面影响可以通过想象一些更愉快的事物来缓解，无论那是花朵、日落，还是与孩子的时光。

This sort of idea that the toxicity of the pain could be somehow remedied by thinking about something that was far more pleasant, whatever it might be, flowers, sunset, time with your kids.

这种做法对一部分人非常有效，但并非对所有人都有效，这一点要明确。

And it seemed to be really effective in a percentage of people, not everybody, to be clear.

但对于那些从中受益的人而言，效果极其显著。

But for the people who for whom it was beneficial, it was extremely beneficial.

在他们实际进行MORE疗法期间，有一段时间他们的疼痛评分确实降低了。

While they were actually undergoing the MORE protocol, for a period of time, they could take their pain scores down.

疼痛会再次出现。

The pain would come back.

这类疗法的效果是有半衰期的。

There is a half life to these sorts of therapies.

但你所提到的这种疗法，Mariel，或者这种包含多种成分的正念导向康复增强疗法，能够在一段时间内将疼痛评分降低到如此程度，这证明了疼痛在多大程度上是大脑活动的结果，以及我们在多大程度上能够掌控它。

But the idea that the type of therapy that you're talking about, Mariel, or this mindfulness oriented recovery enhancement, which has many components to it, could bring pain scores down that low for a period of time was proof of concept of just how much of this is occurring in the brain and how much of that was in our control.

第三点启示：大脑训练和正念练习是治疗无明确损伤的慢性疼痛的有前景的方法。

Takeaway three, brain training and mindfulness exercises are promising treatments for chronic pain where there's no identifiable injury.

这些练习是免费的，你可以在家进行，而且没有任何负面副作用。

These exercises are free, you can do them at home, and they have no negative side effects.

那为什么不试试呢？

So why not try, right?

它们可以包括引导性想象、身体扫描——从头部到脚部 mentally 扫描并专注于感觉而不加评判，还有冥想和写作练习等。

They can include guided visualizations, body scans where you mentally scan from your head to your feet and focus on the sensations without judgment, meditation and writing exercises among other things.

此外，与专攻慢性疼痛的临床医生进行谈话治疗也可能有帮助。

Also talk therapy with a clinician who specializes in chronic pain could be helpful.

他们会了解这些练习，并能帮助你应对一些研究者认为在慢性疼痛患者中更常见的倾向，比如完美主义。

They'll know about these kinds of exercises and they can help you work through tendencies that some researchers say are more common in people with chronic pain, like perfectionism.

还有一些应用程序可以引导你完成这些练习并提供提示。

There are also apps that can walk you through these exercises and give you prompts.

很多人使用的各种策略都属于正念的范畴，不同类型的正念。

A lot of strategies that people use sort of in the bucket of mindfulness, different types of mindfulness.

比如一种分析型冥想，你真正地分析自己的疼痛，以一个好奇的观察者身份对待它，而不是让疼痛占据你的身体。

So like an analytical sort of meditation where you are truly analyzing your pain and treating it as a curious observer rather than having that pain inhabit your body.

哎，我就想，哦，这太有趣了。

Like, I'm just gonna, oh, this is fascinating.

让我看看这里到底发生了什么。

Let me see sort of what's happening here.

哦，原来是这个形状。

Oh, it's this shape.

这是分析型的，和那种你想着愉快事情的冥想方式不同。

And it's that analytical versus the type of meditation where you might be thinking about something pleasant.

还有各种其他的疗法。

There are all sorts of other therapies.

我的意思是，全国各地的一些急诊室几乎都不使用阿片类药物。

I mean, there's emergency rooms around the country that will hardly use any opioids.

它们被称为无阿片或少阿片急诊室。

They are called opioid free or opioid sparing emergency rooms.

除了冥想之类的方法，他们还在使用氯胺酮。

Besides things like meditation, they're using things like ketamine.

有些病人会接受神经阻滞。

You have patients who will get nerve blocks.

我见过一位八十岁的老人，他摔倒了，髋骨骨折，非常疼痛，但他不愿意使用麻醉药，急诊室也不愿意给他开麻醉药。

So I saw an eighty year old guy who came and fell, broke his hip, very painful, did not want narcotics and the ER did not want to give him narcotics.

他接受了神经阻滞，整个过程大约花了十分钟。

He got a nerve block, took about ten minutes for the nerve block.

会有一支团队前来操作，但他的疼痛缓解速度比使用阿片类药物要快得多。

You have a team that comes down and does it, but he got faster pain relief in terms of how quick the nerve block kicked in than he would have if he had been given opioids.

这些并不是新的疗法，但我认为阿片类药物长期以来占据了所有关注。

These are not new therapies, but I think opioids are just sucked all the oxygen out of the room for a long time.

许多现有的疗法因此被弱化甚至忽视了。

And a lot of existing therapies got minimized or even ignored.

你是要让我别吃药，而是去冥想吗？

Are you gonna tell me to go be mindful instead of taking a pill?

但在我们国家，人们过去并不是这样思考的。

It just wasn't how people were thinking in this country.

这种情况正在开始改变。

It's starting to change.

但我认为我写这本书的部分原因，是想向人们展示背后的数据，让他们看到希望，知道未来还有其他非常有效的选择。

But I think part of the reason I wrote the book was I wanted to show people the data behind this, you know, and give them some hope that there were other really, really effective options moving forward.

第四点：除了阿片类药物，还有其他缓解疼痛的方法，除了我们之前提到的心理锻炼，以及非甾体抗炎药和对乙酰氨基酚等止痛药。

Takeaway four, There are other options for pain relief besides opioids and in addition to the mental exercises we talked about and painkillers like NSAIDs and acetaminophen.

你可能可以接受神经阻滞或触发点注射，也就是医生将局部麻醉药，有时还加上类固醇，直接注射到肌肉中以治疗疼痛的结节。

You might be able to get a nerve block or a trigger point injection which is when your doctor injects a local anesthetic and sometimes a steroid directly into your muscle to treat painful knots.

还有局部治疗方法，比如热敷和利多卡因贴片。

There are topical treatments like heat packs and lidocaine patches.

一些医生会用低剂量的氯胺酮治疗患者，这可以快速缓解疼痛，并在慢性疼痛发作时有所帮助。

Some doctors treat their patients with low doses of ketamine, which can provide rapid pain relief and be helpful when chronic pain flares.

此外，还有一些生活方式习惯可能有助于减轻你的疼痛。

Also there are lifestyle habits that might improve your pain levels.

规律运动、改善睡眠、抗炎饮食，甚至人际连接。

Regular movement, better sleep, an anti inflammatory diet, and even connection.

有朋友，有社群。

Having friends, having community.

知道其实有很多方法可以尝试，这很有帮助。

It's helpful to know there are actually lots of things to try.

你只需要接入正确的信息或找到合适的诊所。

You just have to get plugged into the right information or the right clinic.

找到疼痛诊所或疼痛科医生有多容易？

How easy is it to find a pain clinic or a pain doctor?

这很有挑战性。

It's challenging.

是的。

Yeah.

我的意思是，这真的很有挑战性。

I mean, it is really challenging.

而且，你知道，我写这本书时有一个大胆的想法：当你在医院工作时，尤其是写书的时候，你往往会看到事情是如何运作的。

And, you know, I think I had an audacious sort of thought when I was writing the book that when you work in a hospital, and especially if you're writing a book, you tend to see how things work.

你意识到，很多这些方法都可以融入人们的日常生活。

And you recognize that a lot of those things are adaptable into people's lifestyles.

疼痛医生是非常了不起的人，因为坦白说，他们无所不能。

Pain doctors are are remarkable people because they you know, frankly, they're everything.

他们就像多功能瑞士军刀。

They're like these Swiss army knives.

他们是医生。

They're doctors.

他们也是心理学家。

They're psychologists.

他们懂得各种治疗方法。

They understand techniques.

他们知道如何进行神经阻滞。

They know how to do nerve blocks.

显然，其中很多技术你在家是根本不可能实施的。

Obviously, many of those things you could never possibly do at home.

但我认为有很多事情是你能做的，我们比以往任何时候都更痛苦的原因也有很多，其中很多都在我们的掌控之中。

But I think there's a lot of things that you can do, and there's lots of reasons why we are hurting more than ever, and many of those things are within our control.

桑贾伊，非常感谢你分享这些。

Sanjay, thank you so much for this.

和你聊天真的很愉快。

It's been really nice to talk to you.

我都可以整天聊这个，你知道的？

I could talk about this all day, you know?

我也是。

Same.

好吧。

All right.

该做个小结了。

Time for a recap.

第一点收获。

Takeaway one.

疼痛即使在没有受伤或组织损伤的情况下也可能存在。

Pain can exist even in the absence of injury or tissue damage.

它也可能在受伤愈合后持续很久。

It can also linger well after an injury has healed.

研究人员表示，我们的环境和情绪也会影响我们的疼痛程度。

And researchers say that our surroundings and our emotions can affect our pain levels too.

要点二：慢性疼痛是指持续至少三个月的疼痛。

Takeaway two: Chronic pain is pain that's occurred for at least three months.

有时这发生在已知的受伤或创伤之后。

Sometimes this happens after a known injury or trauma.

其他时候则没有明显的诱因。

Other times there's no obvious cause.

要点三：对于没有明确受伤原因的慢性疼痛，大脑训练和正念练习是颇具前景的治疗方法。

Takeaway three: Brain training and mindfulness exercises are promising treatments for chronic pain where there's no identifiable injury.

这些方法可以包括引导性想象、身体扫描、写作练习、冥想等。

These can include guided visualizations, body scans, writing exercises, meditation and more.

此外，与专门治疗慢性疼痛的临床医生进行心理治疗也可能对你有帮助。

Also talk therapy with a clinician who specializes in chronic pain could be helpful for you.

第四点，除了阿片类药物，以及那些心理训练和非甾体抗炎药、对乙酰氨基酚等止痛药外，还有其他缓解疼痛的选择。

And takeaway four, there are other options for pain relief besides opioids and alongside those mental exercises and painkillers like NSAIDs and acetaminophen.

你可能可以接受神经阻滞或触发点注射。

You might be able to get a nerve block or a trigger point injection.

还有外用治疗方法，比如热敷和利多卡因贴片。

There are also topical treatments like heat packs and lidocaine patches.

一些医生会给患者使用低剂量的氯胺酮。

And some doctors give their patients low doses of ketamine.

此外，一些生活方式的改变也可能有助于缓解慢性疼痛，包括规律运动和睡眠、抗炎饮食，以及更多地与他人互动。

Also, some lifestyle changes might help with chronic pain levels, including regular movement and sleep, an anti inflammatory diet, and connecting more often with other people.

这就是我们的节目。

And that's our show.

不过，在你离开之前，你觉得在你的播客应用中为《LifeKit》打分和评论怎么样？

While you're here though, what do you think about rating and reviewing LifeKit in your podcast app?

这里有一条我最近喜欢的听众fwalter819的评论。

Here's a recent review I liked from listener fwalter819.

主题：坦白说。

The subject line: Admit it.

你也很需要这个。

You need this too.

我通过艰难的方式学到了这些教训，因此我推荐Life Kit。

Having learned many of these lessons the hard way I recommend Life Kit instead.

对于他们涵盖的那些我从未学过的教训，谢谢。

And for all the lessons they cover that I never learned, thanks.

迟来总比不来好。

Better late than never.

感谢收听，FWalter819。

Thanks for listening FWalter819.

本集Life Kit由玛格丽特·塞里诺制作。

This episode of Life Kit was produced by Margaret Cerrino.

我们的数字编辑是马利卡·加里布，梅根·凯恩是我们高级主管编辑。

Our digital editor is Malika Garib and Megan Cain is our senior supervising editor.

贝丝·多诺万是我们执行制片人。

Beth Donovan is our executive producer.

我们的制作团队还包括安迪·泰格尔、克莱尔·玛丽·施耐德、西尔维·道格拉斯和米卡·艾利森。

Our production team also includes Andy Tegel, Claire Marie Schneider, Sylvie Douglas, and Mika Ellison.

工程支持由蒂芙尼·维拉·卡斯特罗提供。

Engineering support comes from Tiffany Verra Castro.

事实核查由泰勒·琼斯和巴克莱·沃尔什负责。

Fact checking by Tyler Jones and Barclay Walsh.

我是玛丽埃尔·塞加拉。

I'm Mariel Segarra.

感谢收听。

Thanks for listening.