Rachel Zoffness

You bring up a really good point, which is about more than prediction, which is that emotions always impact the pain we feel. And what neuroscience shows is that stress and anxiety amplifies pain and it turns up the brain’s pain dial.

So the way I like to explain how pain works is, if you imagine in your central nervous system, which is your brain and your spinal cord, that you have what I’m going to call a pain dial, and it operates much like the volume knob on your car stereo. You can turn pain volume up and you can turn pain volume down.

And there’s many things, as we all know, that adjust pain volume. So of course, pain medication is one of those things. But it turns out that there’s three other things that I want to talk about that also change pain volume. One is stress and anxiety, one is mood and emotions and the third is attention or what we’re focusing on.

雷切尔·佐夫内斯

你提出了一个非常好的观点，这不仅仅是预测，情绪总是会影响我们感受到的痛。神经科学表明，压力和焦虑会加剧疼痛，并调高大脑的疼痛度盘。

所以我想用汽车音响的音量旋钮，来解释疼痛是怎样起作用的。你可以调高疼痛量，也可以调低疼痛量。

众所周知，有很多东西可以调节疼痛程度。当然，止痛药就是其中之一。但事实证明，还有另外三件我想谈的事情也会改变疼痛量。一是压力和焦虑，一是心情和情绪（mood and emotions），三是注意力或我们在关注的东西。

So specifically what neuroscience says is, when stress and anxiety are high, and our bodies and our muscles are tense and tight, and our thoughts are worried, our brain raises and amplifies pain volume, so pain will feel worse when we’re stressed or anxious.

Thing two is mood and emotions. What neuroscience says is when our emotions are negative, we’re sad, we’re miserable, we’re depressed, our brain, and in particular, or limbic system, amplifies pain volume. So pain will feel worse when emotions are negative. And by the way, that includes anger and rage will amplify pain volume.

And thing three is attention or what we’re focusing on. And what we know, of course, is that attention changes the pain we feel too. So if you’re home in bed thinking about your pain, focusing on your pain, missing out on work and life and hobbies, your brain, and specifically your prefrontal cortex will amplify pain volume. So pain feels worse when you’re thinking about it and when you’re focusing on it.

所以神经科学具体说的是，当压力和焦虑很高，我们的身体和肌肉紧张和紧张，我们的想法很担心时，我们的大脑会增加和放大疼痛量，所以当我们有压力或焦虑。

第二件事是心情和情绪。神经科学所说的是，当我们的情绪消极、悲伤、痛苦、沮丧时，我们的大脑，尤其是边缘系统，会放大疼痛量。所以当情绪消极时，疼痛会感觉更糟。顺便说一句，包括愤怒和暴怒在内的情绪会放大疼痛量。

第三件事是注意力或我们关注的东西。当然，我们所知道的是，注意力也会改变我们感受到的痛苦。所以如果你躺在床上想着你的痛，专注于你的痛，错过了工作、生活和爱好，你的大脑，特别是你的前额叶皮层会放大疼痛量。因此，当你考虑并专注于它时，疼痛会感觉更糟。

The great news for people living with pain and for people who treat pain is that the opposite is also true. The opposite is also true. When stress and anxiety are low, your muscles are relaxed, your thoughts are calm, your brain sends a message to the pain dial lowering pain volume.

There’s a reason why a bazillion studies show — even though people think it’s floof and pseudoscience — that relaxation strategies, and diaphragmatic breathing, and mindfulness-based stress reduction, which have a fund of literature supporting them, lower pain volume.

Thing two we said is mood and emotions. So when our mood is high, we’re feeling joyful and happy, we’re having pleasurable experiences, our brain sends a message to the limbic system — our brain’s emotion center, as well as other parts of the central nervous system — and that lowers pain volume.

So pain feels less bad when emotions are positive. We’re engaged in our lives, we’re feeling good, we’re feeling happy. And thing three is attention. It turns out cognitive factors, what we’re paying attention to, what we’re thinking about, what we’re focusing on, even our belief systems change pain all the time too.

So when we are distracted, we’re focused on other things — I like to ask my patients, will you tell me about a time you were so absorbed in some activity, you briefly forgot about your pain? And almost everyone can give me an example of that. And that is not magic. That is your brain’s pain dial.

So when you are distracted, you’re out with friends, you’re doing things, you’re engaged in your hobbies, your brain sends a message to your pain dial lowering pain volume. So pain feels less bad in summary, when you are relaxed and calm, when you’re cultivating positive emotions, and when you are distracted and not thinking about your pain and engaged in your life.

But we know that negative emotions and stress and anxiety in particular will amplify the brain’s danger alarm. Let’s talk about why that’s so logical. In an emergency situation, you have to pay more attention. In an emergency situation, you are more likely to be harmed. You do want to be paying more attention to your body, and it’s highly adaptive for stress and anxiety to drive your attention inward and to amplify the sense of danger.

And as long as you’re in a state of stress and anxiety, all throughout your body, you’re going to be more sensitive. You’re going to be on more alert. You’re going to be in this mode of, is everything OK? So we know from research that the experience that you just had makes perfect sense when you think about the emotional aspect of pain.

对于患有疼痛的人和治疗疼痛的人来说，好消息是，相反的情况也是如此。反之亦然。当压力和焦虑较低时，你的肌肉就会放松，你的思想就会平静，你的大脑会向疼痛刻度盘发送信息以降低疼痛量。

有大量研究表明——尽管有人认为这是胡说八道和伪科学——放松策略、横膈膜呼吸和基于正念的减压——有大量文献支持——可以减轻疼痛，这是有原因的。

我们说的第二件事是心情和情绪。所以当我们情绪高涨时，我们感到快乐和快乐，我们有愉快的经历，我们的大脑会向边缘系统——我们大脑的情绪中心，以及中枢神经系统的其他部分——发送信息降低疼痛量。

所以当情绪是积极的时候，疼痛感觉不那么糟糕。我们从事我们的生活，我们感觉良好，我们感到快乐。第三件事是注意力。事实证明认知因素，我们正在关注什么、我们在想什么、我们关注什么、甚至我们的信仰体系也一直在改变痛苦。

所以当我们分心时，我们会专注于其他事情——我喜欢问我的病人，你能告诉我有一次你如此专注于某项活动，以至于你短暂地忘记了你的痛苦吗？几乎每个人都可以给我举个例子。那不是魔术。那是你大脑的疼痛刻度盘。

因此，当你分心、与朋友外出、做事、从事自己的爱好时，你的大脑会向你的疼痛刻度盘发送一条信息，以降低疼痛程度。所以总的来说，当你放松和平静，当你培养积极的情绪，当你分心，不去想你的痛苦和投入你的生活时，疼痛感觉不那么糟糕。

但我们知道，负面情绪，尤其是压力和焦虑会放大大脑的危险警报。让我们谈谈为什么这如此合乎逻辑。在紧急情况下，你必须更加注意。在紧急情况下，你更有可能受到伤害。你确实想要更多地关注你的身体，它高度适应压力和焦虑，将你的注意力转移到内心并放大危险感。

只要你全身都处于压力和焦虑状态，你就会变得更加敏感。你会更加警觉。你将处于这种模式，一切都好吗？因此，我们从研究中得知，当你考虑疼痛的情感方面时，你刚才的经历非常有意义。

（待续）