Dr. Sean Mackey: Tools to Reduce & Manage Pain

My guest today is Dr. Sean Mackey.

今天我的客人是肖恩·麦基博士。

Dr. Sean Mackey is a medical doctor, that is he treats patients, as well as a PhD, meaning he runs a laboratory.

肖恩·麦基博士是一名医生，即他治疗患者，同时也是一名博士学位，即他经营一家实验室。

He is the Chief of the Division of Pain Medicine and a professor of both anesthesiology and neurology at Stanford University School of Medicine.

他是斯坦福大学医学院疼痛医学科主任、麻醉学和神经病学教授。

Today we discuss what is pain.

今天我们讨论什么是疼痛。

Most of us are familiar with the notion of pain from having a physical injury or some sort of chronic pain or a headache.

我们大多数人都熟悉身体受伤或某种慢性疼痛或头痛引起的疼痛的概念。

Today Dr. Mackey makes clear what the origins of pain are, both in the nervous system and outside the nervous system.

今天，麦基博士阐明了疼痛的根源，包括神经系统内和神经系统外的疼痛。

That is the interactions between the brain and the body that give rise to this thing that we call pain.

这就是大脑和身体之间的相互作用，导致了我们所说的疼痛。

Indeed, we discuss the critical link between physical pain and emotional pain and how altering one's perception of emotional or physical pain can often change the other.

事实上，我们讨论了身体疼痛和情感疼痛之间的关键联系，以及改变一个人对情感或身体疼痛的感知通常如何改变另一个人。

We also discuss some of the changes in the nervous system that occur when we experience pain and how that can give rise to chronic pain.

我们还讨论了当我们经历疼痛时神经系统发生的一些变化以及如何导致慢性疼痛。

We also, of course, cover different methods to reduce pain safely.

当然，我们还介绍了安全减轻疼痛的不同方法。

And those methods include behavioral tools, psychological tools, nutrition, supplementation, and of course, prescription drugs.

这些方法包括行为工具、心理工具、营养、补充剂，当然还有处方药。

We discuss the intimate relationship between temperature, that is heat and cold, and pain and pain relief.

我们讨论温度（即热和冷）与疼痛和疼痛缓解之间的密切关系。

So if you're interested in the use of heat or cold to modulate pain, that conversation ought to be of interest as well.

因此，如果您对使用热或冷来缓解疼痛感兴趣，那么该对话也应该很有趣。

We also touch on some highly controversial topics such as opioids.

我们还涉及一些极具争议性的话题，例如阿片类药物。

Opioids are a substance that your body naturally makes.

阿片类药物是您的身体自然产生的一种物质。

But of course, many people are familiar with exogenous opioids.

当然，许多人都熟悉外源性阿片类药物。

That is, opioids that are available as drugs and the so called opioid crisis.

也就是说，可作为药物使用的阿片类药物和所谓的阿片类药物危机。

Dr. Mackey makes very clear which specific clinical circumstances warrant the use of exogenous opioids with, of course, a warning about their potent addictive potential.

麦基博士非常清楚哪些特定的临床情况需要使用外源性阿片类药物，当然，也警告其潜在的成瘾性。

And we get into a bit of discussion about where the opioid crisis and the use of opioid drugs to control pain is and is going.

我们对阿片类药物危机和使用阿片类药物控制疼痛的现状和进展进行了一些讨论。

Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.

在开始之前，我想强调一下，这个播客与我在斯坦福大学的教学和研究角色是分开的。

It is, however, part of my desire and effort to bring 0 cost to consumer information about science and science related tools to the general public.

然而，我的愿望和努力的一部分是向公众带来有关科学和科学相关工具的零成本消费者信息。

In keeping with that theme, I'd like to thank the sponsors of today's podcast.

为了与这个主题保持一致，我要感谢今天播客的赞助商。

Our first sponsor is AeroPress.

我们的第一个赞助商是爱乐压。

AeroPress is similar to a French press for making coffee but is, in fact, a much better way to make coffee.

AeroPress 与冲泡咖啡的法压壶类似，但事实上，这是一种更好的冲泡咖啡方式。

The AeroPress was developed by Alan Adler, who is an engineer at Stanford.

AeroPress 由斯坦福大学工程师艾伦·阿德勒 (Alan Adler) 开发。

I knew of Alan because I used to see him in my hometown of Palo Alto test flying the so called Aerobie Frisbee.

我认识艾伦是因为我经常看到他在我的家乡帕洛阿尔托试飞所谓的 Aerobie 飞盘。

So he was sort of famous around my town as this brilliant engineer that would create these unusual products.

因此，他在我们镇上有点出名，因为他是一位才华横溢的工程师，能够创造出这些不寻常的产品。

So when I heard about the AeroPress, I got it, I tried it, and I absolutely loved it, because it does indeed create the best tasting cup of coffee or loose leaf tea.

因此，当我听说爱乐压时，我得到了它，我尝试了它，我非常喜欢它，因为它确实创造了一杯味道最好的咖啡或散叶茶。

With AeroPress, you can brew an incredible tasting coffee or tea and clean up the whole process in less than two minutes.

使用爱乐压，您可以冲泡令人难以置信的美味咖啡或茶，并在不到两分钟的时间内完成整个过程。

The key thing to know about the AeroPress is that it's not just some trivial variation on the French press.

关于爱乐压机，需要了解的关键一点是，它不仅仅是法国压滤机的一些微不足道的变体。

That shortened brewing time that the AeroPress uses really changes the flavor of your cup of coffee or tea.

爱乐压 (AeroPress) 缩短的冲泡时间确实改变了咖啡或茶的味道。

It makes it exceptionally smooth.

它使它异常光滑。

If you'd like to try AeroPress, you can go to aeropress.com/huberman.

如果您想尝试 AeroPress，可以访问 aeropress.com/huberman。

That's A-E-R-O-P-E-S-S dot com slash Huberman to get 20% off any AeroPress coffeemaker.

这是 A-E-R-O-P-E-S-S . com 削减 Huberman 以获得任何 AeroPress 咖啡机 20% 的折扣。

AeroPress ships anywhere in the USA, Canada, and over 60 other countries around the world.

爱乐压 (AeroPress) 可向美国、加拿大以及全球其他 60 多个国家/地区的任何地方发货。

Again, that's aeropress.com/huberman to get 20% off.

再次强调，aeropress.com/huberman 提供 20% 折扣。

Today's episode is also brought to us by Levels.

今天的节目也是Levels给我们带来的。

Levels is a program that lets you see how different foods and activities impacts your blood glucose levels using a continuous glucose monitor.

Levels 是一个程序，可让您使用连续血糖监测仪了解不同的食物和活动如何影响您的血糖水平。

One of the most important factors impacting your energy levels as well as your immediate and long term health are your blood glucose levels, sometimes referred to as your blood sugar levels.

影响您的能量水平以及您的近期和长期健康的最重要因素之一是您的血糖水平，有时称为血糖水平。

To maintain mental and physical energy and focus, you want your blood glucose levels to be relatively stable throughout the day.

为了保持精神和身体的活力和注意力，您希望血糖水平全天相对稳定。

Levels makes it extremely easy to determine how specific foods and food combinations, meal timing, exercise, and sleep work alone and in combination to impact your blood glucose levels.

通过水平，可以非常轻松地确定特定食物和食物组合、进餐时间、运动和睡眠如何单独或组合地影响您的血糖水平。

I started using Levels about two years ago and find it to be immensely beneficial.

我大约两年前开始使用关卡，发现它非常有用。

It's helped me better arrange what I eat, when I eat, when to exercise, and my sleep patterns.

它帮助我更好地安排我吃什么、什么时候吃、什么时候锻炼以及我的睡眠模式。

So if you're interested in learning more about Levels and trying a CGM yourself, go to levels.link/huberman.

因此，如果您有兴趣了解有关 Levels 的更多信息并亲自尝试 CGM，请访问levels.link/huberman。

Levels has launched a new CGM sensor that is smaller and has even better tracking than the previous versions.

Levels 推出了一款新的 CGM 传感器，它比以前的版本更小，但跟踪能力更好。

Right now they're also offering an additional two free months of membership.

现在他们还提供额外两个月的免费会员资格。

Again, that's levels.link, L-I-N-K, slash Huberman.

再说一遍，这是levels.link，L-I-N-K，斜杠Huberman。

Today's episode is also brought to us by BetterHelp.

今天的节目也是由 BetterHelp 为我们带来的。

BetterHelp offers professional therapy with a licensed therapist carried out online.

BetterHelp 提供由持证治疗师在线进行的专业治疗。

I've been going to therapy for well over 30 years.

我接受治疗已有 30 多年了。

Initially I didn't have a choice.

最初我没有选择。

It was a condition of being allowed to stay in school.

这是被允许留在学校的一个条件。

But pretty soon, I realized that therapy is extremely valuable.

但很快，我意识到治疗非常有价值。

In fact, I consider doing regular therapy just as important as getting regular exercise, including cardiovascular exercise and resistance training, which, of course, I also do every week.

事实上，我认为定期治疗与定期锻炼一样重要，包括心血管锻炼和阻力训练，当然，我每周也会进行这些锻炼。

The reason I know therapy is so valuable is that if you can find a therapist with whom you can develop a really good rapport, you not only get terrific support for some of the challenges in your life, but you also can derive tremendous insights from that therapy, insights that can allow you to better not just your emotional life and your relationship life, but of course, also the relationship to yourself and to your professional life to all sorts of career goals.

我知道治疗如此有价值的原因是，如果你能找到一位可以与你建立良好融洽关系的治疗师，你不仅可以在生活中的一些挑战中获得极好的支持，而且还可以从治疗中获得巨大的见解，这些见解不仅可以让你改善你的情感生活和人际关系生活，当然也可以让你改善与自己的关系、与职业生活的关系以及各种职业目标。

In fact, I see therapy as one of the key components for meshing together all aspects of one's life and being able to really direct one's focus and attention toward what really matters.

事实上，我认为治疗是将一个人生活的各个方面融合在一起并能够真正将一个人的注意力集中在真正重要的事情上的关键组成部分之一。

With BetterHelp, they make it extremely easy to find a therapist that's ideal for your needs, your life circumstances, and that can match to your schedule in a very convenient way.

通过 BetterHelp，他们可以非常轻松地找到最适合您的需求、生活环境并且能够以非常方便的方式匹配您的日程安排的治疗师。

If you'd like to try BetterHelp, go to betterhelp.com/huberman to get 10% off your first month.

如果您想尝试 BetterHelp，请访问 betterhelp.com/huberman，第一个月可享受 10% 的折扣。

Again, that's betterhelp.com/huberman.

再说一次，这是 betterhelp.com/huberman。

And now for my discussion with Dr. Sean Mackey.

现在我与肖恩·麦基博士进行讨论。

Dr. Mackey, welcome.

麦基博士，欢迎。

It takes an incredible toll on society when it goes chronic, when it becomes persistent to the tune of about 100 million Americans and at last count about a half a trillion dollars a year in medical expenses.

当它变成慢性病时，当它持续影响大约一亿美国人并最终导致每年约五万亿美元的医疗费用时，它会给社会带来令人难以置信的损失。

So an astounding problem we're facing in society and one that's only getting worse.

因此，我们在社会中面临着一个令人震惊的问题，而且这个问题只会变得更糟。

And I'm hoping during the course of this discussion that we can break down a little bit of the foundation of pain and kind of build it back up.

我希望在这次讨论的过程中，我们能够打破一点痛苦的基础，并将其重新建立起来。

Because unfortunately, in society there's a lot of misunderstanding about what pain is.

因为不幸的是，社会上对什么是疼痛存在很多误解。

And I think hopefully we can build that foundation and then layer on some useful treatments and useful options for people.

我认为希望我们能够建立这个基础，然后为人们提供一些有用的治疗方法和有用的选择。

What's going on is that there are sensors in our skin or soft tissue or deep tissues called nociceptors.

发生的事情是，我们的皮肤、软组织或深层组织中有一些传感器，称为伤害感受器。

And these nociceptors are sensing elements.

这些伤害感受器是传感元件。

And they sense different types of stimuli.

他们感受到不同类型的刺激。

They can sense temperature, heat, cold.

他们可以感知温度、热、冷。

They sense pressure.

他们感受到压力。

They can sense pH changes due to, for instance, inflammation that may occur from something going on in your neck or your shoulder.

它们可以感知 pH 值的变化，例如，由于颈部或肩部发生炎症而引起的炎症。

Those send signals up nerve fiber types.

它们向神经纤维类型发送信号。

And the two that we refer to are A delta and C fibers.

我们所说的两种纤维是 A delta 纤维和 C 纤维。

One transmits very fast.

一个传输速度非常快。

It's responsible that sharp jolt of pain that goes to your brain when we step on a tack or put our hand on a hot stove.

当我们踩到大头钉或把手放在热炉子上时，大脑会感到剧烈的疼痛，这就是原因。

And there's another fiber called a C fiber, which is much slower and responsible for that dull, achy pain.

还有另一种纤维称为 C 纤维，它的速度要慢得多，并且会导致隐隐作痛。

Now, these signals, they go to the spinal cord.

现在，这些信号进入脊髓。

Lie up and down from our head down to our back.

从头到背，上下躺着。

And they're shaped, they're changed a little bit.

它们已经成型了，也发生了一些变化。

They then are sent up to the brain.

然后它们被发送到大脑。

And it's once they hit the brain and they converge with this magical mystery set of nerves in the brain that it becomes the experience of pain.

一旦它们击中大脑并与大脑中这组神奇的神秘神经融合，它就变成了疼痛的体验。

And if there's one key message I'd like to get to the audience is that what goes on out here, what goes on in your shoulder, in your neck is not pain.

如果我想向观众传达一个关键信息，那就是这里发生的事情，你肩膀上发生的事情，你脖子上发生的事情并不是疼痛。

That's nociception.

这就是伤害感受。

Those are electrical signals, electrochemical impulses being transmitted.

这些是电信号，正在传输的电化学脉冲。

And that is to be distinguished from what becomes the subjective experience of pain that you have.

这与你所经历的疼痛的主观体验是有区别的。

And why it's critical is that our brain serves so many functions of emotions, cognitions, memory, action.

为什么它如此重要是因为我们的大脑具有情感、认知、记忆、行动等多种功能。

All of that shapes those signals coming in from our body to create your unique experience of pain that's different from everybody else's.

所有这些都会塑造来自我们身体的信号，从而创造出与其他人不同的独特疼痛体验。

And I think that's important to note, because we are frequently left with this notion of this one to one concordance between the stimulus and the experience of pain.

我认为这一点值得注意，因为我们经常留下刺激和疼痛体验之间一对一一致性的概念。

Rene Descartes, that French philosopher, I think 17th century, was the one who first postulated this idea of this direct linkage between the body and our actions and the stimulus and the response.

我认为 17 世纪的法国哲学家勒内·笛卡尔 (Rene Descartes) 是第一个提出身体与我们的行为、刺激与反应之间存在直接联系的想法的人。

And it's wrong.

这是错误的。

And unfortunately, even in medical care, we have this biomedical model that still is perpetuating this idea of a one to one relationship.

不幸的是，即使在医疗保健领域，我们的生物医学模型仍然延续着这种一对一关系的理念。

And that's a critically important point to get across, in large part because frequently, as humans, we tend to project onto others our own experiences of pain.

这是需要理解的至关重要的一点，很大程度上是因为，作为人类，我们经常倾向于将自己的痛苦经历投射到别人身上。

And when we see somebody who's got an injury or something else going on, we immediately put that on them.

当我们看到有人受伤或发生其他事情时，我们会立即将其放在他们身上。

And that has also been a problem with many people suffering in chronic pain, which is often viewed as the invisible disease.

这也是许多患有慢性疼痛的人面临的一个问题，慢性疼痛通常被视为看不见的疾病。

And the reason I ask this is that for vision, for hearing, for touch, we probably all experience those somewhat differently.

我问这个问题的原因是，对于视觉、听觉、触觉，我们可能都会有不同的体验。

Your perception of red is probably a little different than my perception of red.

您对红色的看法可能与我对红色的看法略有不同。

We don't know for sure, but experiments support that idea.

我们不确定，但实验支持这个想法。

But there's a major difference between people experiencing the same thing differently according to a mysterious mechanism in the brain as opposed to an area in the brain that we can look and say, hey, that's where pain is represented.

但是，根据大脑中的神秘机制，人们对同一件事的体验有所不同，这与我们可以观察并说，嘿，这就是代表疼痛的大脑区域不同。

That's where all these inputs from the body are put together to create this thing that we call pain.

这就是来自身体的所有这些输入汇集在一起​​创造出我们称之为疼痛的东西的地方。

Is there an area of the thalamus, a structure in the middle of the brain, that takes incoming sensory information that we could say, oh, that's the pain pathway?

丘脑中是否有一个区域（大脑中部的一个结构）可以接收传入的感觉信息，我们可以说，哦，这就是疼痛通路？

Is there a part of our neocortex, the outer shell of the brain more or less, beneath the skull, but nonetheless on the outer portion of the human brain, that we could say, oh, that's where pain exists?

我们的新皮质（大脑的外壳）是否有一部分或多或少位于头骨下方，但仍然位于人脑的外部，我们可以说，哦，这就是疼痛存在的地方？

Or is it a distributed phenomenon?

或者说这是一种分布式现象？

Now, to get to your point, no, there's not one pain brain area.

现在，言归正传，不，大脑中没有一个疼痛区域。

It is thought to be more of a distributed network of different brain systems.

它被认为更像是不同大脑系统的分布式网络。

We at one point in time called it the pain matrix, which represented areas such as the insular cortex, the cingulate cortex, the amygdala, a number of these brain regions that all subserve different functions.

我们曾一度将其称为疼痛矩阵，它代表岛叶皮层、扣带皮层、杏仁核等区域，这些区域都具有不同的功能。

We're moving away from that, because it seems like every year or so we pick up another region of the brain that's contributing to this network that subserves some additional functions, some nuanced layer to it.

我们正在远离这一点，因为似乎每年左右我们都会选择大脑的另一个区域，该区域对这个网络有贡献，该区域提供一些额外的功能，一些微妙的层。

That said, we have been able to identify some common signatures, common brain networks that seem to represent the experience of pain.

也就是说，我们已经能够识别出一些共同的特征，共同的大脑网络，它们似乎代表了疼痛的经历。

And this is where the development of brain based biomarkers has come in.

这就是基于大脑的生物标志物的发展的切入点。

And this is some of the work that I've done starting, gosh, well over a dozen years ago and others have been building on.

这是我十几年前开始做的一些工作，还有其他人一直在做的工作。

And what we're finding is that there does seem to be this conserved region, set of distributed regions that do represent the experience of pain.

我们发现，似乎确实存在这个保守区域，一组确实代表疼痛体验的分布式区域。

And so one of the things that happens after an injury is that we get sensitization of the area that's injured.

因此，受伤后发生的事情之一就是我们对受伤区域变得敏感。

And it's a beautiful thing, because it sends a message to us to protect it.

这是一件美丽的事情，因为它向我们发出了保护它的信息。

What the NSAIDs do is they reduce some of that sensitization out in the periphery and then back in the spinal cord and in the brain.

非甾体抗炎药的作用是减少外周的一些敏感性，然后回到脊髓和大脑。

But they don't actually-- so for instance, I was going to say try this at home, but probably not.

但他们实际上并没有——所以举例来说，我本来想说在家里尝试一下，但可能不会。

You can in a normal situation hit your hand with a fork.

在正常情况下，您可以用叉子敲击手。

Measure the amount of pain.

测量疼痛程度。

Now go take an NSAID like ibuprofen.

现在去服用布洛芬等非甾体抗炎药。

If you hit your hand with that same fork, there'll be no difference.

如果你用同一把叉子敲击你的手，那就没有什么区别了。

I mean, any time I've done surgeries on animals, which I don't do anymore in the laboratory, but we used to, you would give them painkillers postoperatively.

我的意思是，每当我对动物进行手术时，我不再在实验室做手术，但我们过去常常这样做，术后你会给它们止痛药。

I've had surgeries before.

我以前做过手术。

I've had painkillers postoperatively, although I don't like taking them.

术后我曾服用止痛药，尽管我不喜欢服用它们。

I don't like the way they make my brain feel.

我不喜欢他们给我的大脑带来的感觉。

But we of course know that if you increase the dose of any pain medication too much, then that animal or a human can potentially injure themselves worse or not protect that injured area.

但我们当然知道，如果过多增加任何止痛药的剂量，那么该动物或人类可能会更严重地伤害自己，或者无法保护受伤部位。

So it raises a whole set of medical ethical but also just purely biological questions.

因此，它提出了一整套医学伦理问题，但也只是纯粹的生物学问题。

How do you set the threshold for, yes, blunt pain versus, no, allow the pain to be there as an adaptive way of protecting yourself and healing?

你如何设定阈值，是的，钝痛，还是，不，允许疼痛存在，作为保护自己和治愈的适应性方式？

Presumably the inflammation is part of the healing process too.

据推测，炎症也是愈合过程的一部分。

And as you mentioned before, pain is so subjective and it's different between all of us.

正如您之前提到的，疼痛是非常主观的，而且我们每个人的疼痛都是不同的。

I mean, how do we decide whether or not it's a good or a bad idea to blunt that pain?

我的意思是，我们如何决定减轻痛苦是好主意还是坏主意？

After a sunburn, you end up having more sensitization.

晒伤后，您会变得更加敏感。

That is what we refer to as peripheral sensitization.

这就是我们所说的外周敏化。

Because it's out in the periphery, we're winding up or amplifying the response.

因为它位于外围，所以我们正在结束或放大响应。

Aspirin, NSAIDs in general will reduce that inflammation.

阿司匹林、非甾体抗炎药通常会减轻炎症。

They're anti-hyperalgesic.

它们具有抗痛觉过敏作用。

And pardon again the jargony terms that we use.

再次请原谅我们使用的行话。

So the prostaglandins seem to be one of the main ways that our immune system responds to a physical or chemical injury and creates inflammation.

因此，前列腺素似乎是我们的免疫系统对物理或化学损伤做出反应并产生炎症的主要方式之一。

And as you said, that inflammation sensitizes an area, makes it literally more sensitive.

正如你所说，炎症会使某个区域变得敏感，使其变得更加敏感。

And then we introduce these drugs to restore normal functioning and living.

然后我们引入这些药物来恢复正常的功能和生活。

Could we establish what normal functioning is?

我们能否确定什么是正常功能？

I mean, for instance, if we make this really concrete, could we say, well, if you can fall asleep at night and stay asleep or perhaps go back to sleep after you've woken up in the middle of the night, then, well, you heal during sleep.

我的意思是，例如，如果我们把这个说得非常具体，我们可以说，好吧，如果你可以在晚上入睡并保持睡眠状态，或者在半夜醒来后重新入睡，那么，好吧，你会在睡眠中痊愈。

And so take as little painkiller as possible but enough that still lets you sleep well at night.

因此，尽可能少服用止痛药，但足以让您晚上睡个好觉。

Is that sort of normal functioning?

这样的功能正常吗？

Because when I have a kink in my neck, I don't want to do much of anything.

因为当我脖子扭结时，我什么都不想做。

I try but it's really frustrating.

我尝试过，但这真的很令人沮丧。

So I mean, as a physician and as a patient, how do we determine normal functioning?

所以我的意思是，作为医生和患者，我们如何确定功能正常？

And so now you've got on one hand a medication that may help with pain, help you improve function.

现在，您一方面拥有了一种可以帮助缓解疼痛、改善功能的药物。

You've got on the other hand something you're taking that may delay the process.

另一方面，您正在服用的某些药物可能会延迟该过程。

Where do you draw the line?

你在哪里划清界限？

As a physician, my approach is really basically what you said.

作为一名医生，我的方法基本上就是你说的。

It's balancing the fact that if you're not sleeping at night, you're not going to heal and you're not going to be able to do what you need to do the next day.

它平衡了这样一个事实：如果你晚上不睡觉，你就不会痊愈，而且你第二天也无法做你需要做的事情。

And if taking an NSAID helps you sleep and helps you engage with what you need to do, take it at the lowest dose that you can get away with.

如果服用非甾体抗炎药可以帮助您入睡并帮助您完成需要做的事情，请以您能承受的最低剂量服用。

And so I'm wondering if somebody has some pain that makes moving about frustrating and it's difficult but they can sleep at night reasonably well, maybe not as well as they normally do, would your suggestion to that person, if their goal is to heal as quickly as possible, to just not take anything?

所以我想知道是否有人有一些疼痛，使移动令人沮丧，而且很困难，但他们晚上可以睡得相当好，也许不像平时那样好，如果他们的目标是尽快康复，你会建议那个人不要吃任何东西吗？

So one of the other interesting things about NSAIDs, like we mentioned ibuprofen and Naprosyn, huge individual variability around those.

关于非甾体抗炎药的其他有趣的事情之一，就像我们提到的布洛芬和萘普生一样，这些药物存在巨大的个体差异。

So personally, ibuprofen is not very effective for me.

所以就我个人而言，布洛芬对我来说不是很有效。

Naprosyn is.

萘普生是。

For others it may be just exactly the opposite.

对于其他人来说，情况可能恰恰相反。

So there's value in rotating them and finding out which works best for your particular situation.

因此，轮换它们并找出最适合您的特定情况的方法是有价值的。

You mentioned the timing of it.

你提到了它的时间安排。

Ibuprofen is typically given no more than three times a day.

布洛芬通常每天给药不超过 3 次。

It's got a short half life.

它的半衰期很短。

Naprosyn, twice a day.

萘普生，一天两次。

What's critical, I need to give this message, is in both situations, make sure that you have food in your stomach.

关键的是，我需要传达这个信息，在这两种情况下，都要确保你的胃里有食物。

Make sure you're not taking it on an empty stomach.

确保您不是空腹服用。

Make sure you're drinking plenty of fluids.

确保你喝了足够的液体。

And if you've got any GI issues, if you've got any bleeding issues, if you've got kidney issues, if you've got heart issues, talk to your doc.

如果您有任何胃肠道问题、如果您有任何出血问题、如果您有肾脏问题、如果您有心脏问题，请咨询您的医生。

Talk to your clinician before you embark on this, because these medications do have side effects and adverse consequences in vulnerable people.

在开始之前先咨询您的临床医生，因为这些药物确实对弱势群体有副作用和不良后果。

Now, gut health is something that over the last 10 years we realized is not just important for the health of our gut but also for our immune system and for the production of neurotransmitters and neuromodulators, things like dopamine and serotonin.

现在，在过去的十年里，我们意识到肠道健康不仅对我们的肠道健康很重要，而且对我们的免疫系统以及神经递质和神经调节剂（如多巴胺和血清素）的产生也很重要。

In other words, gut health is critical for proper brain functioning.

换句话说，肠道健康对于大脑的正常运作至关重要。

Now of course, I strive to consume healthy whole foods for the majority of my nutritional intake every single day.

当然，现在我努力食用健康的天然食品作为我每天摄入的大部分营养。

But there are a number of things in AG1, including specific micronutrients, that are hard to get from whole foods or at least in sufficient quantities.

但 AG1 中的许多物质，包括特定的微量营养素，很难从天然食物中获取，或者至少很难从足够的量中获取。

So AG1 allows me to get the vitamins and minerals that I need, probiotics, prebiotics, the adaptogens, and critical micronutrients.

因此，AG1 可以让我获得所需的维生素和矿物质、益生菌、益生元、适应原和关键的微量营养素。

So any time somebody asks me if they were to take just one supplement what that supplement should be, I tell them AG1, because AG1 supports so many different systems within the body that are involved in mental health, physical health, and performance.

因此，每当有人问我是否只服用一种补充剂时，我都会告诉他们 AG1，因为 AG1 支持体内涉及心理健康、身体健康和表现的许多不同系统。

To try AG1, go to drinkag1.com/huberman and you'll get a year's supply of vitamin D3 K2 and five free travel packs of AG1.

要尝试 AG1，请访问 Drinkag1.com/huberman，您将获得一年的维生素 D3 K2 和 5 个免费旅行装 AG1。

Again, that's a drinkag1.com/huberman.

再说一遍，这是 Drinkag1.com/huberman。

I promise we won't go into every medication in such detail, but these are the most commonly used over-the-counter treatments for pain, as far as I know.

我保证我们不会如此详细地讨论每种药物，但据我所知，这些是最常用的非处方止痛疗法。

Are there any issues with people who drink caffeine who then are taking these drugs?

喝咖啡因然后服用这些药物的人有什么问题吗？

What are some of the interactions that these things can have?

这些东西可以有哪些相互作用？

As far as I know, caffeine actually touches into the prostaglandin pathway, doesn't it?

据我所知，咖啡因实际上会影响前列腺素通路，不是吗？

You brought up earlier acetaminophen or Tylenol.

您之前提到了对乙酰氨基酚或泰诺。

Tylenol doesn't have the same side effect or adverse event profile that the NSAIDs do.

泰诺没有与非甾体抗炎药相同的副作用或不良事件。

So Tylenol is safe on the stomach.

所以泰诺对胃是安全的。

Where you need to be careful about Tylenol is not to exceed 4,000 milligrams or 4 grams per day in divided doses.

需要注意的是，泰诺的用量不要超过 4,000 毫克或每天分次服用 4 克。

So two Extra Strength Tylenol done four times a day for many people is safe.

因此，对于许多人来说，每天服用四次两片特强泰诺是安全的。

Some say 2 grams, some say 4 grams.

有的说2克，有的说4克。

The key here is around your liver.

这里的关键是在你的肝脏周围。

So if you've got good liver function, if you're not abusing alcohol, that's a general rule of thumb that you can use for Tylenol.

因此，如果您的肝功能良好，并且不酗酒，那么这是您可以使用泰诺的一般经验法则。

But it's not going to upset your stomach.

但它不会让你的胃不舒服。

There are versions of the NSAIDs that we refer to as cox2 inhibitors.

有些版本的 NSAID 被我们称为 cox2 抑制剂。

They're very selective, like celecoxib, that is less irritating on the stomach.

它们非常有选择性，比如塞来昔布，对胃的刺激较小。

That's by prescription only though.

但这只能通过处方。

But you can think of it as working very much the same as the Naprosyn and the ibuprofen.

但您可以认为它的作用与萘普生和布洛芬非常相似。

So talk with your clinician to try to tease those apart.

因此，请与您的临床医生交谈，尝试将它们区分开来。

If you have problems in your stomach with the NSAIDs and they're really effective for you, you can be given other types of medications that help block or reduce the GI issues associated with the NSAIDs.

如果您因服用非甾体抗炎药而出现胃部问题，并且它们确实对您有效，那么您可以服用其他类型的药物来帮助阻止或减少与非甾体抗炎药相关的胃肠道问题。

Where we all have this instinctual response, animals have it too, if you bump your knee or your toe that you grab it and you rub it and that that rubbing response is actually contributing to the activation of a neural pathway that does indeed reduce the pain through a legitimate neural inhibition.

我们都有这种本能反应，动物也有，如果你撞到膝盖或脚趾，你就会抓住它并摩擦它，这种摩擦反应实际上有助于激活神经通路，从而通过合理的神经抑制确实减轻疼痛。

And tell me if this is still considered correct and then I'll let you elaborate on it.

并告诉我这是否仍然被认为是正确的，然后我会让你详细说明。

But I think that is an opportunity for us to also talk more generally or for you to educate us more generally on the mechanistic interventions for pain.

但我认为这对我们来说是一个更广泛地讨论的机会，或者对您来说也是一个机会，可以更广泛地教育我们关于疼痛的机械干预措施。

Maybe massage above or below the site of pain.

也许可以按摩疼痛部位的上方或下方。

Maybe acupuncture.

也许是针灸。

So again, there will be chemical consequences of any mechanical intervention, as we know, because that's the language of the nervous system, electricity, and chemicals.

再说一次，正如我们所知，任何机械干预都会产生化学后果，因为这是神经系统、电力和化学物质的语言。

But as opposed to taking a drug, you could imagine using manual stimulation or rubbing around it or perhaps we can also talk about heat and cold.

但与服用药物不同，您可以想象使用手动刺激或摩擦它，或者我们也可以讨论热和冷。

So can we explore that space a bit?

那么我们可以探索一下这个空间吗？

From the periphery, we've got also fibers called touch fibers.

从外围，我们还得到了称为触摸纤维的纤维。

These are the ones where they get activated with light touch, stroking.

这些是通过轻触、抚摸而激活的。

They're referred to as A beta fibers.

它们被称为 A β 纤维。

They're fast conducting.

他们的传导速度很快。

They head back to the spinal cord, and they make some connections with those nociceptive fibers.

它们回到脊髓，并与那些伤害性纤维建立一些联系。

So with that grounding, imagine what you said.

因此，有了这个基础，想象一下你所说的。

You hit your thumb with a hammer you.

你用锤子敲击你的拇指。

You bang something on an extremity.

你用四肢敲击某物。

What is the first thing you do when you hit your thumb with a hammer?

当你用锤子敲击拇指时，你做的第一件事是什么？

Some people rub it.

有的人会擦。

What's interesting, Wall and Melzack sometime later, there was the introduction of a device to take advantage of this called the tens device.

有趣的是，沃尔和梅尔扎克后来引入了一种设备来利用这一点，称为十设备。

And tens is an acronym.

十是缩写。

Transcutaneous electrical nerve stimulation.

经皮神经电刺激。

And what the tens device is doing, and there's many versions of it now, but there are those black electrodes you put over the area.

数十个设备正在做什么，现在有很多版本，但是您在该区域上放置了那些黑色电极。

And they're hooked up to wires.

它们连接到电线上。

And when you turn it on, it causes a buzzing sensation.

当你打开它时，它会引起嗡嗡声。

And that buzzing sensation is activating those touch fibers, the A beta fibers.

这种嗡嗡声正在激活那些触觉纤维，即 A β 纤维。

And so it's causing that neuromodulation back in the spinal cord.

所以它会引起脊髓中的神经调节。

What explains different pain thresholds?

如何解释不同的疼痛阈值？

I could imagine it could be any or all of the locations that we've been discussing.

我可以想象它可能是我们一直在讨论的任何或所有地点。

And it could be the context as well.

这也可能是上下文。

I've heard before, and I don't know if this is true, that if you have a lot of adrenaline, epinephrine, in your system that your threshold for pain goes way, way up.

我以前听说过，但我不知道这是否属实，如果你的系统中有大量肾上腺素，你的疼痛阈值就会大大提高。

There's probably a chemical basis for that.

这可能有化学基础。

And maybe it's all anecdote.

也许这都是轶事。

But certainly people have different thresholds for pain.

但可以肯定的是，人们对于疼痛的阈值是不同的。

I, for instance, do not have a high pain threshold, but I've noticed I have a very quick pain response.

例如，我的疼痛阈值不高，但我注意到我的疼痛反应非常快。

So if I stub my toe, it feels like the most painful thing I could possibly experience.

因此，如果我撞到脚趾，那感觉就像是我可能经历过的最痛苦的事情。

But then it's gone very quickly.

但很快就消失了。

So it's like a quick inflection and then down.

所以这就像一个快速的变化然后下降。

Other people I know, we've never done the experiment, I see them stub their toe and they're like, ugh, and then 10 minutes later, they're still feeling the ache.

我认识的其他人，我们从未做过这个实验，我看到他们绊倒了脚趾，然后他们就说，呃，然后 10 分钟后，他们仍然感到疼痛。

So whose pain threshold is higher?

那么谁的痛阈更高呢？

It depends on how you define pain threshold.

这取决于您如何定义疼痛阈值。

So how do we define pain threshold?

那么我们如何定义疼痛阈值呢？

What determines pain threshold?

疼痛阈值由什么决定？

And I guess the $6 million question, are there different pain thresholds between men and women?

我猜想这个 600 万美元的问题是，男性和女性之间的疼痛阈值是否不同？

As it relates to the whole story about childbirth being very painful and that women, quote unquote, have "higher pain thresholds." I just sent you about 10 questions.

因为它涉及到整个故事，即分娩非常痛苦，并且女性（不引述）具有“更高的疼痛阈值”。我刚刚向您发送了大约 10 个问题。

So forgive me.

所以请原谅我。

So what is pain threshold?

那么什么是痛阈呢？

You mentioned some of the distinction between your experiences of pain to a stimulus and your buddies.

您提到了您对刺激的痛苦经历与您的好友之间的一些区别。

And that's normal.

这很正常。

That first onset of pain, again, those fast fibers, those A delta fibers, boom, right to your brain.

第一次疼痛再次出现，那些快速纤维，那些 A δ 纤维，轰隆隆地传到你的大脑。

Those are the protective ones that when we put our hand on a hot stove, we immediately jerk it back.

这些都是保护性的，当我们把手放在热炉子上时，我们会立即将其缩回。

We don't even have a conscious perception yet that we did that.

我们甚至还没有意识到我们这样做了。

And then it's a moment later when the C fibers are getting up to the brain and the other A delta fibers are converging into conscious areas of brain that were like, oh wow, that stove is really hot.

过了一会儿，C 纤维到达大脑，其他 A δ 纤维汇聚到大脑的意识区域，就像，哦，哇，那个炉子真的很热。

And the C fibers in particular are converging on more emotional regions in the brain that are conveying an unpleasantness to that experience.

尤其是 C 纤维聚集在大脑中更多的情绪区域，这些区域传达了对该体验的不愉快感。

You don't like it.

你不喜欢它。

And you don't want it to happen again, which is why it encodes memories.

而且你不希望它再次发生，这就是它对记忆进行编码的原因。

So you only had to do that once as a child.

所以你小时候只需要这样做一次。

Now, getting into the pain threshold.

现在，进入疼痛阈值。

You asked one of the other questions is do men and women have different pain thresholds.

您问的其他问题之一是男性和女性是否有不同的疼痛阈值。

The short answer is yes.

简短的回答是肯定的。

This has been established.

这已经成立了。

And I want to be careful here with saying a couple of things.

我想在这里谨慎地说几件事。

One is in general, men have higher pain thresholds to things like heat stimulus than women.

一是一般来说，男性对热刺激等事物的疼痛阈值高于女性。

And what people have to also, though, understand, as scientists, we make a big deal out of small differences.

不过，人们也必须明白，作为科学家，我们会从小差异中发现大问题。

What we do is we take a group of people, in this case, men and women, and we apply the same thermal stimulus to them.

我们所做的就是招募一群人，在本例中是男性和女性，然后对他们施加相同的热刺激。

And we draw averages.

我们得出平均值。

The average man has this stimulus.

一般人都有这种刺激。

The average woman has this stimulus.

一般女性都有这种刺激。

And we say, well, women have a little bit more sensitivity to that heat stimulus.

我们说，嗯，女性对热刺激更敏感一些。

And so we then go into the press and we say, men are tougher than women.

然后我们向媒体说，男人比女人更强硬。

That's a terrible statement.

这是一个可怕的声明。

There's a lot of things that play into changes in pain thresholds.

有很多因素会影响疼痛阈值的变化。

And this is where the brain comes in.

这就是大脑发挥作用的地方。

Because much of the nociception, much of the signals that we're transducing, we're transmitting, in many of us, it's very much the same.

因为我们许多人所传递的许多伤害感受、许多信号都是非常相似的。

It's when it gets to the brain now it's shaped.

当它到达大脑时，它就成型了。

And it's shaped by things such as your beliefs about that stimulus, your expectations around it, how much anxiety you're having at the moment.

它是由你对刺激的信念、你对刺激的期望、你目前的焦虑程度等因素决定的。

I could imagine it going either way.

我可以想象这两种情况都会发生。

I could imagine the kid that was told, don't be a wuss when they cried as a consequence of expressing pain or an experience of pain secretly feeling more pain because they aren't able to express the emotionality around the pain.

我可以想象那些被告知的孩子，当他们因为表达痛苦或痛苦的经历而哭泣时，不要表现得像个胆小鬼，因为他们无法表达围绕痛苦的情感，所以私下里感到更痛苦。

But that if we just look from the outside, we say wow, they're a pretty tough adult, because they're not crying out in pain.

但如果我们只从外表来看，我们会说哇，他们是一个非常坚强的成年人，因为他们不会因痛苦而哭泣。

So do we have any-- are there any experiments that have explored that?

那么我们有没有任何实验对此进行过探索？

But does there get to be a point where you're ignoring your child or your loved one's painful issue?

但是，您是否会忽视您的孩子或您所爱之人的痛苦问题呢？

Yeah.

是的。

Now you're getting into some maladaptive, some bad space where I think it's sending that person the wrong message.

现在你进入了一些不适应的、一些糟糕的空间，我认为它向那个人发送了错误的信息。

And they may very well have problems later on.

他们以后很可能会遇到问题。

But once and only once we had some friends.

但曾经且仅有一次我们有一些朋友。

I won't tell you what country they were from.

我不会告诉你他们来自哪个国家。

But they lived not far from where both Ian and I grew up, since we grew up near one another.

但他们住的地方离伊恩和我长大的地方不远，因为我们从小一起长大。

And I'll never forget that the younger brother of a friend of mine ran over to the father.

我永远不会忘记我一个朋友的弟弟跑到父亲身边。

He had cut his thumb on the bandsaw.

他的拇指被带锯割伤了。

And it wasn't particularly deep, but he was crying in pain.

而且不是特别深，但他却痛得哭了。

And the father wrapped it, picked up his chin, and smacked him across the face and said, don't ever do that again.

父亲包住了它，拿起他的下巴，打了他的脸，说，不要再这样做了。

And so what I think he was doing was compounding the lesson about the saw, but clearly had no regard for the pain that the injury probably caused.

所以我认为他正在做的是复合有关锯子的教训，但显然没有考虑到受伤​​可能造成的疼痛。

Now, I haven't followed up with that kid.

现在，我还没有再去追踪那个孩子。

I think we can all agree that by today's standards, that would be considered abusive parenting or perhaps one could say that was on the far extreme of a response.

我想我们都同意，按照今天的标准，这将被视为虐待性养育，或者也许有人可以说这是一种极端的反应。

But I'll never forget that.

但我永远不会忘记这一点。

And I went home and I told my mom.

我回家告诉了妈妈。

And she said, oh yeah, when I was growing up, that was actually a more frequent response to kids hurting themselves, especially boys.

她说，哦，是的，在我成长的过程中，这实际上是对孩子伤害自己的更常见的反应，尤其是男孩。

And so things have really changed in terms of how we react to children in pain.

因此，我们对痛苦儿童的反应方式确实发生了变化。

But the reason I find this interesting is that ultimately what we're talking about is how should we interpret our own pain?

但我觉得这很有趣的原因是，最终我们讨论的是我们应该如何解释自己的痛苦？

Why I bring this up, not only to help explain that father's actions, somehow I don't think that he was thinking, oh, my kids got a painful hand or finger.

为什么我提出这个，不仅是为了帮助解释父亲的行为，不知何故，我不认为他在想，哦，我的孩子们的手或手指很痛。

He cut himself.

他割伤了自己。

I'm going to slap him off the side of the head.

我要一巴掌打掉他的头。

He'll feel better.

他会感觉好一些。

I don't think that's what was going through his head.

我不认为这就是他的想法。

Let's go back to heat and cold.

让我们回到热和冷。

We briefly touched on heat, but let's talk about the use of, quote unquote, "therapeutic heat" or therapeutic cold, a cold pack for a bruise that really aches or maybe even a break or a sprain or heat.

我们简单地谈到了热疗，但让我们谈谈“治疗性热疗”或治疗性冷敷的使用，即用冷敷袋治疗真正疼痛的瘀伤，甚至可能是骨折、扭伤或热敷。

In the world of sport physio, cold is now heavily debated, localized cold, is heavily debated.

在运动理疗界，感冒现在引起了激烈的争论，局部感冒引起了激烈的争论。

You get people saying things, I don't know if this is true, that it creates a sludging of the fluids trying to head in and out of the injury.

人们会说，我不知道这是否属实，它会造成液体淤积，试图进出伤口。

So cold is not as good as heat.

所以冷不如热。

Heat allows for the inclusion and removal of waste products.

热量可以包含和去除废物。

And there are all sorts of just so stories that people make up, some of which might be true.

人们编造了各种各样的故事，其中一些可能是真的。

I don't know.

我不知道。

But what do we know about heat and cold as physiological stimuli in terms of their ability to ameliorate, to help pain?

但是，我们对热和冷作为生理刺激改善、帮助疼痛的能力了解多少呢？

Because of course, you get things hot enough or you get them cold enough, you can create pain with heat or cold.

当然，因为如果你把东西弄得足够热或者你把它们弄得足够冷，你就会因为热或冷而产生疼痛。

But let's assume we're not getting to that level of heat or cold and one is in pain.

但我们假设我们还没有达到那种热或冷的程度，并且一个人感到疼痛。

When I was a kid, we had a hot water bottle that for times when we were sick or something.

当我还是个孩子的时候，我们有一个热水袋，当我们生病或者其他什么的时候。

But sometimes if I felt an ache on the side, I'd put some hot water in the hot water bottle and lie on that thing and watch some cartoons.

但有时如果我感觉一侧疼痛，我就会在热水袋里放点热水，然后躺在那个东西上看一些动画片。

I definitely felt better.

我确实感觉好多了。

Cold has some really cool effects.

寒冷有一些非常酷的效果。

Cold reduces inflammation.

寒冷可以减少炎症。

So it reduces some of the release of those inflammatory chemicals.

因此它减少了一些炎症化学物质的释放。

We talked about prostaglandins, cytokines, histamines, other chemokines, all these fancy terms for substances that sensitize the primary nociceptor.

我们讨论了前列腺素、细胞因子、组胺、其他趋化因子，所有这些奇特的术语都是指使初级伤害感受器敏感的物质。

And it reduces the release of those and it reduces inflammation.

它减少了这些物质的释放并减少了炎症。

Another cool thing often not appreciated is nerves don't fire as fast when they're cold.

另一件经常被忽视的很酷的事情是神经在寒冷时不会那么快地放电。

And so if you've got nociceptors that are firing and you put cold, it's slowing the number of signals coming up.

因此，如果你的伤害感受器正在放电，而你却处于寒冷状态，就会减慢发出的信号数量。

And by definition, it's reducing ultimately the pain you're experiencing.

根据定义，它最终会减轻您所经历的痛苦。

Now, heat, heat has an obvious effect of increasing blood flow.

现在，热敷、热敷有明显的增加血流量的作用。

It's going to help relax muscles and get blood into those muscles.

它将帮助放松肌肉并使血液进入这些肌肉。

And that's probably why you're putting that hot water bottle on.

这可能就是你戴上热水袋的原因。

And it just darn feels good.

感觉真好。

And so what do I tell people?

那么我要告诉人们什么呢？

In part, I tell people use whichever works best for them.

在某种程度上，我告诉人们使用最适合他们的方式。

I find there's huge individual variability in whether people like heat or like cold.

我发现人们喜欢热还是喜欢冷存在巨大的个体差异。

And within reason, they're safe.

在合理范围内，他们是安全的。

What do I mean within reason?

我的意思是在合理范围内？

Don't go putting an ice pack on an extremity for two hours.

不要将冰袋放在四肢上两个小时。

You'll get a frostbite.

你会被冻伤的。

So take care with that.

所以要小心。

Is it possible to raise one's pain threshold through the regular exposure to pain in ways that are safe, such as deliberate cold exposure, assuming that one doesn't stay in too long and it's not too cold?

是否有可能通过以安全的方式定期接触疼痛来提高人的疼痛阈值，例如故意暴露在寒冷中，假设一个人不会呆太久并且天气不太冷？

And/or through we were talking about sports earlier, but just in general, can we raise our pain threshold so that life is less painful?

和/或通过我们之前谈论的运动，但总的来说，我们可以提高我们的疼痛阈值，以便生活不那么痛苦吗？

I think one of the questions that would come up with, for instance, the cold exposure, and I don't know the answer to this, but I'm sure maybe somebody out there does, is there cross-modality changes in pain thresholds?

我认为会出现的问题之一是，例如，寒冷暴露，我不知道这个问题的答案，但我确信也许有人知道，疼痛阈值是否存在跨模态变化？

I mean, if you expose yourself a lot to cold, does it change your heat thresholds?

我的意思是，如果你经常暴露在寒冷中，它会改变你的热阈值吗？

I would be surprised if it did.

如果确实如此，我会感到惊讶。

Can you change ultimately your thresholds?

你最终能改变你的门槛吗？

Yeah.

是的。

Where that involves is a lot of cognitive control.

这涉及到大量的认知控制。

It's a lot of cognitive training around that space.

围绕这个空间进行了大量的认知训练。

And there's clearly approaches to that.

显然有解决方法。

People have learned that there's different manipulations around that.

人们已经了解到，围绕这一点有不同的操纵方式。

So one experiment, this wasn't intended, at least I don't believe so, they were measuring heat thresholds on college students.

所以一项实验，这不是故意的，至少我不这么认为，他们正在测量大学生的热阈值。

And we experiment a lot on students, as we all know.

众所周知，我们在学生身上进行了很多实验。

We pay them well.

我们付给他们丰厚的报酬。

And what they found is that when they're studying guys, studying dudes, when there was an attractive woman who was delivering the stimulus, the thresholds were higher.

他们发现，当他们研究男人、研究男人时，当有一个有吸引力的女人在提供刺激时，阈值会更高。

Because the guys did not want to look like a wuss in front of this attractive young woman.

因为男人们不想在这个年轻漂亮的女人面前显得懦弱。

And that's been pretty well established.

这已经很确定了。

So the experimenter, their gender plays a big role in that.

因此，实验者的性别在其中起着重要作用。

A major problem with a lot of blood tests out there, however, is that you get information back about metabolic factors, lipids, and hormones and so forth, but you don't know what to do with that information.

然而，大量血液测试的一个主要问题是，您获得有关代谢因素、脂质和激素等的信息，但您不知道如何处理这些信息。

With InsideTracker, they make it very easy because they have a personalized platform that allows you to see the levels of all those things, metabolic factors, lipids, hormones, et cetera, but it gives you specific directives that you can follow that relate to nutrition, behavioral modification, supplements, et cetera that can help you bring those numbers into the ranges that are optimal for you.

有了InsideTracker，他们就变得非常容易，因为他们有一个个性化的平台，可以让你看到所有这些东西的水平，代谢因素、脂质、激素等，但它为你提供了可以遵循的与营养、行为改变、补充剂等相关的具体指示，可以帮助你将这些数字调整到最适合你的范围。

If you'd like to try InsideTracker, you can go to insidetracker.com/huberman to get 20% off any of InsideTracker's plans.

如果您想尝试 InsideTracker，您可以访问 insidetracker.com/huberman，享受任何 InsideTracker 计划 20% 的折扣。

Again, that's insidetracker.com/huberman.

同样，这是 insidetracker.com/huberman。

One thing I'm fascinated by in the whole mindfulness space is this idea of whether or not under conditions of stress, or in this case pain, whether or not the most adaptive mindset, assuming it's not a tissue damaging level of pain, would be to think about something else, distract oneself from the pain.

在整个正念空间中，我着迷的一件事是，无论是否在压力条件下，或者在这种情况下疼痛，最适应的心态，假设这不是组织损伤程度的疼痛，是否会考虑其他事情，分散自己对疼痛的注意力。

Or conversely, whether or not one should, quote unquote, "go into the pain."

或者相反，无论一个人是否应该，引用不引用，“进入痛苦”。

So for people who have chronic pain, maybe it's in a small area of the body that experiences chronic pain, pain quite often, a.k.a.

因此，对于患有慢性疼痛的人来说，可能是身体的一小部分区域经常经历慢性疼痛，又称疼痛。

chronic pain, or maybe it's whole body pain.

慢性疼痛，或者可能是全身疼痛。

I don't think it really matters for the question I'm asking.

我认为这对于我问的问题并不重要。

And people are trying to develop some cognitive ways, so what we call as neuroscientists, you and I, top down mechanisms for things like, OK, I'm going to distract myself from the pain.

人们正在尝试开发一些认知方式，所以我们所谓的神经科学家，你和我，自上而下的机制，比如，好吧，我要分散自己对痛苦的注意力。

I'm going to focus on other things I really enjoy.

我将专注于我真正喜欢的其他事情。

Or rather I'm going to really go into the pain, meet the pain, and realize, I don't know, somehow that it's not as bad, like somehow there's-- and again, this becomes very opaque.

或者更确切地说，我将真正进入痛苦，面对痛苦，并意识到，我不知道，不知何故，它并没有那么糟糕，就像不知何故那样——而且，这再次变得非常不透明。

We don't really know what we're talking about when we do these sorts of protocols.

当我们进行此类协议时，我们并不真正知道我们在谈论什么。

But those sorts of things are out there in the mindfulness space.

但这些事情都存在于正念空间中。

And I think I certainly take mindfulness seriously as an intervention.

我想我确实认真对待正念作为一种干预措施。

But what always bothers me about those sorts of interventions is that they lack the specificity and the granularity and there's no kind of mechanistic logic to explain them.

但这类干预措施总是让我困扰的是，它们缺乏特异性和粒度，而且没有任何机械逻辑可以解释它们。

So what are your thoughts on meeting the pain versus distracting oneself from the pain?

那么，对于应对痛苦和分散自己的注意力，你有何看法呢？

What we've learned is that attentional distraction engages specific brain networks.

我们了解到，注意力分散会涉及特定的大脑网络。

They tend to be some of the outer layer of brain networks and your prefrontal cortex, some in your cingulate cortex, and other regions which are clearly involved with distraction.

它们往往位于大脑网络和前额皮质的外层，部分位于扣带皮层，以及其他明显与分心有关的区域。

It's not necessarily that distraction is going to completely eliminate one's pain, but it can reduce it significantly.

分心不一定能完全消除痛苦，但可以显着减轻痛苦。

And this is why the biggest problem with distraction from a time of the day is at night.

这就是为什么一天中某个时间分心的最大问题是在晚上。

It's when people are trying to sleep.

这是人们想睡觉的时候。

Because during the daytime, you can read that book.

因为白天你可以看那本书。

You can spend time with friends and family.

您可以与朋友和家人共度时光。

But people with chronic pain that have it 24/7, you can't distract yourself at night when you're trying to get into a relaxed state and fall asleep.

但对于患有 24/7 全天候慢性疼痛的人来说，当您试图进入放松状态并入睡时，您无法在晚上分散自己的注意力。

And that's why sleep is such a big issue for people with chronic pain.

这就是为什么睡眠对于患有慢性疼痛的人来说是一个大问题。

So attentional distraction, it works.

所以分散注意力是有效的。

Distraction works.

分散注意力是有效的。

Now, what you said, I mean the second piece, you said let's meet the pain, if you will.

现在，你所说的，我指的是第二部分，你说如果你愿意的话，让我们来面对痛苦。

And there's different approaches to meeting the pain.

有不同的方法来缓解疼痛。

One approach that you invoked with mindfulness is addressing the pain from a non-judgmental, accepting manner.

你用正念调用的一种方法是用一种不评判、接受的方式来解决痛苦。

I'm aware the pain is there.

我知道疼痛就在那里。

I am not going to judge it.

我不打算评判它。

I'm not going to put a value on its bad, it's good, or anything.

我不会评价它的好坏或其他什么。

I'm just going to note its presence.

我只是要注意它的存在。

And that has been shown to work as well.

事实证明这也有效。

In fact, actually when Jon Kabat-Zinn originally developed mindfulness based stress reduction, people with low back pain.

事实上，当 Jon Kabat-Zinn 最初开发基于正念的减压方法时，针对的是患有腰痛的人。

Plenty of studies have shown that it works.

大量研究表明它是有效的。

I've completed just some recent studies in MBSR as well.

我最近也完成了一些 MBSR 的研究。

And we're diving deeply into the data.

我们正在深入研究数据。

So it's this non-judgmental acceptance, if you will, of the pain.

所以，如果你愿意的话，这就是对痛苦的不带评判的接受。

It's a great skill to learn.

这是一项非常值得学习的技能。

No side effects.

无副作用。

Takes a little bit of time to learn it.

需要一点时间来学习它。

And it can be in some people effective and helpful for pain.

它对某些人的疼痛有效且有帮助。

And that's the key that we're going to keep coming back to is some of these things work for some of the people some of the time.

我们要继续讨论的关键是，其中一些东西在某些时候对某些人有用。

There's a third aspect of meeting the pain.

应对痛苦还有第三个方面。

And that is more of a direct cognitive reframing about the meaning of the pain.

这更多的是对疼痛含义的直接认知重构。

Now you're coming at the pain and you have an approach.

现在你正面临着痛苦并且你有一个方法。

You're making effort on what you're thinking of the pain.

你正在为你所想到的痛苦而努力。

Is that pain damaging, threatening, harmful, or do you view it as, yeah, it hurts, but it's not harming me.

这种痛苦是破坏性的、威胁性的、有害的，还是你认为它是，是的，它很痛，但它并没有伤害我。

That is a critical, critical aspect of pain management.

这是疼痛管理的一个非常重要的方面。

And that serves as a foundation for something called cognitive behavioral therapy.

这是认知行为疗法的基础。

The cool thing about a number of these is that there's actually different neural circuits engaged with these different approaches.

其中一些很酷的事情是，实际上有不同的神经回路参与这些不同的方法。

And I think the key that we have to figure out, and this is where research is going, is which approach works for which person under which circumstance.

我认为我们必须弄清楚的关键是哪种方法适用于哪种情况下的哪种人，这也是研究的方向。

It's like, I'm hurt, but am I injured?

就像，我受伤了，但我受伤了吗？

That's the first question.

这是第一个问题。

I've rolled an ankle.

我扭伤了脚踝。

I'm limping.

我一瘸一拐的。

This hurts.

这很痛。

Am I injured?

我受伤了吗？

Meaning am I going to be back at it in an hour or tomorrow versus I've broken bones and it's a great empathy for anybody that does.

这意味着我会在一小时或明天后回来，而不是我骨折了，这对任何这样做的人来说都是一种极大的同情。

When you're injured, you feel the snap and you know you're out for a while in some cases.

当你受伤时，你会感觉到骨折，并且知道在某些情况下你会缺席一段时间。

So I think knowing the difference between being hurt and being injured is something that's kind of that key moment.

所以我认为了解受伤和受伤之间的区别是关键时刻。

And for me, it's always been experienced as a moment of anxiety after feeling pain, especially in sports.

对我来说，这总是感觉疼痛后的焦虑时刻，尤其是在运动中。

You're oh, am I going to have to take two weeks off?

你哦，我要休息两周吗？

Or is this just pain?

或者这只是痛苦？

So I think for people to be able to recognize when pain is reporting an injury versus when pain is just reporting a temporary sensation is really important.

因此，我认为人们能够识别疼痛何时报告受伤，何时疼痛仅报告暂时的感觉非常重要。

And perhaps also for psychological hurt versus psychological injury.

也许还可以针对心理伤害与心理伤害。

I mean, that gets to some larger context themes these days of somebody says something.

我的意思是，现在有人说了什么，这涉及到一些更大的背景主题。

It upsets us.

这让我们心烦意乱。

Are we hurt or are we injured?

我们受伤了还是我们受伤了？

I think it gets very murky.

我认为事情变得非常模糊。

So how does one determine if they are hurt versus injured?

那么，如何确定自己是否受伤呢？

And then maybe we could even stretch into the psychological realm.

然后也许我们甚至可以延伸到心理领域。

Neither of us are psychologists.

我们都不是心理学家。

But it sounds like so much of what you do represents the bridge from the body into the mind.

但听起来你所做的很多事情都代表着从身体到心灵的桥梁。

And so we'd be remiss if we didn't talk about emotional pain as well.

因此，如果我们不谈论情感上的痛苦，那就是失职了。

Guy's in his 40s, a master's level tennis player.

盖伊四十多岁，是一位大师级网球运动员。

Tennis is his life.

网球就是他的生命。

He works as some executive somewhere but he lives for tennis.

他在某处担任高管，但他为网球而生。

Comes hobbling in on crutches.

拄着拐杖一瘸一拐地进来。

Sits down and he's got pain in his foot.

坐下来，他的脚感到疼痛。

And he was told not to put pressure on his foot because he's got this injury and it's going to be worse.

他被告知不要对他的脚施加压力，因为他受了伤，而且情况会更糟。

And this has been going on now for months.

这种情况已经持续了几个月了。

And he's now depressed because he can't play tennis.

他现在很沮丧，因为他不能打网球。

Tennis is his life.

网球就是他的生命。

This guy's life is tennis.

这家伙的生命就是网球。

So I examined this guy.

所以我检查了这个人。

And it turns out what he has is something called a Morton's neuroma.

事实证明他得的是一种叫做莫顿神经瘤的东西。

And a Morton's neuroma is a fibrous thickening of tissue around the nerves that go to your toes.

莫顿神经瘤是指延伸到脚趾的神经周围组织的纤维增厚。

And it gets to be this bundled tissue, nerves, and it's really painful.

组织、神经都被捆绑起来，这真的很痛苦。

It's very painful.

这是非常痛苦的。

But it's not causing harm.

但它不会造成伤害。

There's no harm there.

那里没有什么坏处。

It's really painful.

真的很痛苦。

So I explained this to the guy.

所以我向那家伙解释了这一点。

And he looks at me and this light bulb goes off.

他看着我，灯泡就灭了。

And he's like, you mean I can play tennis?

他说，你是说我可以打网球？

And I'm like, yeah, guy, you can go play all the tennis you want.

我说，是的，伙计，你可以去打你想要打的所有网球。

It's just going to hurt.

只会很痛。

He got up.

他站了起来。

He left the crutches in the exam office and he walked away.

他把拐杖留在考试办公室，然后走开了。

Now, that's an extreme example.

现在，这是一个极端的例子。

I don't want people, please, to think that that kind of thing occurs all the time.

我不想让人们认为这种事情经常发生。

It doesn't.

事实并非如此。

Chronic pain conditions are often incredibly complicated and need much more than a 45 minute or 60 minute education session and back to the tennis court.

慢性疼痛的情况通常非常复杂，需要的不仅仅是 45 分钟或 60 分钟的教育课程然后回到网球场。

He still had pain in his foot, by the way.

顺便说一句，他的脚仍然很痛。

But he could play.

但他可以打球。

But that gives that example of addressing that fear and the anxiety around that issue.

但这给出了解决围绕该问题的恐惧和焦虑的例子。

And I think that's what we first have to learn is does that pain that we're experiencing represent something that is harming us, something that we either need to seek medical attention now or sometime soon, and whether does continued activity worsen the tissue injury or not?

我认为我们首先要了解的是，我们正在经历的疼痛是否代表着正在伤害我们的东西，我们需要现在或不久就需要寻求医疗救助，以及持续的活动是否会加剧组织损伤？

In my world where I'm carrying mostly for people with chronic pain, we've moved beyond the tissue healing.

在我的世界里，我主要为患有慢性疼痛的人提供帮助，我们已经超越了组织愈合的范围。

By definition, by one of the definitions for chronic pain, is that the pain persists beyond the time of tissue healing.

根据定义，慢性疼痛的定义之一是疼痛持续超过组织愈合时间。

So in many of our sessions, our times, we're educating people, hurt versus harm.

因此，在我们的许多会议中，我们的时代，我们正在教育人们，伤害与伤害。

It's back pain.

这是背痛。

We evaluate the spine.

我们评估脊柱。

We make sure is the spine stable?

我们确定脊柱稳定吗？

Is there anything sinister causing damage?

是不是有什么不祥之物造成了损害？

In most of the cases, it's not.

在大多数情况下，事实并非如此。

And we help people understand that distinction.

我们帮助人们理解这种区别。

Critical, critical for people.

关键，对人来说关键。

And yet at the same time, you don't want to just ignore something that is a real medical issue that's getting worse and needs medical attention.

但与此同时，您不想忽视一些真正的医疗问题，该问题正在恶化并需要医疗护理。

And that's where the complexity of all this comes in.

这就是所有这一切的复杂性所在。

Did I answer your question?

我回答你的问题了吗？

But we'd be avoiding the obvious if we didn't say that in the last really 10 to 15 years, there's been a pretty dramatic shift in terms of how society at large interprets emotional pain.

但如果我们不说在过去 10 到 15 年里，整个社会对情感痛苦的解读方式发生了相当戏剧性的转变，我们就回避了显而易见的事实。

People hearing things or seeing things.

人们听到或看到事情。

And the idea that emotional pain could be related to physical pain or at least similar enough to it that people's emotional pain is valid.

情绪痛苦可能与身体疼痛相关，或者至少与身体疼痛足够相似，以至于人们的情绪痛苦是正确的。

And if anything, I'm here to validate the fact that emotional pain is valid, like any other pain, except it is different because it becomes very hard to point to a specific kind of threshold.

如果有的话，我来这里是为了验证这样一个事实：情感痛苦是有效的，就像任何其他痛苦一样，只不过它是不同的，因为它变得很难指出特定类型的阈值。

We're using that word a lot today, but I think it's appropriate here.

我们今天经常使用这个词，但我认为用在这里是合适的。

Threshold between hurt and harmed.

受伤与被伤害之间的界限。

Whereas if I tell you that my left foot hurts, which it did a lot in high school, and then you took an X-ray of my foot in high school, you'd say your foot is broken, because it was broken a lot in high school.

然而，如果我告诉你我的左脚很痛，高中时经常这样，然后你在高中时给我的脚拍了X光片，你会说你的脚骨折了，因为高中时经常骨折。

And that's harmed.

这受到了伤害。

I mean, to continue to do what I was doing to break it in the first place, I was clearly going to harm myself worse.

我的意思是，继续做我一开始就打破它的事情，我显然会对自己造成更严重的伤害。

So I had to I had to heal up.

所以我必须要痊愈。

But when it comes to psychological pain, psychiatry has all these thresholds for normal functioning versus abnormal functioning.

但当谈到心理痛苦时，精神病学对正常功能与异常功能有所有这些阈值。

Are you sleeping well, normal relationships, and on and on.

你睡得好吗，正常的人际关系等等。

We don't want to go there, because that's not our place.

我们不想去那里，因为那不是我们的地方。

But how do you, when you see patients, how do you take into account the level or the thresholds for their emotional pain?

但是，当你看病人时，你如何考虑他们情绪痛苦的程度或阈值？

Because that's part of your job.

因为那是你工作的一部分。

So I'm asking you this from the perspective of somebody who treats pain.

所以我是从治疗疼痛的人的角度来问你这个问题的。

How do you gauge somebody's psychological pain?

你如何衡量一个人的心理痛苦？

Is it by how intensely they vocalize their pain?

是因为他们表达痛苦的强度有多大吗？

Or does it always go back to how well or poorly their life is being managed at the level of sleep, nutrition, relationships, and so forth?

或者，这是否总是取决于他们在睡眠、营养、人际关系等方面的生活管理得有多好或有多差？

The thing to note is that least in people that come into our Stanford Pain Management Center and other pain centers is that remember pain is a sensory and emotional experience.

需要注意的是，至少对于进入我们斯坦福疼痛管理中心和其他疼痛中心的人来说，记住疼痛是一种感觉和情感体验。

It's all wrapped up.

一切都包起来了。

And so we want to treat the whole person.

所以我们想要治疗整个人。

Sometimes we get easy.

有时我们会变得轻松。

We get easy ones and we just go do a nerve block and the pain goes away and that's simple.

我们有简单的方法，只需做神经阻滞，疼痛就会消失，这很简单。

But usually it's much more complex where we're seeing the interaction of an expression of pain that includes a significant amount of anxiety, of depression.

但通常情况要复杂得多，我们会看到疼痛表达的相互作用，其中包括大量的焦虑和抑郁。

You mentioned this term catastrophizing, which we can break down if you'd like.

您提到了“灾难化”这个术语，如果您愿意，我们可以对其进行分解。

And that's probably one of the biggest predictors, factors in an amplification of pain and worsening pain and poor treatment response is catastrophizing.

这可能是最大的预测因素之一，疼痛加剧和疼痛恶化以及治疗反应不佳的因素是灾难性的。

I try to treat the whole person and not really parcel out all this.

我试着对待整个人，而不是真正把这一切都分开。

At Stanford, I built a digital health system that captures, measures a lot of data around a patient's experience across physical, psychological, and social functioning.

在斯坦福大学，我建立了一个数字健康系统，可以捕获、测量患者在身体、心理和社会功能方面的大量数据。

And we use that data to target therapies, to understand how much their depressive symptoms are, anxiety, anger.

我们利用这些数据来进行针对性治疗，了解他们的抑郁症状、焦虑、愤怒程度。

Anger, big issue and pain.

愤怒、大问题和痛苦。

Huge in pain.

巨大的痛苦。

And so sometimes we can't just eliminate the nociception and the periphery.

所以有时我们不能仅仅消除伤害感受和外围环境。

Sometimes we can reduce it.

有时我们可以减少它。

But what we have to do is target everything.

但我们要做的就是瞄准一切。

And we have to try to target all these circuits up here.

我们必须尝试瞄准这里的所有这些电路。

And in many cases, what we're doing is through education, through pain psychology, through physical therapy and rehabilitative approaches on top of it.

在许多情况下，我们正在做的是通过教育、疼痛心理学、物理治疗和康复方法。

And yes, the medications we have now.

是的，我们现在拥有的药物。

We touched base on a few earlier, but we have over 200 medications available for pain.

我们之前接触过一些药物，但我们有 200 多种可用于止痛的药物。

Very few of them FDA approved.

其中很少有 FDA 批准的。

We tend to steal from all the other fields.

我们倾向于从所有其他领域偷窃。

We can take from the cardiologists medications that work on the heart, anti-arrhythmia or heart rhythm drugs.

我们可以从心脏病专家那里服用对心脏有效的药物、抗心律失常或心律失常药物。

They are potent sodium channel blockers.

它们是有效的钠通道阻滞剂。

And the sodium channels, as you know, are responsible for the action potential that generates the nerve impulse signal.

如您所知，钠通道负责产生神经脉冲信号的动作电位。

And so they're like an oral local anesthetic that you take.

因此它们就像您服用的口服局部麻醉剂。

And so we take from everybody in our field on the medications.

因此，我们从我们领域的每个人那里获取药物。

Getting back to what you said, so just summarizing, one, I don't really distinguish psychological versus physical pain in my world.

回到你所说的，所以总结一下，第一，我并没有真正区分我的世界中的心理痛苦和身体痛苦。

I find it better just to treat it as pain and look at the person holistically and go after all the components at once.

我发现最好将其视为痛苦并从整体上看待这个人并立即处理所有组成部分。

I find that's where we get the best results.

我发现这就是我们获得最佳结果的地方。

And it is typically bringing a lot of tools to bear.

它通常会带来很多工具。

I've had my experiences with chronic pain.

我有过慢性疼痛的经历。

I developed an abdominal chronic pain problem shortly after I turned 50.

50 岁后不久，我就出现了腹部慢性疼痛问题。

I was throwing a happy hour for our pain psychologists of all people.

我正在为我们所有人的疼痛心理学家带来欢乐时光。

Went to a Mexican restaurant.

去了一家墨西哥餐厅。

I won't name which one.

我不会说出是哪一个。

Got food poisoning.

食物中毒了。

That's why I'm not naming it.

这就是为什么我不给它命名。

Good Mexican food, bad food poisoning.

好的墨西哥食物，坏的食物中毒。

And ever since that event, I can't eat anything in the onion family.

自从那次事件之后，我再也不能吃洋葱家族的任何东西了。

And what actually benefited me was, of all things, the pandemic.

真正让我受益的是这场流行病。

Why?

为什么？

Because what did we all do?

因为我们都做了什么？

We isolated and we started eating the same foods.

我们被隔离了，我们开始吃同样的食物。

And I started noticing I was feeling better when I was eating certain foods.

我开始注意到，当我吃某些食物时，我感觉好多了。

My abdominal pain went away.

我的腹痛消失了。

And I'd start doing, as a scientist, experiments.

作为一名科学家，我开始做实验。

And I finally was able to isolate and determine what the problem was.

我终于能够隔离并确定问题所在。

So now I have complete avoidance on that.

所以现在我完全回避这一点。

I'm a little difficult to go out to a restaurant and have dinner.

我有点难以出去餐厅吃饭。

But I could imagine somebody going to their physician and that physician not being you and saying, yeah, I notice that when I eat certain foods I'm in a lot of pain.

但我可以想象有人去找他们的医生，而那个医生不是你，他说，是的，我注意到当我吃某些食物时，我会感到很痛苦。

And the physician simply saying, well, don't eat those foods.

医生只是说，好吧，不要吃这些食物。

But unless that person is a trained scientist, not knowing how to go about doing the sorts of experiments that you did would be difficult.

但除非那个人是一位训练有素的科学家，否则不知道如何进行你所做的那种实验将会很困难。

I am intrigued by the onion example, even though it's your case in particular and we don't want to extrapolate too broadly.

我对洋葱的例子很感兴趣，尽管这是你的具体情况，而且我们不想推断得太宽泛。

Is there something about onions that's triggering a particular neurochemical or immune pathway?

洋葱是否有某种物质可以触发特定的神经化学物质或免疫途径？

Do we have any knowledge of why onions would create that kind of gut pain?

我们知道为什么洋葱会造成这种肠痛吗？

Basically the short answer is you get an infection, and your gut no longer responds properly to a normal food item.

基本上，简短的答案是您受到感染，并且您的肠道不再对正常食物做出正确反应。

And so one explanation may be I got this infection.

所以一种解释可能是我感染了这种病毒。

I was at a Mexican restaurant.

我当时在一家墨西哥餐厅。

A lot of onions.

很多洋葱。

And I got sensitized through that infection now subsequently to onions.

通过这种感染，我现在对洋葱变得敏感。

I saw a Stanford allergist, Hannah Watford, who's awesome, by the way.

顺便说一句，我见过斯坦福大学的过敏症专科医生汉娜·沃特福德（Hannah Watford），她很棒。

And after I'd had this I think figured out and I went in and I'm like, well, Dr. Watford, is there anything I can do for this?

在我得到这个之后，我想明白了，我进去了，我想，沃特福德博士，我能为此做些什么吗？

And she laughed and she's like, no, you're doing everything.

她笑了，她说，不，你正在做一切。

It's all just avoidance.

一切都只是逃避而已。

And I, thinking I was rather unique and special about this thing, I said, do you ever see this?

而我，认为我在这件事上相当独特和特别，我说，你见过这个吗？

And she said, oh yeah, I see this all the time.

她说，哦，是的，我一直看到这个。

Every day.

每天。

I see this all the time.

我经常看到这个。

And I was like, this isn't unusual?

我当时想，这不奇怪吗？

And she's like, no, I see this thing all the time.

她说，不，我一直看到这个东西。

I'm fortunate that if I have a stomachache or a headache, it means something's wrong.

我很幸运，如果我胃痛或头痛，就意味着出了什么问题。

I rarely get those.

我很少得到这些。

I've sometimes been called I have a stomach of steel, not because it's hard from the outside, but because I can eat pretty much anything, although I eat pretty cleanly.

有时有人说我有一个钢铁般的胃，不是因为它的外表很难，而是因为我几乎可以吃任何东西，尽管我吃得很干净。

A lot of people write to me and ask questions on social media about irritable bowel syndrome and other forms of gut pain and viscera pain, pain that they feel is really deep within their system.

很多人写信给我，并在社交媒体上询问有关肠易激综合症和其他形式的肠道疼痛和内脏疼痛的问题，他们觉得这些疼痛确实深植于他们的系统中。

Typically how is that sort of pain dealt with at a clinical level?

通常在临床层面如何处理这种疼痛？

But getting back to visceral pain.

但回到内脏疼痛。

So the thing about somatic pain, that's another term now, somatic meaning the soma, the extremity that you were alluding to, is the nociceptors there very precisely localize where the stimulus, the painful stimulus, is coming from.

所以关于躯体疼痛，这是另一个术语，躯体的意思是躯体，你提到的肢体，是那里的伤害感受器，非常精确地定位刺激、疼痛刺激的来源。

When you hit your thumb with a hammer, you know exactly where that pain occurred.

当你用锤子敲击拇指时，你就能清楚地知道疼痛发生在哪里。

With the visceral pain, what you have are very diffuse what we refer to as receptive fields.

由于内脏疼痛，你所感受到的非常分散，我们称之为感受野。

Think about the last time you had a stomachache.

想想你上次胃痛是什么时候。

It's not that you put your thumb right here.

这并不是说你把拇指放在这里。

We said it kind of hurts like this.

我们说这有点痛。

Now, there's some fascinating stuff that occurs with visceral pain, because those fibers that extend from the viscera, meaning the lungs, the abdomen, the pelvis, they all head into the spinal cord too.

现在，内脏疼痛会发生一些令人着迷的事情，因为那些从内脏延伸出来的纤维，即肺、腹部、骨盆，它们也都进入脊髓。

And it just so happens that they make kind of indirect direct connections with the same level that represents the body.

碰巧的是，它们与代表身体的同一层面建立了某种间接的直接联系。

So let's think about pelvic pain, for instance.

例如，让我们考虑一下骨盆疼痛。

You frequently will find people that have pelvic pain that will describe having lower back pain too.

您经常会发现有骨盆疼痛的人也描述有下背部疼痛。

And it's because of this visceral somatic convergence in the spinal cord.

这是因为脊髓中的内脏体细胞汇聚。

It's not that there's something going on in their back.

并不是说他们背后有什么事情。

It's that these signals that are being driven heavily from the pelvis are coming in and connecting with the same regions from the back.

这些信号从骨盆强烈驱动，从背部传入并与相同区域连接。

And the convergence of that is now being perceived as pain in both.

现在，这种融合对双方来说都是痛苦的。

And we're seeing that more and more in the research this visceral somatic convergence.

我们在研究中看到越来越多的内脏躯体融合。

People have pain in their pelvis and then also over their abdomen.

人们会感到骨盆疼痛，然后腹部也会疼痛。

Classic one that we're aware of, we see this in the TV and the movies and unfortunately real life, are heart attacks.

我们知道的经典心脏病，我们在电视和电影中看到，不幸的是在现实生活中，心脏病发作。

So the visceral fibers that subserve the heart, typically the first through the fourth thoracic region, well, those converge in the spinal cord and similar regions that subserve sensation under the arm up here.

因此，支持心脏的内脏纤维，通常是第一到第四胸部区域，这些纤维会聚在脊髓和类似的区域，这些区域支持手臂下方的感觉。

That's why people will often say they've got pain with a heart attack radiating down into their arm.

这就是为什么人们经常说他们的心脏病发作时疼痛已经扩散到手臂上。

And I used to think it was sciatica, because you assume anything on the right back side, it must be wallet induced sciatica.

我曾经认为这是坐骨神经痛，因为你假设右后侧有任何东西，那一定是钱包引起的坐骨神经痛。

Back pocket wallet induced sciatica.

后口袋钱包诱发坐骨神经痛。

But what I eventually realized is that, well, it's this disk bulge.

但我最终意识到，这就是磁盘凸起。

It just so happens that the nerves that emit from that region, they branch out to a bunch of different areas.

碰巧的是，从该区域发出的神经，它们分支到许多不同的区域。

And so you think the pain is in your leg, but the issue is someplace else.

所以你认为疼痛出在你的腿上，但问题出在其他地方。

And occasionally indeed I feel the pain elsewhere in my body as well.

有时我确实也会感觉到身体其他部位的疼痛。

It's sort of like a matching of regions for pain that seem unrelated.

这有点像看似无关的疼痛区域的匹配。

Is that a way to think about reference pain?

这是思考参考疼痛的一种方式吗？

So that's another distinction you brought up nicely.

这是你很好地提出的另一个区别。

Good segue into there's thought to be several different types or categories of pain.

人们认为疼痛有几种不同类型或类别。

We have been talking through much of this time about somatic pain, injury out here.

这段时间我们大部分时间都在谈论身体疼痛和受伤。

We talked about visceral pain.

我们讨论了内脏疼痛。

And when you have damage to a peripheral nerve, damage, injury to a peripheral nerve or the central nervous system, we refer to that as neuropathic pain.

当周围神经或中枢神经系统受损时，我们将其称为神经性疼痛。

It frequently has different qualities, different characteristics.

它通常具有不同的品质、不同的特征。

People will refer to it as shooting, stabbing, shock-like, burning.

人们会把它称为射击、刺伤、震撼、燃烧。

It can frequently when there's a damage to a nerve or damage to certain regions of the brain be incredibly challenging to treat.

当神经受损或大脑某些区域受损时，治疗往往非常困难。

By the way, the good news is with that light disk bulge is the vast majority of time, the disks reabsorb.

顺便说一句，好消息是，在绝大多数情况下，磁盘轻微凸起时，磁盘会重新吸收。

As long as we're talking about referenced pain, somatic, visceral, and all the rest, what about associative or referenced pain where it's psychological?

既然我们谈论的是躯体疼痛、内脏疼痛以及所有其他疼痛，那么心理上的联想疼痛或参考疼痛又如何呢？

And I don't want to get too abstract here, but more and more these days I hear from people who say, I was in this job and the job sucked.

我不想在这里说得太抽象，但这些天我听到越来越多的人说，我从事这份工作，但这份工作很糟糕。

Or I was in this relationship and the relationship sucked.

或者我处于这段关系中，但这段关系很糟糕。

And I had terrible back pain, really acute, localized back pain or chronic headaches or migraines.

我有严重的背痛，非常严重的局部背痛或慢性头痛或偏头痛。

And then they go on vacation or they change their circumstances and lo and behold, the pain goes away.

然后他们去度假或者改变他们的环境，你瞧，痛苦消失了。

Does that surprise you as an expert in pain?

作为疼痛专家，您对此感到惊讶吗？

The brain controls our sympathetic nervous system and parasympathetic nervous system, the sympathetic being the fight and flight response.

大脑控制我们的交感神经系统和副交感神经系统，交感神经是战斗和逃跑反应。

It controls the tone of cortisol that's being released.

它控制正在释放的皮质醇的色调。

And we all know that in acute situations, rapid increases of cortisol and noradrenaline is keeps us away from the lions and tigers and the bears, oh my.

我们都知道，在紧急情况下，皮质醇和去甲肾上腺素的快速增加会让我们远离狮子、老虎和熊，天哪。

But in a chronic situation, and Robert Sapolsky, as you know, at Stanford has built a career around chronic stress at least in part.

但在长期的情况下，正如你所知，斯坦福大学的罗伯特·萨波尔斯基（Robert Sapolsky）至少在一定程度上围绕着慢性压力建立了自己的职业生涯。

And very bad for us.

对我们来说非常糟糕。

And so these chronic stressors impact the end organ, the tissue.

因此，这些慢性压力源会影响终末器官，即组织。

And it's real pain.

这真的很痛苦。

It doesn't mean that we need to go get back surgery.

这并不意味着我们需要进行背部手术。

It means that probably we need to identify the stressors that are contributing to that and address those.

这意味着我们可能需要确定造成这种情况的压力源并解决这些问题。

And we'll often find that in the scenarios you outlined that the pain gets better.

我们经常会发现，在您概述的场景中，疼痛会减轻。

Some of those targets are interesting.

其中一些目标很有趣。

There's a lot of memory associated with pain.

有很多记忆与疼痛有关。

This is where early life events occur.

这是早期生活事件发生的地方。

And those early life events and injuries can sensitize us to future vulnerability.

那些早年的生活事件和伤害可以让我们对未来的脆弱性更加敏感。

So I was in a bad car accident when I was 16.

所以我16岁时遭遇了一场严重的车祸。

Fortunate to walk away from it.

庆幸自己能够远离它。

Got bad whiplash.

受到了严重的鞭打。

If I get stressed, a lot of my pain manifests in my neck.

如果我感到压力，我的脖子就会出现很多疼痛。

For me as a pain doc, it's a signal to me that's like, go work out.

对于我作为一名疼痛医生来说，这对我来说是一个信号，那就是去锻炼。

Go for a walk in the forest.

去森林里散步。

And take some time away from the computer.

并离开电脑一段时间。

Again, that's a simplistic message.

再说一次，这是一个简单的消息。

And my experience doesn't translate into everybody else.

我的经验并不适用于其他人。

But I'm just validating everything that you said.

但我只是验证你所说的一切。

And we were having a glass or two of wine and I'm asking Art, have you ever studied pain?

我们喝了一两杯酒，我问阿特，你研究过疼痛吗？

He's like no, I study love.

他说不，我研究爱情。

And he's like, have you ever studied love?

他说，你研究过爱情吗？

No, I study pain.

不，我研究疼痛。

Has anybody ever studied the intersection?

有人研究过十字路口吗？

Another glass of wine.

再来一杯酒。

No. Let's do it.

不，我们就这么做吧。

So we came back to Stanford.

所以我们回到了斯坦福。

And there was a young post-doc Jarred Younger, who's now a professor at the University of Alabama.

还有一位年轻的博士后贾里德·杨格（Jarred Younger），他现在是阿拉巴马大学的教授。

And I said, Jarred, we're either going to fall flat on our face or this is going to be a cool study.

我说，贾里德，我们要么会一败涂地，要么这将是一项很酷的研究。

And Jarred took this on.

贾里德接手了这件事。

Great job.

干得好。

So what we did is we advertised on campus for couples in an early phase of a romantic relationship.

所以我们所做的就是在校园里为处于恋爱关系早期阶段的情侣做广告。

Because there's a reason for choosing that.

因为选择它是有原因的。

In an early phase of a romantic relationship, you are deeply focused on your beloved.

在恋爱关系的早期阶段，您非常关注您所爱的人。

They're on your mind all the time.

他们一直在你的脑海里。

You feel great when you're with them.

当你和他们在一起时你感觉很棒。

You feel terrible when you're not with them.

当你不和他们在一起时，你会感觉很糟糕。

Doesn't that just sound like an addiction?

这听起来不像是一种瘾吗？

We needed a control condition for this, because thinking about your beloved is very attentionally demanding.

为此我们需要一个控制条件，因为思考你所爱的人是非常需要注意力的。

Remember we talked about attentional distraction earlier.

请记住我们之前讨论过注意力分散。

So we gave people what's called a word generation task.

所以我们给了人们所谓的单词生成任务。

Very simply, can you think about every sport that doesn't involve a ball.

很简单，你能想象一下每一项不涉及球的运动吗？

Frisbee, hockey.

飞盘、曲棍球。

What do we find?

我们发现了什么？

Love works great.

爱情效果很好。

Love works great.

爱情效果很好。

It was a wonderful analgesic.

这是一种极好的镇痛药。

It significantly reduced people's pain.

它显着减轻了人们的痛苦。

And it turned out the more in love you were, the more pain relief you got.

事实证明，你爱得越多，你得到的痛苦就越减轻。

I'll leave you with one last side note that we didn't publish on.

我会给你留下最后一个我们没有发表的旁注。

And that is Jarred went back a year later and we assessed the students' strength of their relationship, assuming it was still ongoing.

一年后，贾里德回来了，我们评估了学生们之间关系的强度，假设这种关系仍在继续。

And he found that there was a rather high correlation between the love induced analgesia and brain activity and the caudate nucleus and in the insular with the strength of their relationship a year later.

一年后，他发现爱情引起的镇痛和大脑活动与尾状核和岛叶之间的关系强度有相当高的相关性。

So we had a brain scan that was a predictor of future strength of a relationship.

因此，我们进行了脑部扫描，以预测未来关系的强度。

But we've also all heard it the opposite way as well, which is fools rush in or that things that start fast end fast or things like that.

但我们也都听到过相反的说法，即傻瓜蜂拥而至，或者快速开始的事情很快结束，或者类似的事情。

But here you're talking about the early phase of passion serving this interesting role in terms of analgesia alleviating pain, but also predicting some stability of the relationship over time.

但在这里，你谈论的是激情的早期阶段，它在止痛、减轻疼痛方面发挥着有趣的作用，但也预测随着时间的推移，关系会保持一定的稳定性。

It's kind of interesting.

这有点有趣。

I find, again, the different circuits for different approaches to reducing pain fascinating.

我再次发现，不同的减轻疼痛方法的不同回路令人着迷。

Again, that gets to the question you asked me earlier.

这又回到了你之前问我的问题。

Is there one circuit?

有一个电路吗？

And the answer is no. What we have to do is figure out what is the best circuit for a particular person or set of circuits?

答案是否定的。我们要做的是弄清楚对于特定的人或一组电路来说什么是最好的电路？

And then I'd like to also talk about some of the things that are adjacent to the prescription, opioids things like kratom, which right now are sort of called into question as to whether or not they will continue to be legally available over the counter.

然后我还想谈谈一些与处方相关的东西，比如卡痛叶之类的阿片类药物，目前人们对它们是否会继续在柜台合法销售存在疑问。

So first and foremost, what are the endogenous opioids?

首先，什么是内源性阿片类药物？

How do they work?

它们如何工作？

And that I think will set the stage for the rest.

我认为这将为其余部分奠定基础。

What chemists have figured out is how to bring in exogenous opioids.

化学家已经弄清楚如何引入外源性阿片类药物。

And morphine was the prototypical one from the poppy.

吗啡是罂粟中的典型吗啡。

And since then, medicinal chemists have built on variations of morphine and created other compounds.

从那时起，药物化学家基于吗啡的变体并创造了其他化合物。

Again, variations on morphine.

再次，吗啡的变体。

Some are purely synthetic, like the oxycodone.

有些是纯合成的，例如羟考酮。

So I have seen opioids positively transform people's lives, help them get back to work, spend time with friends and family, relieve suffering, particularly in situations end of life but also in people with chronic pain.

因此，我看到阿片类药物积极地改变了人们的生活，帮助他们重返工作岗位，与朋友和家人共度时光，减轻痛苦，特别是在生命即将结束的情况下，但也适用于患有慢性疼痛的人。

And I have seen opioids destroy lives.

我亲眼目睹阿片类药物摧毁生命。

At a personal level, I come from a family background deep, deep in addiction.

就我个人而言，我的家庭背景是深深的毒瘾。

I have lost close loved family members to addiction.

我因毒瘾而失去了挚爱的家人。

And I'm respectful of that.

我对此表示尊重。

What I've learned is to not get into this binary mode of thinking.

我学到的是不要陷入这种二元思维模式。

It's either this or it's this.

要么是这个，要么就是这个。

But to treat opioids, as a clinician, as a tool to be used in certain circumstances in some people, not typically as a front line or first line agent.

但作为临床医生，将阿片类药物视为某些人在某些情况下使用的工具，而不是通常作为前线或一线药物。

Typically much later down if they have failed other therapies.

如果其他治疗失败，通常会晚得多。

You cannot approach the challenge of opioids without appreciating the deep complexity that we're faced with, particularly now in society with all of the litigation ongoing and all the money involved.

如果不认识到我们所面临的深刻复杂性，就无法应对阿片类药物的挑战，特别是现在社会上所有诉讼都在进行，而且涉及所有金钱。

It's a highly nuanced topic.

这是一个非常微妙的话题。

So what more would you like to talk about opioids?

那么关于阿片类药物您还想谈什么吗？

I have a not close family member but a distant family member who had his entire life arranged beautifully.

我有一个不是近亲却是远亲的人，他的一生都被安排得很美好。

He was a practicing lawyer with a beautiful wife and family.

他是一名执业律师，拥有美丽的妻子和家庭。

Had a back injury.

背部受过伤。

Was prescribed OxyContin.

开了奥施康定。

It helped him initially, but then it set off some behavioral psychological pathways that had him seeking more, forging prescriptions.

它最初对他有帮助，但随后它引发了一些行为心理途径，让他寻求更多，制定处方。

He understood the law.

他了解法律。

He was a lawyer.

他是一名律师。

He eventually went to jail, got out.

他最终进了监狱，又出狱了。

The same thing happened again.

同样的事情又发生了。

He eventually ended up dead.

他最终还是死了。

And I think there are many examples of that that we hear about, and those are very salient and very disturbing, very saddening.

我认为我们听到过很多这样的例子，这些例子非常突出，非常令人不安，非常令人悲伤。

So I think that most people, including myself, hear the opioid crisis and assume that what we really should be doing is seeking a better alternative.

因此，我认为大多数人，包括我自己，听到阿片类药物危机并认为我们真正应该做的是寻求更好的替代品。

But what I'm hearing from you is that there are use cases where opioids make a great deal of sense and that they've really helped improve people's lives and that none of what I just described or anything like it is experienced by those people.

但我从你们那里听到的是，在某些用例中，阿片类药物非常有意义，它们确实帮助改善了人们的生活，而这些人都没有经历过我刚才描述的或类似的事情。

In fact, quite the opposite.

事实上，恰恰相反。

Do I have that right?

我有这个权利吗？

And there's a lot of nuance and reasons why in large part.

在很大程度上，有很多细微差别和原因。

Physicians, we get terrible education around pain and we don't know how to treat it in general.

医生们，我们在疼痛方面接受的教育很糟糕，我们不知道如何治疗它。

Coming out of medical school, we get about seven hours of education on pain.

从医学院毕业后，我们接受了大约七个小时的疼痛教育。

Veterinarians get 40.

兽医得到40。

It's great if you're taking, I think your dog's name is Costello.

如果你接受的话那就太好了，我想你的狗的名字是科斯特洛。

There is a much smaller group of docs doing the wrong thing for the right reasons.

有一小部分文档以正确的理由做错误的事情。

What I mean by that is these are docs who did overprescribe opioids in this case, in this context.

我的意思是，在这种情况下，这些医生确实过量开了阿片类药物。

They did buy into the marketing messages that were put forward.

他们确实接受了所提出的营销信息。

They did not have much education around alternatives in treating pain.

他们没有接受过太多关于治疗疼痛的替代方案的教育。

And they thought by handing out pills, just pills in their very brief visits with patients.

他们认为，通过分发药片，只是在对患者进行短暂访问时分发药片。

Remember, primary care docs, my heart goes out to them.

请记住，初级保健医生，我的心与他们同在。

What do they get, 14 minutes or so with the patient?

与病人相处 14 分钟左右，他们能得到什么？

They gave them something that they thought would help.

他们给了他们一些他们认为有帮助的东西。

They were doing the wrong thing for the right reasons.

他们以正确的理由做错误的事。

The thing is that little group at the top in the million or so physicians we have in this country, it represents such a small representation, but it got blown out by the media and everybody else.

问题是，在这个国家大约一百万名医生中，这个小群体占据了顶端，它只代表了很小的一部分，但它却被媒体和其他人所报道。

Particularly those docs doing the right thing for the right reasons got caught up in it.

特别是那些出于正确的原因做正确的事情的文档陷入其中。

It engendered a huge amount of fear.

它产生了巨大的恐惧。

A huge amount of fear on the physician side.

医生方面有很大的恐惧。

And then what happened is the docs just started abandoning patients.

然后发生的事情是医生开始抛弃病人。

They cut their patients off.

他们切断了病人的联系。

I had a young housewife, two young kids.

我有一个年轻的家庭主妇，两个年幼的孩子。

Doc cut her off from a little bit of Vicodin that she was taking intermittently for some back pain that had been well managed on this.

医生让她停止服用一点维柯丁，因为她因背部疼痛而间歇性服用维柯丁，但在这方面已经得到了很好的控制。

She was doing all the right things.

她正在做所有正确的事情。

Cut her off.

打断她。

She turned to black tar heroin.

她转向黑焦油海洛因。

California, great state of California, tried an experiment where they monitored death certificates in our state and the Doc's prescribing opioids for that.

加利福尼亚州，伟大的加利福尼亚州，尝试了一项实验，他们监控我们州的死亡证明以及医生为此开出的阿片类药物处方。

And they went after the docs thinking that if they targeted the docs doing that, it would lead to a reduction in opioid deaths.

他们追查医生，认为如果他们针对这样做的医生，就会减少阿片类药物的死亡。

It led to a doubling.

这导致了翻倍。

I know, counterintuitive.

我知道，违反直觉。

Because what happened is the docs abandoned the patients.

因为发生的事情是医生抛弃了病人。

And so we have to be aware of the negative consequences of this.

因此我们必须意识到这样做的负面后果。

Now, the current-- I'm not trying to minimize the opioid crisis, because it's real.

现在，我并不是想最小化阿片类药物危机，因为它是真实的。

But we also now need to put some context.

但我们现在还需要提供一些背景信息。

The opioid crisis is being driven by the illicit fentanyls.

阿片类药物危机是由非法芬太尼引发的。

It is more, if you just look at the CDC data, it's very clear that the fentanyl is coming in via Mexico, China, and others is what's driving most of the deaths.

更重要的是，如果你看看疾病预防控制中心的数据，很明显芬太尼是通过墨西哥、中国和其他国家进入的，这是导致大部分死亡的原因。

Keith, getting back to Keith, led a beautiful Lancet Stanford commission on the North American opioid crisis and put together a very rational plan.

回到基思，基思领导了一个关于北美阿片类药物危机的美丽的《柳叶刀》斯坦福委员会，并制定了一个非常合理的计划。

I just finished serving as a senior advisor to the medical board of California where we revised our prescribing guidelines here.

我刚刚完成了加州医疗委员会高级顾问的职务，我们在这里修订了我们的处方指南。

They were very draconian before, hard limits.

以前他们的限制非常严厉。

Made people fearful, both patients and docs.

让人们感到恐惧，无论是患者还是医生。

And we've shifted it back over to put the control back in the hands of the physician patient relationship.

我们已经将其转移回来，将控制权重新交到医患关系手中。

We're hoping it'll make a difference.

我们希望它能有所作为。

You can see I'm going on a bit here.

你可以看到我在这里继续说一点。

There's this huge complexity in this space.

这个领域非常复杂。

I understand you're going to do an episode, some time on it in the future.

我知道你会在未来某个时间制作一集。

And I hope the audience has more opportunity to listen to this.

我希望观众有更多的机会听到这个。

Other questions I can answer for you though on that.

关于这一点，我可以为你回答其他问题。

Which you can understand why they would do that.

你可以理解为什么他们会这样做。

I mean, I'm not justifying anyone doing anything illegal.

我的意思是，我不会为任何人的违法行为辩护。

But somebody is in pain and they had something that worked and now they don't, and they're going to go looking for things that are similar to that thing.

但有人正处于痛苦之中，他们曾经有一些有效的东西，但现在却不起作用了，他们会去寻找与该东西类似的东西。

And you're telling us that fentanyl in street drugs, basically, is what's killing people, presumably.

你告诉我们，街头毒品中的芬太尼基本上可能是杀人的原因。

I doubt it's fentanyl prescribed by physicians.

我怀疑这是医生开的芬太尼。

Or perhaps it is.

或者也许是这样。

And we're just seeing this incredible epidemic wave of it.

我们刚刚看到了这一令人难以置信的流行浪潮。

It can be made so cheaply, brought across the borders reasonably easily.

它的制造成本非常低，而且很容易跨境运输。

Something we definitely need to address.

我们确实需要解决一些问题。

We want to be careful about not conflating that crisis with the issue of pain, which is an epidemic in its own right, and for the segment of people who are using opioids responsibly and effectively for their pain.

我们希望谨慎行事，不要将这场危机与疼痛问题混为一谈，疼痛本身就是一种流行病，对于那些负责任且有效地使用阿片类药物来缓解疼痛的人群来说也是如此。

And that's where, again, that nuance comes in.

这就是细微差别再次出现的地方。

Are there patients who are also on opioids that have been weaned down?

是否有同时服用阿片类药物的患者已经戒断？

You can wean them down gently, compassionately, and they do better.

你可以温柔地、富有同情心地让他们戒掉，他们会做得更好。

The answer is yes.

答案是肯定的。

My partner Beth is just finishing up a study on that and showing that with compassionate care, a number of these patients can be weaned down who voluntarily want to come down.

我的搭档贝丝刚刚完成了一项相关研究，结果表明，通过富有同情心的护理，许多自愿断奶的患者可以断奶。

And sometimes I find their pain actually improves.

有时我发现他们的疼痛实际上有所改善。

And part of that improvement may be that opioids have degrees of side effects.

这种改善的部分原因可能是阿片类药物有一定程度的副作用。

And by elimination of those side effects and the other aspects, they're seeing improvement.

通过消除这些副作用和其他方面，他们看到了改善。

So there's a slew.

所以就有了一个转折。

There's, I don't know, more than 20 different opioids within that list of 200 medications that we have.

我不知道，我们拥有的 200 种药物清单中有 20 多种不同的阿片类药物。

Methadone is another one.

美沙酮是另一种。

People usually think of methadone is a medication used to treat addiction.

人们通常认为美沙酮是一种用于治疗成瘾的药物。

People go to methadone clinics.

人们去美沙酮诊所。

It's a long lasting opioid.

它是一种长效阿片类药物。

In the right person in certain circumstances, it can be used effectively for chronic pain.

在某些情况下，对合适的人来说，它可以有效地治疗慢性疼痛。

By and large, they all have the same or similar mechanisms of actions, working on opioid receptors.

总的来说，它们都具有相同或相似的作用机制，作用于阿片受体。

This is getting back to your original question to me about where these things work.

这又回到了你最初向我提出的关于这些东西在哪里发挥作用的问题。

There are opioid receptors in the periphery.

外周有阿片受体。

There are rich sources of opioid receptors in the spinal cord and the dorsal-- the back part of the spinal cord.

脊髓和脊髓后部有丰富的阿片受体来源。

And then there are many areas in the brain that are rich in opioid receptors.

大脑中有很多区域富含阿片受体。

It's all a naturally occurring area.

这都是一个自然发生的区域。

And when we put in an opioid by mouth, we're binding to those receptors and activating those neural circuits.

当我们口服阿片类药物时，我们会与这些受体结合并激活这些神经回路。

In many cases when I say activating, they have an inhibitory role.

在很多情况下，当我说激活时，它们具有抑制作用。

I mean, that's one of the major parts.

我的意思是，这是主要部分之一。

And so I put out a tweet.

所以我发布了一条推文。

I guess now that Twitter is called X, I guess I put out an X?

我猜现在 Twitter 被称为 X，我猜我放了一个 X？

Anyway, it doesn't matter.

无论如何，没关系。

And I said that my first pass view of the literature on kratom, the scientific literature, is that it had a lot of properties similar to opioids although different as well and that it seemed kind of odd and maybe even problematic that it was so widely available.

我说，我对卡痛叶文献（即科学文献）的第一印象是，它具有许多与阿片类药物相似的特性，尽管也有所不同，而且它的广泛使用似乎有点奇怪，甚至可能是有问题的。

And I got bombarded with I don't want to call them kratom enthusiasts, because what I soon discovered was that these people were angry with me for placing even a partial shadow on kratom.

我不想称他们为卡痛叶爱好者，因为我很快发现这些人对我感到愤怒，因为我给卡痛叶带来了部分阴影。

But what was interesting to me was that they were saying that in their case, and I'm assuming they were telling the truth, that kratom had helped them get off prescription opioids and that they heavily rely on kratom in various levels of dosage in ways that they felt really help them.

但令我感兴趣的是，他们说，就他们的情况而言，我假设他们说的是实话，卡痛叶帮助他们摆脱了处方阿片类药物，并且他们严重依赖各种剂量的卡痛叶，他们认为这些方式确实对他们有帮助。

And so two things happened.

于是发生了两件事。

One, I've been put in the crosshairs of the pro-kratom community.

第一，我已经成为支持卡痛叶社区的焦点。

Not to a severe extent.

还没有达到严重的程度。

But perhaps the more important thing is, and I want to thank that community in part, for now it's inspired me to do a deep dive search on kratom.

但也许更重要的是，我想部分感谢该社区，现在它激励我对 kratom 进行深入研究。

I'm going to be interviewing one of the laboratories that's done a lot of the research on kratom later in 2024.

我将在 2024 年晚些时候采访其中一家对卡痛叶进行了大量研究的实验室。

But also it's made me realize there are these compounds that are available over the counter that many people feel so passionately about because they really feel like it's helped them.

但这也让我意识到，这些化合物可以在柜台上买到，很多人都对它们充满热情，因为他们真的觉得它对他们有帮助。

I'm not saying it has.

我并不是说有。

I'm not saying it hasn't.

我并不是说没有。

But then again, I've never taken it.

但话又说回来，我从来没有接受过它。

What is kratom?

卡痛叶是什么？

Or perhaps what receptors does it tickle?

或者它会刺激哪些受体？

And what are your thoughts about kratom and people using kratom?

您对卡痛叶和使用卡痛叶的人有何看法？

And maybe I'm pronouncing it wrong.

也许我的发音是错误的。

I've also heard "krah-tom." I'm calling it "kray-tam."

我也听过“krah-tom”。我称之为“kray-tam”。

I have heard the same stories that you have heard about people taking kratom and saying it's helping them to stay off of prescription opioids or illicit opioids.

我听过和你听过的故事一样，人们服用卡痛叶，并说它可以帮助他们远离处方阿片类药物或非法阿片类药物。

And I get that.

我明白了。

I think in some way it's binding opioid receptors and reducing the natural craving for these other substances.

我认为在某种程度上它可以结合阿片受体并减少对这些其他物质的自然渴望。

And it makes perfect sense.

这很有道理。

Methadone does that.

美沙酮就是这样做的。

Buprenorphine, which I didn't mention before, but is an interesting opioid that binds to these receptors and it reduces craving.

丁丙诺啡，我之前没有提到，但它是一种有趣的阿片类药物，可以与这些受体结合并减少渴望。

Where I have challenges is in just because something is natural doesn't mean that it is safe.

我面临的挑战是，仅仅因为某些东西是天然的并不意味着它是安全的。

We are seeing an increased number of overdose deaths associated with kratom.

我们发现与卡痛叶相关的过量死亡人数有所增加。

Is it polysubstance?

是多物质吗？

Yeah, in some cases, it is.

是的，在某些情况下，确实如此。

But I think there's a lot we don't know.

但我认为还有很多我们不知道的事情。

So I'm hoping that we're going to get the research that we need to really understand what it's doing and whether it is safe and effective.

所以我希望我们能够进行我们需要的研究，以真正了解它的作用以及它是否安全有效。

I'm left with a lot of unknowns right now.

我现在还有很多未知数。

But I think you'll find, and my experience has been, that people appreciate that we're having the conversation.

但我认为你会发现，根据我的经验，人们会欣赏我们正在进行的对话。

And we do read all the comments.

我们确实阅读了所有评论。

And those comments often, as I mentioned in my earlier anecdote about that tweet, often direct us to explore things further.

正如我在之前关于该推文的轶事中提到的那样，这些评论常常引导我们进一步探索事物。

And we can always have a second discussion about this down the line.

我们随时可以对此进行第二次讨论。

So we invite all your comments and criticism.

因此，我们邀请您提出意见和批评。

From larger scale epidemiology studies and even larger clinic based studies that I've done, we find it has not been particularly helpful on average compared to people not on cannabis.

从我所做的更大规模的流行病学研究和更大规模的临床研究来看，我们发现与不吸食大麻的人相比，平均而言它并不是特别有帮助。

There's a lot we don't know about the causality of that and the direction of it.

关于其因果关系及其方向，我们还有很多不了解的地方。

But all to say that there are many, many questions that remain.

但总而言之，还有很多很多问题仍然存在。

I think the challenge that I personally have is that we're running huge population level experiments as we speak right now by providing unfettered use of cannabis.

我认为我个人面临的挑战是，正如我们现在所说，我们正在通过提供不受限制的大麻使用来进行大规模的人口水平实验。

And the bad news is that we're probably going to see some real untoward consequences of it.

坏消息是我们可能会看到它带来的一些真正的不良后果。

And we already are.

我们已经是了。

The good news is I'm hoping that at a state level, we'll be able to use that data to really inform what's going on with cannabis.

好消息是，我希望在州一级，我们能够利用这些数据来真正了解大麻的情况。

I mean, some of the challenges are what I refer to with kratom.

我的意思是，有些挑战就是我提到的卡痛叶所面临的挑战。

Cannabis is not cannabis is not cannabis.

大麻不是大麻不是大麻。

Which do I think it works at the end of the day?

我认为哪一个最终有效？

Do I think there is some variation of cannabis, THC, CBD ratios that will provide some benefit?

我认为大麻、THC、CBD 比例的一些变化会带来一些好处吗？

Oh, absolutely.

哦，绝对是。

There's too many receptors in our brain that are involved with the modulation of pain.

我们的大脑中有太多的受体与疼痛的调节有关。

I just don't know what those are.

我只是不知道那些是什么。

A friend of mine, Mark Wallace, runs pain at UC San Diego, has come up with a really nice recipe cocktail of ratios of THC to CBD that he feels very strongly that he can help people using that as an active agent.

我的一个朋友马克·华莱士（Mark Wallace）在加州大学圣地亚哥分校患有疼痛症，他想出了一种非常好的 THC 与 CBD 比例鸡尾酒配方，他强烈地认为他可以帮助人们使用它作为活性剂。

So these plant based compounds have their place, whether or not it's kratom, perhaps, we're remaining open about that, or cannabis, the THC, or the CBD or some combination.

因此，这些植物基化合物有其一席之地，无论是卡痛叶，还是大麻、THC、CBD 或某种组合，我们对此仍持开放态度。

I think it's really interesting.

我觉得这真的很有趣。

I think as long as we're talking about plant compounds, how do you view the fields that are what I would call somewhat adjacent to traditional medicine?

我认为只要我们谈论植物化合物，您如何看待我所说的与传统医学有些相似的领域？

So things like acupuncture, chiropractic, physical therapy, and so forth.

针灸、脊椎按摩疗法、物理疗法等等。

Three, psychological and behavioral therapies.

三、心理和行为疗法。

Pain, psychology which has many forms now.

疼痛，心理学现在有多种形式。

Can be very effective.

可以非常有效。

Four, physical and occupational therapy approaches to chronic pain.

第四，针对慢性疼痛的物理和职业治疗方法。

Five, this is what we typically call complementary alternative medicine approaches.

第五，这就是我们通常所说的补充替代医学方法。

It's a little bit of an outdated term.

这是一个有点过时的术语。

But I think of that as acupuncture, nutraceuticals.

但我认为这是针灸、营养保健品。

These are the over-the-counter agents that have actually shown to have benefit in pain that you can get over the counter.

这些非处方药实际上已被证明可以在痛苦中获益，您可以通过非处方药购买。

And last but not least, six, what I call self empowerment or increasing your agency.

最后但并非最不重要的一点是，第六点，我称之为自我赋权或增强你的能动性。

And here it's about education.

这是关于教育的。

It's about learning skills.

这是关于学习技能的。

It's about being here on the Huberman Lab podcast learning about pain.

这是关于在休伯曼实验室播客上了解疼痛。

It's that self empowerment.

这就是自我赋权。

And what we find is that those six categories all brought together typically have the best benefit for people living with chronic pain.

我们发现，这六个类别加在一起通常对患有慢性疼痛的人有最大的好处。

Are they just like pain treats pain?

它们就像疼痛治疗疼痛一样吗？

Is that what it is about?

这就是它的意义吗？

But as you and I both know, unless it's being performed incorrectly, acupuncture is not painful to receive.

但正如你我都知道的那样，除非操作不当，否则针灸治疗不会感到疼痛。

Does acupuncture help treat certain forms of pain?

针灸有助于治疗某些形式的疼痛吗？

Is there any scientific basis?

有科学依据吗？

And it's not vanity, but I didn't like the way that the needles were introducing angiomas to my face.

这不是虚荣，但我不喜欢针在我脸上引入血管瘤的方式。

Now, that was probably because this acupuncturist wasn't doing things correctly.

现在，这可能是因为这位针灸师没有正确做事。

I'm not saying all acupuncturists do that.

我并不是说所有针灸师都这样做。

But here's the problem.

但问题就在这里。

How do you know which acupuncturists are reliable versus not?

您如何知道哪些针灸师可靠哪些不可靠？

And for that matter, how do you know which physician is reliable versus not?

就此而言，您如何知道哪个医生可靠哪个不可靠？

I mean, I work at an institution like Stanford where I can ask a lot of people, and I still, my senior administrators won't like this, but when I get a recommendation from a doc at Stanford, I always call somebody at UCSF and cross check.

我的意思是，我在斯坦福这样的机构工作，在那里我可以问很多人，但我的高级管理人员仍然不喜欢这样，但是当我得到斯坦福大学博士的推荐时，我总是打电话给加州大学旧金山分校的人并进行交叉核对。

And I don't tell them that I'm cross checking.

我不会告诉他们我正在交叉检查。

And I'll do the reverse as well.

我也会做相反的事情。

When I was at UC San Diego, I would check up with Stanford.

当我在加州大学圣地亚哥分校时，我会向斯坦福大学核实。

But most people don't have access to that kind of community.

但大多数人无法进入这种社区。

I mean, I can pick up the phone and contact somebody in pretty much any medical specialty and at multiple institutions.

我的意思是，我可以拿起电话联系几乎任何医学专业和多个机构的人员。

But for most people, they're wading into the abyss of acupuncturists, of physicians.

但对于大多数人来说，他们正在步入针灸师、医生的深渊。

I mean, how are people supposed to navigate this?

我的意思是，人们应该如何应对这个问题？

The recommendation would be to try to get a referral or recommendation from somebody who refers to that acupuncturist.

建议是尝试从推荐该针灸师的人那里获得转介或推荐。

Docs want to have relationships with people, with other clinicians that do a really good job.

医生希望与人、与其他做得很好的临床医生建立关系。

We don't want to be referring to somebody who's bad, because it reflects badly on us.

我们不想指的是坏人，因为这会给我们带来不好的影响。

So it's really doing what, in a way, what you were doing.

所以在某种程度上，它实际上是在做你正在做的事情。

So, try to connect with your primary care doctor, others, and get some recommendation for who is high quality.

因此，尝试与您的初级保健医生和其他人联系，并获得一些高质量的建议。

With regard to clinicians, pain physicians for instance, that's tough.

对于临床医生（例如疼痛科医生）来说，这很困难。

There's 5,000 to 10,000 of us that are subspecialty trained out there.

我们有 5,000 到 10,000 人接受过专业培训。

If your pain is really complicated, a complex pain problem, you're probably better off with a tertiary referral center that can provide comprehensive services where possible.

如果您的疼痛确实很复杂，是一个复杂的疼痛问题，您可能最好选择可以提供全面服务的三级转诊中心。

I didn't answer your question.

我没有回答你的问题。

Is there a reliable source of quality?

有可靠的质量来源吗？

I still think at the end it's going to be relationships and word of mouth and referral.

我仍然认为最终会是关系、口碑和推荐。

I do the same thing you do.

我做你做的同样的事情。

To see Hannah Watford the allergist, I asked my primary care doc at Stanford, who's the best?

为了去看过敏症专家汉娜·沃特福德，我问我在斯坦福大学的初级保健医生，谁是最好的？

Who is the person that knows the most about food related issues?

谁是最了解食品相关问题的人？

I'm curious about chiropractic.

我对脊椎按摩疗法很好奇。

For a lot of people, not chiropractors, let's not talk about the people specifically, but chiropractic.

对于很多人来说，不是脊椎按摩师，我们不具体说人，而是脊椎按摩师。

A lot of people put acupuncture and chiropractic adjacent to one another.

许多人将针灸和脊椎按摩疗法放在一起。

But my understanding is that insurance often will cover acupuncture but not chiropractic work.

但我的理解是，保险通常会承保针灸，但不承保脊椎按摩治疗。

Maybe I got that backwards or maybe I'm just all out wrong.

也许我搞反了，或者也许我完全错了。

But with chiropractic work, you're talking about often the attempt to relieve compression of nerves.

但在脊椎按摩治疗中，您经常谈论的是缓解神经压迫的尝试。

Certainly nerves are being manipulated if any part of the body is being manipulated.

当然，如果身体的任何部分受到操纵，神经也会受到操纵。

I guess manipulated it's kind of a word that implies something sinister is happening.

我想“操纵”这个词暗示着一些邪恶的事情正在发生。

It's being adjusted.

正在调整中。

What are your thoughts about chiropractors?

您对脊椎按摩师有何看法？

Assuming the chiropractor is well trained and responsible.

假设脊椎按摩师训练有素且负责任。

Can it help pain?

可以帮助止痛吗？

Can it help back pain, neck pain, whole body pain?

它可以帮助缓解背痛、颈痛、全身痛吗？

And it's worth a try.

这值得一试。

CMS, Center for Medicare, is now paying for acupuncture for people over the age of 65.

CMS（医疗保险中心）现在为 65 岁以上的人支付针灸费用。

Medicare for Medicare patients, that's something recent.

为医疗保险患者提供医疗保险，这是最近才发生的事情。

And we were happy to see that.

我们很高兴看到这一点。

I believe that was for back pain.

我相信那是为了治疗背痛。

That should be fact checked.

这应该进行事实核查。

But chiropractic, mixed data.

但脊椎按摩疗法的数据好坏参半。

Well controlled studies, some have shown that it can be helpful for low back pain.

良好的对照研究表明，一些研究表明它有助于治疗腰痛。

Some have shown it isn't.

有些人已经证明事实并非如此。

It's truly not clear.

确实还不清楚。

The type of chiropractic that doesn't involve the fast, high velocity manipulation, as a physician, I have some concerns about that, particularly around the neck.

脊椎按摩疗法不涉及快速、高速的操作，作为一名医生，我对此有一些担忧，尤其是颈部周围。

I've taken care of patients that have had vertebral artery dissections from that rapid wrenching.

我曾照顾过因快速扭动而导致椎动脉夹层的患者。

Meaning everybody feels good after a massage.

这意味着按摩后每个人都感觉良好。

But a couple few hours later, it's kind of worn off.

但几个小时后，它就有点磨损了。

It's a nice experience in the moment for most people.

对于大多数人来说，目前这是一次很好的经历。

If you're finding that for acupuncture, chiropractic, or anything, for that matter, ask yourself, is it really providing you durable benefit that is worth the effort?

如果你发现针灸、脊椎按摩疗法或任何其他疗法都如此，问问自己，它真的能为你带来持久的好处，值得你付出努力吗？

Or is it just rapid, it feels good in the moment?

或者只是速度很快，那一刻感觉很好？

We tend to use that in our clinical practice as a threshold.

我们倾向于在临床实践中使用它作为阈值。

And we like to see things that last for a longer period of time.

我们喜欢看到能持续更长时间的东西。

And in many of these treatments, whether it be acupuncture, chiropractic, we use those as an inroad into more of a functional rehabilitative approach.

在许多治疗方法中，无论是针灸、脊椎按摩疗法，我们都将这些方法作为功能康复方法的一个切入点。

Meaning when you get chronic pain, you tend to withdraw.

这意味着当您患有慢性疼痛时，您往往会退缩。

You tend to stop exercising.

您倾向于停止锻炼。

You stop moving.

你停止移动。

Your muscles atrophy.

你的肌肉萎缩。

You become deconditioned because of the pain.

你会因为疼痛而变得精神不振。

And so we want to use these tools that we've been talking about as a way to get people engaged in activity, to correct the underlying biomechanical issues that may be present.

因此，我们希望使用我们一直在讨论的这些工具作为让人们参与活动的一种方式，以纠正可能存在的潜在生物力学问题。

And so they all need to be appropriately staged.

因此，它们都需要适当地上演。

And that's where working with a good clinician can help with that.

这就是与优秀临床医生合作可以提供帮助的地方。

And they're tying in with good physical therapist, occupational therapists, people who can do goal setting.

他们与优秀的物理治疗师、职业治疗师以及能够设定目标的人合作。

Absolutely critical.

绝对关键。

All of the treatments that I provide typically are meant to help support an increase in physical rehabilitative approaches.

我提供的所有治疗通常都是为了帮助支持身体康复方法的增加。

And so when I do nerve blocks or procedures or give a medication and if we end up reducing some pain, we want to tie that in with more activity.

因此，当我进行神经阻滞或手术或给予药物时，如果我们最终减轻了一些疼痛，我们希望将其与更多的活动结合起来。

And what the physical therapists are great, particularly those trained in chronic pain, is knowing that difference between hurt and harm.

物理治疗师，尤其是那些接受过慢性疼痛训练的物理治疗师的伟大之处在于，他们知道伤害和伤害之间的区别。

They can work with people to know what's safe for them to do to rehabilitate.

他们可以与人们合作，了解如何安全地进行康复。

They can teach them more about body mechanics and help improve endurance and strength.

他们可以教给他们更多关于身体力学的知识，并帮助提高耐力和力量。

They can work around pacing.

他们可以围绕节奏进行工作。

Pacing is so critical for people with chronic pain.

起搏对于患有慢性疼痛的人来说非常重要。

Now, this isn't just exclusive to the physical therapists.

现在，这不仅仅是物理治疗师的专利。

The psychologists do pacing.

心理学家会进行调整。

I do pacing.

我会踱步。

What is pacing?

什么是节奏？

Here's the problem with chronic pain, one of the many problems.

这是慢性疼痛的问题，这是众多问题之一。

It waxes and wanes.

它有盛有衰。

And so what happens is you go out and have a good day.

所以发生的事情就是你出去度过美好的一天。

You go out like gangbusters and you go do everything that you haven't been able to do for the last week because you've been in pain.

你像猛兽一样出去，去做上周因为痛苦而无法做的一切。

And then you pay the price.

然后你就付出代价。

And when you pay the price, you're back in bed or you're on the couch and you're not moving.

当你支付费用时，你会回到床上或躺在沙发上，一动不动。

And what happens is you go into this roller coaster of activity and no activity at all.

发生的情况是，你进入了活动的过山车，却根本没有活动。

And what happens is it entrains in our brain.

发生的事情就是它夹带在我们的大脑中。

It's a classic negative reinforcement model.

这是一个经典的负强化模型。

This is classic psychology.

这是经典心理学。

And so then people become fearful of more movement.

于是人们开始害怕更多的运动。

And as a consequence, they get more and more disuse, atrophy, and then more disability.

结果，他们变得越来越废用、萎缩，然后越来越残疾。

So the key.

所以关键。

What do you do about that?

你对此怎么办？

The key is you set small goals, baby steps.

关键是你要设定小目标，一步一步地前进。

If you can walk comfortably for a block right now, great.

如果您现在可以轻松地步行一个街区，那就太好了。

Walk that block tomorrow.

明天步行那个街区。

Maybe walk a block plus an extra 50 feet.

也许步行一个街区再加上 50 英尺。

And maybe the next day another 50 feet.

也许第二天还会再走 50 英尺。

No more.

不再。

No more.

不再。

If you're having a great day, don't go do five blocks.

如果你今天过得愉快，就不要跑五个街区。

You're training for a marathon.

你正在为马拉松训练。

You're training for the long win.

你正在为长期胜利而训练。

Now, what's going to happen along the way is that you're going to have good days and you're going to have bad days.

现在，一路上会发生的事情是，你会度过美好的日子，也会度过糟糕的日子。

On the good days, don't go out and exceed it.

好的日子里，不要外出，也不要超越。

Set a threshold.

设定一个阈值。

Time it on your watch set a distance.

在手表上计时设定距离。

On the bad days, recognize we all have bad days.

在糟糕的日子里，要认识到我们都有糟糕的日子。

Everybody has bad days.

每个人都有糟糕的日子。

And you may need some rest during those bad days.

在那些糟糕的日子里你可能需要休息一下。

But then the next day, get up and restart where you were.

但第二天，起床并重新开始。

And that's the type of thing a physical therapist, good pain psychologist, good physician can help you with.

这就是物理治疗师、优秀的疼痛心理学家、优秀的医生可以帮助你的事情。

And tying that in, by the way, with these other therapies.

顺便说一句，将其与其他疗法联系起来。

So for neuropathic pain, acetyl-l-carnitine is one of them.

因此对于神经性疼痛，乙酰左旋肉碱就是其中之一。

Acetyl-l-carnitine is thought to work on mitochondrial metabolism and improve mitochondrial health.

乙酰左旋肉碱被认为有助于线粒体代谢并改善线粒体健康。

And it's been used, I believe, as a anti-aging and maybe even a cognitive enhancement agent.

我相信，它已被用作抗衰老剂，甚至可能是认知增强剂。

And it's been studied out of an Australian study, I think it was called the Sydney trials actually.

澳大利亚的一项研究对此进行了研究，我认为它实际上被称为悉尼试验。

And what they found, it's one of the few over-the-counter agents that actually had disease modifying properties.

他们发现，它是少数真正具有疾病缓解特性的非处方药之一。

Meaning they studied this in diabetic neuropathy.

这意味着他们在糖尿病神经病变中研究了这一点。

The clinical endpoint was not pain reduction.

临床终点不是减轻疼痛。

The clinical endpoint was nerve conduction velocity changes.

临床终点是神经传导速度的变化。

And that's how we monitor nerve health is in a normal nerve, nerve impulses move at a certain rate.

这就是我们监测正常神经神经健康状况的方式，神经冲动以一定的速率移动。

And when they're injured from diabetes, it's much slower and you lose signal.

当他们因糖尿病受伤时，速度会慢得多，并且信号会丢失。

This actually improved nerve health.

这实际上改善了神经健康。

You can buy those at a Vitamin Shoppe, order them online.

您可以在维生素专柜购买，然后在线订购。

Alpha lipoic acid is another one.

α-硫辛酸是另一种。

Alpha lipoic acid, at least two mechanisms.

α-硫辛酸，至少有两种机制。

One is it's a free radical scavenger.

一是它是一种自由基清除剂。

And second that's been more recent is it is a T type calcium channel modulator.

第二个是最近出现的，它是一种 T 型钙通道调节剂。

And calcium channels are in our nerves.

钙通道位于我们的神经中。

And it turns those down and it can have some benefit for neuropathic pain.

它会降低这些，并且对神经性疼痛有一些好处。

People have taken alpha lipoic acid for a general sense of well being.

人们服用α-硫辛酸是为了获得普遍的健康感。

And it is generally well tolerated.

而且它通常具有良好的耐受性。

It can cause a little bit of stomach upset.

它可能会引起一些胃部不适。

I will tell you I took this one myself for a while.

我会告诉你我自己拿了这个有一段时间了。

And this is, again, just an n of 1, what I found, though, is you have T-Type calcium channels in your heart.

这又只是 n 为 1，但我发现，你的心脏里有 T 型钙通道。

And I do HIIT, High Intensity Interval Training, and I was finding I couldn't get my heart rate over 150.

我进行 HIIT（高强度间歇训练），但发现我的心率无法超过 150。

So I stopped it.

所以我停止了它。

That's not an adverse event.

这不是一个不良事件。

That's just an annoyance.

这只是一个烦恼。

But that's useful.

但这很有用。

Vitamin C.

维生素C。

So if you're going in for surgery and it's maybe a nerve related surgery that you're going to have, they found vitamin C prophylactically can reduce the likelihood of having certain nerve pain conditions after surgery.

因此，如果您要进行手术并且可能是与神经相关的手术，他们发现预防性维生素 C 可以降低手术后出现某些神经疼痛症状的可能性。

Fish oil, the omega 3s have been found to be beneficial around chronic pain.

鱼油、欧米伽 3 脂肪酸已被发现对缓解慢性疼痛有益。

More recently, the data here is on smaller numbers, creatine, which I imagine you've probably talked about it at some length.

最近，这里的数据是关于较小的数字肌酸，我想您可能已经详细讨论过它。

But creatine has shown in small pilot studies some benefit in fibromyalgia and some other types of conditions.

但小型试点研究表明肌酸对纤维肌痛和其他一些类型的疾病有一定的益处。

So there are a number of these substances that are backed up beyond the anecdata that we joke about, the anecdotal.

因此，有许多这样的物质是有证据支持的，超出了我们开玩笑的轶事。

There's actually good randomized controlled trials.

实际上有很好的随机对照试验。

And this is something that people can easily take advantage of.

这是人们很容易利用的东西。

Just be mindful that just because it's natural, just because it's over the counter doesn't equate with 100% safety.

请注意，仅仅因为它是天然的，仅仅因为它是非处方药并不等于 100% 安全。

Meaning get educated about the side effects and the adverse events.

意思是了解副作用和不良事件。

Get educated about the drug-drug interactions, the agent-agent interactions.

了解药物与药物之间的相互作用、药物与药物之间的相互作用。

And for instance, there are these over-the-counter agents, some of which you want to be careful of and not taking when you're going into surgery because they can be platelet inhibitors and they can cause you to bleed more.

例如，有一些非处方药，其中一些您在进行手术时要小心，不要服用，因为它们可能是血小板抑制剂，会导致您流血更多。

There's a paper that just came out in JAMA literally in the last few days where they did a meta analysis of brain imaging studies on people with early adverse life events.

最近几天，《美国医学会杂志》上发表了一篇论文，他们对早期经历过不良生活事件的人的脑成像研究进行了荟萃分析。

And what they found is abnormalities in emotional processing, emotional functioning in people who have these.

他们发现，有这些症状的人的情绪处理和情绪功能存在异常。

Giving strong evidence that what happens to you early in life impacts us as adults and stays with us.

强有力的证据表明，你早年发生的事情会影响我们成年后的生活，并一直伴随着我们。

It changes our wiring.

它改变了我们的接线。

Now, this is where in part pain psychologists, behavioral therapists can come in.

现在，这在一定程度上是疼痛心理学家、行为治疗师可以发挥作用的地方。

They can help with some of the maladaptive coping, the thought processes involved with pain.

它们可以帮助解决一些适应不良的应对方式，即与疼痛有关的思维过程。

They can help teach skills.

他们可以帮助教授技能。

So for the vast majority of pain psychology, this is not your typical psychoanalytic lying on a couch talking about whatever.

因此，对于绝大多数疼痛心理学来说，这并不是典型的躺在沙发上谈论任何事情的精神分析。

This is about teaching people skills.

这是关于教授人际交往能力。

Incredibly helpful.

非常有帮助。

Does it eliminate pain?

它能消除疼痛吗？

Few of the things that we do actually eliminate pain.

我们所做的事情很少能真正消除疼痛。

What we're trying to do is chip away a little bit with this medication, a little bit with this procedure, a bit with psychology.

我们想做的是用这种药物、用这个程序、用心理学来削弱一点。

We're trying to hit all of these pathways in aggregate to make a real difference.

我们正在努力综合所有这些途径，以产生真正的影响。

The pain psychologists use classically techniques like cognitive behavioral therapy, which involves often recognizing these unhelpful thoughts and patterns that we all get into around pain and even life to interrupting those thoughts to helping people, again, with goal setting and pacing to teach people relaxation techniques through deep breathing.

疼痛心理学家使用认知行为疗法等经典技术，其中涉及经常识别我们在疼痛甚至生活中都会遇到的这些无用的想法和模式，以打断这些想法来帮助人们，再次通过目标设定和节奏来教人们通过深呼吸放松技巧。

Things like biofeedback.

比如生物反馈。

In Silicon Valley where I practice, the engineers love the biofeedback.

在我实习的硅谷，工程师们喜欢生物反馈。

I'm an engineer by formal training, so I get it.

我是一名受过正规培训的工程师，所以我明白。

But it's that closed loop feedback.

但这就是闭环反馈。

Because remember, the brain is controlling the periphery and controlling the sympathetic nervous system.

因为请记住，大脑正在控制外周并控制交感神经系统。

And when we're in pain, our sympathetic nervous system gets revved up.

当我们感到疼痛时，我们的交感神经系统就会兴奋起来。

When the sympathetic nervous system gets revved up, blood vessels constrict.

当交感神经系统兴奋时，血管就会收缩。

Heart rate goes up.

心率上升。

Our muscles get tense.

我们的肌肉变得紧张。

And we need sometimes ways of learning how to calm down that sympathetic nervous system.

有时我们需要学习如何让交感神经系统平静下来的方法。

Cognitive behavioral therapy, mindfulness based, stress reduction, acceptance and commitment therapy are some of the tools that they use.

他们使用的一些工具包括认知行为疗法、正念疗法、减压疗法、接受疗法和承诺疗法。

My partner Beth has developed a brief intervention called empowered relief.

我的搭档贝丝制定了一项名为“授权救济”的简短干预措施。

Yes, I'm biased.

是的，我有偏见。

It works.

有用。

We've studied this in an NIH funded study.

我们在美国国立卫生研究院资助的一项研究中对此进行了研究。

And it's a way of getting eight weeks of cognitive behavioral therapy in two hours.

这是一种在两小时内获得八周认知行为治疗的方法。

Not meant to replace CBT but as an additional tool.

并不是要取代 CBT，而是作为一种附加工具。

And you're going to see as time goes by, more and more of these tools come out.

随着时间的推移，您将会看到越来越多的此类工具出现。

And the beauty of them is they're going to be much easier to disseminate broadly to the public than, for instance, a pill.

它们的美妙之处在于，它们比药丸等药物更容易向公众广泛传播。

We can't just go put into FedEx or the US Post Office, start sending out pills to everybody.

我们不能只是把药放进联邦快递或美国邮局，开始向每个人寄药丸。

But we can develop treatments online that can teach people skills and really help.

但我们可以在线开发可以教授人们技能并真正有帮助的治疗方法。

And so I created this platform to be able to capture high quality data, put it to use, use AI in the background for prediction.

因此，我创建了这个平台，以便能够捕获高质量的数据，将其投入使用，并在后台使用人工智能进行预测。

And now Beth has created these brief interventions, which we're integrating.

现在贝丝已经创建了这些简短的干预措施，我们正在整合它们。

And the notion is to make that widely available for free.

我们的想法是免费广泛提供。

We're giving it all away.

我们正在放弃一切。

Like I said, this is a life mission.

就像我说的，这是一个人生使命。

We both have been blessed to be at Stanford where we have everything.

我们都很幸运能够来到斯坦福大学，在那里我们拥有一切。

But you go just 30 miles, 40 miles outside of the Bay Area, and you're in a health care desert.

但只要离开湾区 30 英里、40 英里，你就进入了医疗保健沙漠。

And I don't say that disparaging to any docs working out there.

我这样说并不是贬低在那里工作的任何文档。

But it's different.

但情况不同。

There's only a handful of large academic centers and large practices in the country.

该国只有少数大型学术中心和大型实践机构。

When you get outside those catchment areas, people struggle with how to get good quality care.

当您离开这些服务区域时，人们会为如何获得优质护理而苦苦挣扎。

You asked that question earlier.

你之前问过这个问题。

How do you find good quality care?

您如何找到优质的护理？

And so we're working to make that available to everybody.

因此，我们正在努力让每个人都可以使用它。

So now that that answer was given by me, then it frees up the opportunity for you to give another answer.

既然我给出了这个答案，那么你就有机会给出另一个答案。

If you had one wish for the field of pain medicine going forward, what would that wish be?

如果您对疼痛医学领域的发展有一个愿望，那会是什么？

My wish would be for full implementation of the National Pain Strategy.

我的愿望是全面实施国家疼痛战略。

It unfortunately took a back seat when it was released the same time with the CDC opioid guidelines.

不幸的是，当它与疾病预防控制中心阿片类药物指南同时发布时，它退居二线。

And the opioid guidelines sucked all the oxygen out of the room.

阿片类药物的使用指南吸走了房间里所有的氧气。

But the strategic plan, it was well thought out.

但这个战略计划，是经过深思熟虑的。

It's the one that we have for our country.

这是我们为我们的国家所拥有的。

It's non-controversial, nonpartisan.

这是没有争议的，无党派的。

It is motherhood and apple pie.

这是母性和苹果派。

And if we just actually implement what we put forward, it'll make a huge difference in the lives of people living with pain.

如果我们真正实施我们提出的建议，就会给生活在痛苦中的人们的生活带来巨大的变化。

Thank you for taking us on that tour of the biology, the psychology, the various treatments, the context in which all of this exists.

感谢您带我们参观了生物学、心理学、各种治疗方法以及所有这些存在的背景。

We touched into some somewhat controversial areas, but I really appreciate the thoroughness and the nuance and the sensitivity with which you touch into all of those issues.

我们触及了一些有些争议的领域，但我真的很欣赏你在触及所有这些问题时的彻底性、细微差别和敏感性。

And just on behalf of myself and everybody listening, I just really want to thank you.

我谨代表我自己和所有聆听的人，衷心感谢你们。

You've contributed a great deal today to the public education of what pain is, what it isn't, and how to treat it.

今天，您为公众教育什么是疼痛、什么不是疼痛以及如何治疗疼痛做出了巨大贡献。

So thank you ever so much.

所以非常感谢你。

If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.

如果您正在学习和/或喜欢此播客，请订阅我们的 YouTube 频道。

That's a terrific 0 cost way to support us.

这是支持我们的绝佳零成本方式。

In addition, please subscribe to the podcast on both Spotify and Apple.

此外，请在 Spotify 和 Apple 上订阅该播客。

And on both Spotify and Apple, you can leave us up to a five star review.

在 Spotify 和 Apple 上，您都可以给我们留下五星级的评价。

Please also check out the sponsors mentioned at the beginning and throughout today's episode.

另请查看今天节目开头和整个节目中提到的赞助商。

That's the best way to support this podcast.

这是支持这个播客的最佳方式。

If you have questions or comments for me or guests or topics that you'd like me to include on the Huberman Lab podcast, please put those in the comments on YouTube.

如果您对我或嘉宾有任何疑问或意见，或者您希望我在 Huberman Lab 播客中包含这些主题，请在 YouTube 上发表评论。

I do read all the comments.

我确实阅读了所有评论。

During today's episode and on many previous episodes of the Huberman Lab podcast, we discussed supplements.

在今天的节目和休伯曼实验室播客的许多以前的节目中，我们讨论了补充剂。

While supplements aren't necessary for everybody, many people derive tremendous benefit from them for things like improving sleep, for hormone support, and for focus.

虽然补充剂并不是每个人都需要的，但许多人从它们中获得了巨大的好处，例如改善睡眠、激素支持和注意力集中。

The Huberman Lab podcast has partnered with Momentous Supplements, and we've done that for several reasons.

Huberman Lab 播客与 Momentous Supplements 合作，我们这样做有几个原因。

First of all, Momentous Supplements are of the very highest quality.

首先，Momentous Supplements 具有最高品质。

Second, Momentous ships internationally, which we realize is important because many of you reside outside of the United States.

其次，Momentous 在国际上发货，我们意识到这一点很重要，因为你们中的许多人居住在美国境外。

Third, Momentous Supplements tend to focus on single ingredient formulations, which is important if you want to develop the most biologically and cost effective supplement regimen for you.

第三，重要的补充剂往往专注于单一成分配方，如果您想为您开发最具生物学意义和成本效益的补充剂方案，这一点很重要。

To learn more about the supplements discussed on the Huberman Lab podcast, please go to livemomentous.com/huberman.

要了解有关 Huberman Lab 播客上讨论的补充剂的更多信息，请访问 livemomentous.com/huberman。

Again, that's livemomentous spelled O-U-S dot come slash Huberman.

再说一次，这是一个生动的拼写 O-U-S 点来斜线 Huberman。

If you're not already following me on social media, I am hubermanlab on all social media platforms.

如果您还没有在社交媒体上关注我，我是所有社交媒体平台上的 hubermanlab。

So that's Instagram, Twitter, now called X, Threads, LinkedIn, and Facebook.

这就是 Instagram、Twitter（现在称为 X）、Threads、LinkedIn 和 Facebook。

And on all of those platforms, I discuss science and science related tools, some of which overlaps with the content of the Huberman Lab podcast, but much of which is distinct from the content on the Huberman Lab podcast.

在所有这些平台上，我讨论了科学和科学相关的工具，其中一些与胡伯曼实验室播客的内容重叠，但其中大部分与胡伯曼实验室播客的内容不同。

Again, that's hubermanlab on all social media platforms.

再说一次，这就是所有社交媒体平台上的 hubermanlab。

If you haven't already subscribed to our Neural Network newsletter, it is a zero cost newsletter that includes summaries of podcast episodes as well as protocols in the form of brief one to three page PDFs for things like how to improve sleep, how to regulate dopamine, deliberate cold exposure, deliberate heat exposure, exercise protocols, and much more.

如果您还没有订阅我们的神经网络时事通讯，这是一份零成本的时事通讯，其中包括播客剧集摘要以及一到三页 PDF 形式的协议，内容包括如何改善睡眠、如何调节多巴胺、刻意冷暴露、刻意热暴露、锻炼协议等。

To sign up, simply go to hubermanlab.com, go to the Menu tab, scroll down to Newsletter, and provide us with your email.

要注册，只需访问 hubermanlab.com，转到“菜单”选项卡，向下滚动到“时事通讯”，然后向我们提供您的电子邮件。

And I want to point out that we do not share your email with anybody.

我想指出的是，我们不会与任何人分享您的电子邮件。

And again, the newsletter is completely 0 cost.

再说一遍，时事通讯完全是0成本。

Thank you once again for joining me for today's discussion all about pain and ways to control pain with Dr. Sean Mackey.

再次感谢您今天与 Sean Mackey 医生一起讨论疼痛和控制疼痛的方法。

And last but certainly not least, thank you for your interest in science.

最后但并非最不重要的一点是，感谢您对科学的兴趣。