Ezra Klein

Rachel Zoffness, welcome to the show.

Rachel Zoffness

Ezra Klein, so cool to be sitting across from you.

Ezra Klein

What is pain?

埃兹拉·克莱因

         雷切尔·佐夫内斯，欢迎来到这个节目。

雷切尔·佐夫内斯

          埃兹拉·克莱因，坐在你对面真酷。

埃兹拉·克莱因

          什么是痛？

Rachel Zoffness

Pain is the body’s warning system. It’s our danger detection system. And I’m a nerd, capital N. And I’ve always been a nerd, and I remember taking neuroscience at Brown as an undergrad. And I had this wonderful professor, Mark Bear. I think he’s at M.I.T. now. And he was explaining pain to us. And he explained that there are some people who are born with such an extremely high pain threshold, that they don’t really feel or experience pain. And I remember thinking that sounds so wonderful. And then he went on to say, and those people don’t live very  time. Because if you think about it, you go for a run, you break your leg, your body doesn’t give you any danger messages, that’s extremely bad for your body.

雷切尔·佐夫内斯

疼痛是身体的预警系统。这是我们的危险检测系统。我是个书呆子，大写的 N（即书呆子）。我一直是个书呆子，我记得本科时在布朗大学学习神经科学。我有一位很棒的教授 Mark Bear。我想他现在在麻省理工学院。他向我们解释痛。他解释说，有些人天生就有极高的痛阈，他们不会真正感受到或体验到疼痛。我记得当时觉得这听起来太棒了。然后他接着说，那些人活不了多久。因为如果你想一想，你去跑步，你摔断了腿，你的身体不会给你任何危险信息，那对你的身体非常不利。

You put your hand on a stove and your skin is melting off, and you don’t get any danger or pain messages, that is very bad for your body. So at the end of the day, pain’s job is to protect you. But there’s many other things about pain that people don’t know. It’s complex, it’s subjective and it isn’t what you think it is. It doesn’t just live exclusively in the body is what I mean by that. So oftentimes, when people have pain, like a bad back or a bad knee, we are understandably convinced that that pain lives exclusively in our back. But that’s never, ever, ever true of pain.

你把手放在炉子上，你的皮肤正在被融化，你不会收到任何危险或疼痛的信息，这对你的身体非常不利。所以归根结底，痛的作用就是保护你。但是还有很多关于疼痛的其他事情，人们并不知道。它很复杂，很主观，而且不是你想的那样。它不仅仅存在于体内，这就是我的意思。所以很多时候，当人们感到疼痛时，比如背痛或膝盖痛，我们可以理解地相信这种疼痛只存在于我们的背部。但对于痛苦来说，永远、永远、永远都不是这样。

It turns out there’s a condition called phantom limb pain, which you may have heard of. And what phantom limb pain means is someone loses a limb, an arm or a leg, and they continue to have terrible pain in the missing body part. And what that tells us about pain and its location is that if pain lived exclusively in the body, no leg should mean no pain.

有一种叫做幻肢痛的病症，你可能听说过。幻肢痛意味着某人失去了四肢、手臂或腿，并且他们继续遭受在缺失的身体部位可怕的疼痛。这告诉我们关于疼痛及其位置的信息是，如果疼痛只存在于身体中，那么没有腿就不意味着疼痛。

And the fact that you can have terrible pain in your leg that’s no longer attached to your body tells us that pain is not actually produced exclusively by the body, but rather is constructed by the brain.

事实上，你的腿可能会感到非常的疼痛，而你的腿不再与你的身体相连，这告诉我们，疼痛实际上并不是完全由身体产生的，而是由大脑造成的。

Ezra Klein

And the treatment for that, or at least one of them, is a little mind bending, that you put a mirror up on the other leg. Can you talk about that?

埃兹拉·克莱因

对此，或至少有一种治疗是“欺骗”脑子，你在另一条腿上附近放了一面镜子。你能谈谈吗？

Rachel Zoffness

That’s right. You’ve done your research. There’s a couple of different proposed treatments for phantom limb pain, but one of them is — what happens in phantom limb pain is that your brain gets confused. There’s a part of your brain called your homunculus, and it’s a map of your entire body that lives in your brain.

雷切尔·佐夫内斯

是的。你已经做了调研。有几种不同的治疗幻肢痛的方法，但重要的是——幻肢痛会导致你的大脑变得混乱。你大脑的一部分叫做“小矮人”（homunculus；译者注：不知道中文如何翻译），它是你整个身体的地图，存储在你的大脑中。

So if I said to you right now, Ezra, sense into your foot and notice if it’s hot or cold, and see if you can feel your foot on the floor, you can do that. And one of the reasons you can do that — your brain — it’s complicated, but one of the reasons is because you have a whole map of your body that lives in your brain.

所以如果我现在对你说，埃兹拉，感受你的脚，注意它是热还是冷，看看你是否能感觉到你的脚在地板上，你可以做到。你能做到这一点的原因之一——你的大脑——它很复杂，但其中一个原因是因为你的大脑中有你身体的完整地图。

So what happens sometimes, not always, when you lose a limb, is that the map in your brain doesn’t disappear. So one of the treatments for phantom limb pain is called mirror therapy, where we hold up a mirror so that the brain can sort of get unconfused and recognize that the body part actually isn’t there anymore and the danger messages are no longer necessary, which is a slight oversimplification of what it is.

因此，当你失去一条肢体时，有时（并非总是）会发生的情况是，你大脑中的地图并没有消失。因此，幻肢痛的一种治疗方法称为镜子疗法，我们举起一面镜子，这样大脑就不会感到困惑，并认识到身体的一部分实际上已经不存在了，危险信息也不再需要了，这是对它的内容的轻微过度简化。

But again, this just drives home to me the point that when we have 15 back surgeries for back pain, or we see 25 knee specialists for the bad knee that we’ve had for 10 years, we’re not actually doing our job when we’re talking about treating pain effectively.

同样，这让我明白了一点，当我们因背痛进行了 15 次背部手术，或者我们看到 25 位膝关节专家治疗我们已经有 10 年的膝盖问题时，我们实际上并没有做好我们的治疗工作；因为 我们谈论的是有效治疗疼痛。

Ezra Klein

You write at one point that, quote, “The brain makes pain.” And then there’s this other line you’ll hear in our culture — “It’s all in your head.” What is the difference between those two statements?

埃兹拉·克莱恩

你在书里写道：“大脑制造痛苦。”然后你会在我们的日常生活中听到另一句话——“这一切都在你的脑子里。”这两个陈述有什么区别？

Rachel Zoffness

People with pain are often told, it’s all in your head when we can’t find a particular pathology or there’s pain of an unknown etiology, which happens to a lot of us or will happen to a lot of us, if it hasn’t already. Historically, that happened a lot to women in particular. So if they had pain, or God forbid strong emotions, they were diagnosed with hysteria and told their problems were all in their head.

雷切尔·佐夫内斯

经常告诉身体有疼痛的人，当我们找不到特定的病理或病因不明的疼痛时，一切都在你的脑子里，这发生在我们很多人身上；如果还没有发生，我们很多人都会在将来经历到。从历史上看，这种情况尤其发生在女性身上。因此，如果她们感到疼痛，或者（上帝保佑）强烈的情绪，她们就会被诊断为患有歇斯底里症，并被告知她们的问题都在她们的脑子里。

And pain is always real. The pain we feel is always real. So there’s a difference to me between healthcare providers, who may be well intentioned, and maybe not, who say to patients, oh, it’s all in your head because there’s nothing on this scan, and explaining that pain always involves your brain.

痛总是真实的。我们感受到的痛总是真实的。所以对我来说，医疗保健提供者之间存在差异，他们可能是出于善意，也可能不是，他们对患者说，哦，这一切都在你的脑子里，因为这次扫描没有任何内容，并解释说疼痛总是涉及你的大脑。

So pain is never a purely psychological problem, never ever. It’s always a biopsychosocial problem 100 percent of the time. So we know that cognitions and emotions and perceptions matter a lot when it comes to making pain, but also signals and messages from your body matter too.

所以疼痛从来都不是纯粹的心理问题，从来都不是。这在 100% 的时间里始终是一个生物心理社会问题。所以我们知道，当涉及到产生疼痛时，认知、情绪和感知很重要，但来自身体的信号和信息也很重要。

So it’s not all in your head. Your brain is a critical part of the pain experience. And one of the most important things we want to talk about when we talk about effectively treating pain is that you can’t just go after your back and you can’t just go after your knee, you also have to target your brain.

所以这不全在你的脑子里。你的大脑是疼痛体验的关键部分。当我们谈论有效治疗疼痛时，我们想谈的最重要的事情之一是你不能只关注你的背部，你不能只关注你的膝盖，你还必须瞄准你的大脑。

The message is that the brain is important too. We cannot just focus on body parts if we want people to get well. And that’s part of why chronic pain is on the rise and not going down.

我想说的是大脑也很重要。如果我们希望人们康复，我们不能只关注身体部位。这就是慢性疼痛呈上升趋势而不是下降的部分原因。

Ezra Klein

So the question of what it means to say pain is at least largely or in some cases heavily coming from the brain is part of what led me to you. So I have neck and shoulder problems of, to me, a relatively uninteresting, but quite annoying variety. And when I mentioned this on the show, it must have been a year or two years ago, a bunch of people all at once sent me links to books by a guy named Dr. John Sarno.

埃兹拉·克莱因

所以说疼痛至少在很大程度上或在某些情况下严重和大脑有关是什么意思的问题，是让我找你的部分原因。我有脖子和肩膀的问题，对我来说，这是一种相对无趣但很烦人的问题。当我在节目中提到这个时，一定是一、两年前，一群人突然给我发了一个名叫约翰·萨诺博士的人的书的链接。

And eventually, I had enough neck and back pain that I read them. And they’re interesting. The basic argument there is that you have a lot of back pain, that in his view, is really coming from repressed emotions. And it’s a way of distracting the mind from confronting something it doesn’t want to confront, which on the one hand, it didn’t strike me as hugely convincing or empirical, and on the other hand, it seems to have helped a lot, a lot, a lot of people who are now sending me his book.

最终，我的脖子和背部疼得够呛，所以我读了他的一些书。这些书很有趣。那里的基本论点是你有很多背痛，在他看来，这真的是压抑的情绪造成的。疼痛是一种分散注意力的方法，让我们不去面对它不想面对的事情（即压抑的情绪），一方面，这种说法并没有让我觉得很有说服力或经验，另一方面，它似乎有很大帮助, 很多、很多人现在寄给我他的书。

（译者注：我看了一些约翰·萨诺博士的书，我觉得值得看。）

So as a way into this, what do you think of Dr. Sarno’s work?

你如何看待萨诺博士的工作？

Rachel Zoffness

John Sarno was a controversial and polarizing doctor. And I want to say what I like about his work, and I also want to say what I don’t like about his work. What I really deeply appreciate is that Dr. Sarno was a well established, well known, and well liked clinician who came out and said, emotions don’t just live in your head. They also come out in your body, and they affect your health and they affect your pain, which neuroscience confirms is true.

雷切尔·佐夫内斯

约翰·萨诺 ( John Sarno)是一位备受争议且两极分化的医生。我想说说我喜欢他的哪些工作，我也想说说我不喜欢他的哪些东西。我真正深深感激的是，萨诺博士是一位声名显赫、广为人知且深受喜爱的临床医生，他告诉大家，情绪不仅仅存在于你的脑子里。情绪也会进入你的身体，影响你的健康，影响你的疼痛。神经科学证实了这一点。

So what I liked about his work was that he was helping to bridge this gap that we have between emotional pain and physical pain, and they’re always connected, always. What I don’t particularly love about Sarno was that he sort of pretended that he was the Columbus of emotions live in the body.

所以我喜欢他的工作是，他帮助弥合我们在情感痛苦和身体痛苦之间的鸿沟，而且它们总是联系在一起的。我不太喜欢的是，他假装自己是“情绪活在身体里”的哥伦布。

He planted this white flag on land that was already populated with many decades of research and was like, I have discovered this thing, and I’m going to give it a name, and I’m going to call it T.M.S. And he came up with this whole treatment, and he thought it was about repressed emotions, and there was a lot of psychoanalysis in there.

他在已经进行了几十年研究的土地上插上了这面白旗，就像，我发现了这个东西，我要给它起个名字，我要称它为 TMS ，然后他给出了整个治疗；他认为这是关于压抑的情绪，里面有很多精神分析。

Ezra Klein

It’s a very Freudian theory.

埃兹拉·克莱恩

这是一个非常弗洛伊德的理论。

Rachel Zoffness

It is very Freudian, and I do not subscribe to that. And again, I don’t want to dismiss what he did. In my mind, he’s done a great thing in medicine, and he has helped many thousands of people, and I admire that.

雷切尔·佐夫内斯

的确，这是非常弗洛伊德式的；但是，我不同意这种观点。我再一次强调，我不想否认他所做的。在我看来，他在医学上做了一件了不起的事，他帮助了成千上万的人，我很钦佩这一点。

But the thing that I want to do is take all of this pain research and neuroscience that’s lived in these stuffy medical textbooks, that actually we’ve known for many decades, and trot it out into the sunlight so that everyone who has pain or loves someone with pain knows what to actually do about it.

但我想做的是把所有这些沉闷的医学教科书中的疼痛研究和神经科学，实际上我们已经知道几十年了，把它带到阳光下，这样每个有疼痛人、或你所爱的人有疼痛，知道该怎么做。

And by the way, for chronic pain, science says, and people will be mad at me for this, science says opioids are not the effective treatment for chronic pain. For acute pain, God bless. Like after you have dental surgery, and you don’t have a history of addiction, and you’re not in a high-risk category, blessings.

顺便说一下，对于慢性疼痛，科学表明，科学表明阿片类药物不是治疗慢性疼痛的有效方法。人们听了，会因此而生我的气。对于急性疼痛，上帝保佑。就像在你做了牙科手术之后，你没有毒瘾史，而且你不属于高风险类别，祝福你，你可以用阿片类药物。

But I really appreciate what Sarno did in his move to reunite emotional and physical pain, but I do think he was a little bit off track.

但我真的很欣赏萨诺在重新调整情绪和身体痛苦方面所做的一切，但我也确实认为他有点偏离正轨。

（译者注：我同意这种看法。）

Ezra Klein

One thing I really appreciated about your pain workbook is, at least for me struggling with some of these questions, it gave a fairly convincing account of what is happening when the brain constructs pain. And I want to quote from part of it. You write, “Your appraisal,” you meaning your mind, “your appraisal of the situation is a critical determinant of the pain you feel. Context, thoughts, prior experiences and memories, emotions and the meaning you assign to your pain all change your experience of it.”

埃兹拉·克莱因

我真正欣赏你的疼痛治疗这本书（your pain workbook）的是，至少对于我正在努力解决其中一些问题而言，它对大脑构建疼痛时发生的事情给出了相当有说服力的解释。我想引用其中的一部分。你写道：“你的评估”，你的意思是你的想法，“你对情况的评估是你所感受到的痛苦的关键决定因素。背景、想法、先前的经历和记忆、情绪以及你赋予痛苦的意义都会改变你对痛苦的体验。”

And this matches to what seems to be pretty current in neuroscience, this idea of the brain on some level, is a prediction machine.

这与神经科学中非常流行的观点相符，大脑在某种程度上是一种预测机器。

Rachel Zoffness

You got it.

雷切尔·佐夫内斯：

你说对了。

Ezra Klein

Tell me a bit about that.

埃兹拉·克莱因：

告诉我一些这方面的事。

Rachel Zoffness

So you asked at the beginning, what is pain? And my response, pain is this very complex, subjective thing. But at the end of the day, your brain’s job is to save your life. And pain again, is the body’s danger detection system, your warning system.

雷切尔·佐夫内斯： 

所以你一开始就问，痛是什么？我的回答是，疼痛是一种非常复杂、主观的东西。但归根结底，大脑的任务是拯救你的生命。而疼痛，又是身体的危险检测系统，你的预警系统。

So your brain, as this beautiful machine, uses all available information in any given moment to decide whether or not to make pain and how much, because again, that’s your brain’s job. So if you imagine what that actually looks like, your brain is using information from past experiences. It’s using where you are and who you’re with. It’s using emotions, how you feel. It’s incorporating, of course, sensory messages from your body in all five of your senses.

所以你的大脑，就像一台漂亮的机器，在任何给定的时刻使用所有可用的信息来决定是否有疼痛以及疼痛的程度，因为这是你大脑的责任。因此，如果你想象那实际上是什么样子，你的大脑就会使用来自过去经验的信息。它使用你在哪里以及你和谁在一起。它使用情绪，你的感受。当然，它会在你的所有五种感官中整合来自你身体的感官信息。

And I want to give you a quick story that I think will illustrate this point.

我想给你讲一个简短的故事，我认为它可以说明这一点。

（待续）