Ezra Klein

Well, this goes back to the point about chronic pain being a less reliable guide to harm than acute pain. And so tell me about this idea that the brain practices pain.

埃兹拉·克莱因

这又回到了慢性疼痛作为伤害指南不如急性疼痛可靠的观点。所以，请告诉我大脑练习疼痛（practices pain）的观点。

Rachel Zoffness

People often ask me, well, I’ve had pain for five years, seven years, 20 years. What makes pain chronic? How does pain become chronic? And there are multiple processes by which pain becomes chronic. And one of those processes is called central sensitization.

雷切尔·佐夫内斯

人们经常问我，嗯，我已经痛了五年、七年、20年了。是什么让疼痛变成慢性的？疼痛如何变成慢性的？疼痛变成慢性的过程有好多个。其中一个过程称为中枢敏化（central sensitization）。

Was there ever a skill that you were bad at, and you practiced it over time, and you got good at it eventually? For me, it was piano. I was terrible at it, and my mom made me practice, and over time, I got good at piano. What about you?

有没有你不擅长的技能，你常常练习它，最终你变得擅长了？对我来说，那是钢琴。我弹得很烂，我妈妈让我练习，随着时间的推移，我的钢琴弹得很好。你呢？

Ezra Klein

It took me a very long time to figure out how to tie my shoes, like longer than you would think reasonable. I had a bunch of spatial reasoning issues when I was a young kid, and things like that were hard for me. Now, super easy. Can do it. Can tie my shoes, can tie my kids shoes, can tie your shoes. It’s unbelievably straightforward.

埃兹拉·克莱恩

我花了很长时间才弄清楚如何系鞋带，比你想象的要长。当我还是个孩子的时候，我遇到了很多空间推理问题，像这样的事情对我来说很难。现在，超级简单。可以做到。可以系我的鞋，可以系我孩子的鞋，可以系你的鞋。它简单得令人难以置信。

Rachel Zoffness

The clinician me wants to ask so many questions about that, but I’m stopping myself. Great. So I’m going to say this back to you in neuroscience language. We all know that the brain changes with time and experience. We all know that the brain is plastic.

雷切尔·佐夫内斯

作为临床医生的我想问很多关于你的那个的问题，但我现在不能·。好的。让我用神经科学的语言告诉你。我们都知道大脑会随着时间和经验而变化。我们都知道大脑是可塑的。

There’s this term neuroplasticity, and what that means is the brain changes, again, with time and experience and exposure to things. So the pathways in your brain are like the muscles in your body. The more you use them, the bigger and stronger they get.

有一个术语，神经可塑性（neuroplasticity,），这意味着大脑会随着时间、经验和对事物的接触而发生变化。所以你大脑中的通路就像你身体中的肌肉。你使用它们的次数越多，它们就会变得越大越强。

So Ezra, if you said to me, Zoffness, I want really huge biceps, I would say, that’s cool, Ezra. Go to the gym or get some free weights and lift weights over and over, over many days, and you will see with practice and time and experience, the muscles in your arms, your biceps will get really big and strong.

所以，以斯拉，如果你对我说，佐夫内斯，我想要非常大的二头肌，我会说，这很酷，以斯拉。去健身房或者做一些自由重量和举重，在很多天里，随着练习、时间和经验，你会看到你手臂上的肌肉，你的二头肌会变得非常大和强壮。

Ezra Klein

A bunch of bros are like, you just completely skipped over protein intake and caloric excess. I’m going to get so many emails about this.

埃兹拉·克莱恩

一群我的听众兄弟就会跳起来：你完全跳过了蛋白质摄入和热量过剩。我将会收到很多关于这个的电子邮件（即听众抱怨）。

Rachel Zoffness

Oh, God. I hope not. Right, and I just want to say up front, I am simplifying some very complex processes, and I’m doing that on purpose. So the pathways in the brain are like the muscles in your body. The more you use certain pathways, the bigger and stronger those pathways get.

雷切尔·佐夫内斯

天啊。我希望不会。是的，我只想预先说明，我正在简化一些非常复杂的流程，而且我是有意这样做的。所以大脑中的通路就像你身体中的肌肉。你使用某些途径的次数越多，这些途径就会变得越大越强。

So for me, I mentioned that growing up I didn’t really like playing the piano, but my mom really wanted me to practice. So I would sit and practice. And over time, what happened, and everyone who’s ever played an instrument knows this, eventually, my fingers just magically knew what to do. I didn’t even have to look at the sheet music, and I could hear Chopin in my head. I didn’t even have to listen to the song to hear the music.

所以对我来说，我提到我从小就不喜欢弹钢琴，但我妈妈真的很想让我练习。所以我会坐下来练习。随着时间的推移，发生了什么，所有玩过乐器的人都知道这一点，最终，我的手指神奇地知道该怎么做。我什至不用看乐谱，我就能在脑子里听到肖邦的声音。我什至不必听这首歌，就能听到它的音乐。

So what was happening is that, again, our neuroplastic brain will change with time and practice and experience. So the piano pathway in my brain got bigger and bigger and stronger and stronger the more I played the piano. Guess what happens in the brain the more it inadvertently and accidentally, and I put in quotes, “practices pain?”

原来，我们的神经可塑性大脑，将随着时间、实践和经验而改变。所以我弹钢琴的次数越多，我大脑中的钢琴通路就变得越来越大，越来越强。猜猜大脑中发生的事情越多，它越是不经意地和偶然地，我用引号引起来，“训练痛？” （ “practices pain?”）

（译者注：“practices pain” 不容易翻译，如果你能借用“背痛”，把“背”换成“训练”，比方说弹钢琴训练。试一下。）

The pain pathway in your brain, which, by the way, is not a real thing. There’s no real pathway. There’s lots of parts of your brain that are contributing to pain in your central nervous system, but the more you practice pain for the sake of this analogy, the bigger and stronger the pain pathway in your central nervous system gets.

你大脑中的疼痛通路，顺便说一句，这不是真实的东西。没有真正的“途径”。大脑的很多部分都会导致中枢神经系统疼痛，你体验疼痛（practice pain）的次数越多，中枢神经系统中的疼痛通路就会变得越大越强。

And when that happens, we say that your brain has become sensitive to pain. When we have pain and our pain pathway has become big and strong, what that means is our finely tuned wonderful brain is now picking up on sensory messages from the body and interpreting them as dangerous and amplifying that, even though they’re not dangerous and they don’t need to.

当这种情况发生时，我们说你的大脑对疼痛变得敏感。当我们感到疼痛并且我们的疼痛通路变得又大又强时，这意味着我们精心调整的奇妙大脑现在正在接收来自身体的感官信息并将它们解释为危险并放大，即使它们并不危险并且不需要。

And one great example I like to use of this is with my fibromyalgia patients who have chronic pain, and they go to the park for a picnic, and their brain gives them these loud danger messages, danger, danger. And I think everyone can agree that going to the park when you have fibromyalgia is not dangerous, but your brain is telling you that it’s dangerous anyway.

我喜欢用的一个很好的例子，是患有慢性疼痛的纤维肌痛患者，他们去公园野餐，他们的大脑给了他们这些响亮的危险信息、危险、危险。而且我认为每个人都会同意，当你患有纤维肌痛时去公园并不危险，但你的大脑告诉你，无论如何这都是危险的。

And what I like about this analogy is that it really drives home this idea that pain is really a danger message and the pain system is your danger detection system. And it isn’t always right. And if you’re someone living with pain, and you believe that it’s dangerous for you to go outside and go for a walk, and that it’s dangerous to see friends, you are never going to get well.

我喜欢这个类比的原因是，它确实让人们明白了疼痛实际上是一种危险信息，而疼痛系统就是你的危险检测系统。它并不总是正确的。如果你是一个生活在痛苦中的人，并且你认为出去散步对你来说很危险，而且会见朋友很危险，那么你永远不会好起来。

Because part of the chronic pain cycle is staying inside, and staying in bed, and missing out on life, and that’s understandable. And a lot of people do need to do that, so I’m not saying to never do that. But with chronic pain, it turns out that that kind of pain cycle is the thing that ultimately amplifies pain, perpetuates disability and prevents healing.

因为慢性疼痛循环的一部分是呆在家里、躺在床上、错过生命，这是可以理解的。很多人确实需要这样做，所以我并不是说永远不要那样做。但对于慢性疼痛，事实证明，这种疼痛循环最终会加剧疼痛，使残疾永久化并阻碍愈合。

Ezra Klein

So I had an interesting experience with your book over the weekend.

Rachel Zoffness

I’m dying to hear about this.

埃兹拉·克莱因

我在周末对你的书有了一次有趣的体验。

雷切尔·佐夫内斯

我很想听到这件事。

Ezra Klein

Because I so I mentioned that I have neck and shoulder pain. And something will happen, or I’ll sleep weird, and my neck will crick. But also a couple of times, I was working out and something happened, and I couldn’t move for three or four days, and it was awful.

And then recently, after that experience, like the second really, really rough injury, which happened a couple of months ago, something weird has occurred. And I’ve been scanned, and poked, and prodded, and chiropracted, and nobody can find —

埃兹拉·克莱因

我常常提到我有颈部和肩部疼痛。并且会发生一些事情，否则我会睡得很不踏实，我的脖子会痉挛。但也有几次，我在锻炼时发生了一些事情，我三四天都不能动弹，这太糟糕了。

然后最近，在那次经历之后，就像几个月前发生的第二次非常非常严重的伤害一样，发生了一些奇怪的事情。我被扫描、戳戳这里、戳戳那里、脊椎按摩，但没有人能找到——

Rachel Zoffness

Biological, biological.

雷切尔·佐夫内斯

生物性的，生物性的（病因）。

Ezra Klein

— anything wrong. There’s no issue as far as anybody can tell. Very small things, where I feel a twinge will shut me down much more than they did before. Like I tripped over a cobblestone but didn’t fall, and just felt like the vibration my neck, and was immediately like, oh, no.

Or this weekend, my son dropped a cookie, and I bent down to pick up the cookie, and I just felt a —

I was like, oh, no. And I don’t think anything is going wrong, actually, but I have gotten more afraid of it. And the idea that I’ve become more sensitive feels very true psychologically, that compared to where I was after a couple of really bad experiences, I am more afraid. I freeze up more.

And in a world where part of what is happening is my mind is predicting if something is really gone wrong, a world in which I am constantly wary and scanning for the possibility that something has really gone wrong, is a world that might help explain why this thing nobody can pick up on a scan keeps becoming more sensitive and more problematic.

So it wasn’t good for my weekend exactly, but it extremely good for reading your book and being able to bring a lot of attention to it because it felt very — sensitivity feels like what it’s been.

埃兹拉·克莱恩

- （没有人能找出）哪里有问题了。任何人都可以说，没有问题。非常小的事情，我觉得刺痛会让我比以前更沮丧。就像我被鹅卵石绊倒但没有摔倒，只是感觉脖子在颤抖，然后马上就想，哦，不行了（我会痛）。

或者这个周末，我儿子掉了一块饼干，我弯下腰去捡饼干，我只觉得——

我当时想，哦，不行了（我会痛）。事实上，我不认为有任何问题，但我越来越害怕它。我变得更加敏感的想法在心理上非常真实，与我在经历了几次非常糟糕的经历之后的状态相比，我更加害怕。我害怕得更厉害了。

在一个正在发生的事情的一部分世界里，是我的大脑在预测是否真的出了问题，在一个我不断保持警惕并寻找真的出了问题的可能性的世界里，这个世界可能有助于解释为什么这个扫描时，没人能发现的东西变得越来越敏感，问题也越来越多。

所以这对我的周末来说并不好，但非常适合阅读你的书并能够引起很多关注，因为它感觉非常 --- 敏感度就像是在过去发生那样。

（待续）