Essentials: How to Control Your Sense of Pain & Pleasure

Andrew Huberman: Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance.

安德鲁·胡伯曼（Andrew Huberman）：欢迎来到胡伯曼实验室要点，在这里我们回顾过去的剧集，寻找针对心理健康、身体健康和表现的最有效、最可操作的基于科学的工具。

I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。

Today, we continue our discussion of the senses, and the senses we are going to discuss are pain and pleasure.

今天我们继续讨论感官，我们要讨论的感官是痛苦和快乐。

Pain and pleasure reflect two opposite ends of a continuum, a continuum that involves detection of things in our skin, and the perception, the understanding of what those events are.

痛苦和快乐反映了一个连续体的两个相对端，这个连续体涉及对我们皮肤中事物的检测，以及对这些事件是什么的感知和理解。

Our skin is our largest sensory organ and our largest organ indeed.

我们的皮肤是我们最大的感觉器官，也是我们最大的器官。

It is much larger than any of the other organs in our body.

它比我们身体的任何其他器官都要大得多。

And it's an odd organ if you think about it.

如果你仔细想想，这是一个奇怪的器官。

It has so many functions.

它有很多功能。

It acts as a barrier between our organs and the outside world.

它充当我们的器官和外界之间的屏障。

It harbors neurons, nerve cells that allow us to detect things like light touch or temperature or pressure of various kinds.

它含有神经元，使我们能够检测诸如光触、温度或各种压力等事物。

And it's an organ that we hang ornaments on.

这是我们用来挂装饰品的风琴。

People put earrings in their ears.

人们把耳环戴在耳朵上。

People decorate their skin with tattoos and inks and other things.

人们用纹身、墨水和其他东西来装饰他们的皮肤。

And it's an organ that allows us to experience either great pain or great pleasure.

它是一个让我们体验巨大痛苦或巨大快乐的器官。

So, it's a multifaceted organ, and it's one that our brain needs to make sense of in a multifaceted way.

所以，它是一个多方面的器官，我们的大脑需要以多方面的方式理解它。

I think we all intuitively understand what pleasure and pain are.

我想我们都直观地理解什么是快乐和痛苦。

Pleasure generally is a sensation in the body and in the mind that leads us to pursue more of whatever is bringing about that sensation.

快乐通常是一种身体和心灵的感觉，它引导我们去追求更多能带来这种感觉的东西。

And pain is also a sensation in the body and in the mind that, in general, leads us to want to withdraw or move away from some activity or interaction.

疼痛也是身体和心灵的一种感觉，通常会导致我们想要退出或远离某些活动或互动。

Scientists would call this appetitive behaviors, meaning behaviors that lead us to create an appetite for more of those behaviors, and aversive behaviors, behaviors that make us want to move away from something.

科学家们将这种行为称为“食欲行为”，即导致我们对更多此类行为产生兴趣的行为，以及“厌恶行为”，即让我们想要远离某些事物的行为。

The organ that we call the skin, as I mentioned earlier, is the largest organ in our body, and throughout that organ, we have neurons, little nerve cells.

正如我之前提到的，我们称之为皮肤的器官是我们身体中最大的器官，在这个器官中，我们有神经元，小神经细胞。

Now, to be really technical about it, and the way I'd like you to understand it, is that the so-called cell body, meaning the location of a cell in which the DNA and other goodies, the kind of central factory of the cell, that actually sits right outside your spinal cord.

现在，从技术角度来说，我希望你们能够理解它，即所谓的细胞体，意思是DNA和其他物质所在的细胞的位置，细胞的中心工厂，实际上就位于脊髓的外部。

So, all up and down your spinal cord, on either side, are these little blobs of neurons, little collections of neurons.

因此，脊髓的上下两侧，都是这些小神经元团，小神经元集合。

They're called DRGs, dorsal root ganglia.

它们被称为 DRG，即背根神经节。

A ganglion is just a collection or a clump of cells.

神经节只是细胞的集合或细胞团。

And those DRGs are really interesting because they send one branch that we call an axon, a little wire, out to our skin, and they have another wire from that same cell body that goes in the opposite direction, which is up to our brain, and creates connections within our brain, in the so-called brain stem, okay?

这些 DRG 非常有趣，因为它们将一根我们称之为轴突的分支（一根小电线）发送到我们的皮肤，并且它们还有另一根来自同一细胞体的电线，该电线朝相反的方向延伸，这取决于我们的大脑，并在我们的大脑内（即所谓的脑干）中建立连接，好吗？

These wires are positioned within the skin to respond to mechanical forces, so maybe light touch.

这些电线位于皮肤内以响应机械力，因此可能是轻微的触摸。

Some will only send electrical activity up toward the brain in response to light touch.

有些只会响应轻触而向大脑发送电活动。

Others respond to coarse pressure, to hard pressure, but they won't respond to a light feather.

其他人对粗压力、硬压力有反应，但对轻羽毛没有反应。

Others respond to temperature, so they will respond to the presence of heat or the presence of cold.

其他人会对温度做出反应，因此他们会对热或冷的存在做出反应。

And still others respond to other types of stimuli, like certain chemicals on our skin.

还有一些会对其他类型的刺激做出反应，例如皮肤上的某些化学物质。

So, these neurons are amazing.

所以，这些神经元是惊人的。

They're collecting information of particular kinds from the skin throughout the entire body and sending that information up toward the brain.

他们从整个身体的皮肤收集特定类型的信息，并将这些信息发送到大脑。

And what's really incredible, I just want you to ponder this for a second, what's really incredible is that the language that those neurons use is exactly the same.

真正令人难以置信的是，我只是想让你思考一下，真正令人难以置信的是这些神经元使用的语言是完全相同的。

The neuron that responds to light touch sends electrical signals up toward the brain.

对轻触做出反应的神经元向大脑发送电信号。

The neurons that respond to cold or to heat or to habanero pepper, they only respond to the particular thing that evokes the electrical response.

对冷、热或哈瓦那辣椒做出反应的神经元，它们只对引起电反应的特定事物做出反应。

I should say that they only respond to the particular stimulus, the pepper, the cold, the heat, et cetera, that will evoke an electrical signal, but the electrical signals are a common language that all neurons use.

我应该说，它们只对特定的刺激做出反应，胡椒、寒冷、热等等，这些刺激会引起电信号，但电信号是所有神经元使用的共同语言。

And yet, if something cold is presented to your skin, like an ice cube, you know that that sensation, that thing is cold.

然而，如果一些冷的东西出现在你的皮肤上，比如一块冰块，你就会知道那种感觉，那个东西是冷的。

You don't misperceive it as heat or as a habanero pepper, okay?

你不会把它误认为是热气或哈瓦那辣椒，好吗？

So, that's amazing.

所以，这太棒了。

What that means is that there must be another element in the equation of what creates pleasure or pain, and that element is your brain.

这意味着在创造快乐或痛苦的方程式中必须还有另一个元素，这个元素就是你的大脑。

Your brain takes these electrical signals and interprets them, partially based on experience, but also there are some innate, meaning some hardwired aspects of pain and pleasure sensing that require no experience whatsoever.

你的大脑获取这些电信号并解释它们，部分基于经验，但也有一些与生俱来的，意味着疼痛和快乐感知的一些硬连线方面不需要任何经验。

A child doesn't have to touch a flame but once, and the very first time, they will withdraw their hand from the flame.

孩子不必接触火焰，但只有一次，而且是第一次，他们会将手从火焰上移开。

The pain and pleasure system don't need prior experience.

痛苦和快乐系统不需要事先的经验。

What they need is a brain that can interpret these electrical signals and somehow create what we call pleasure and pain out of them.

他们需要的是一个能够解释这些电信号并以某种方式从中产生我们所说的快乐和痛苦的大脑。

So, what parts of the brain?

那么，大脑有哪些部分呢？

Well, mainly it's the so-called somatosensory cortex, the portion of our neocortex, which is on the outside of our brain, the kind of bumpy part.

嗯，主要是所谓的体感皮层，我们新皮层的一部分，它在我们大脑的外面，那种凹凸不平的部分。

And in your somatosensory cortex, you have a map of your entire body surface.

在你的体感皮层中，你有整个身体表面的地图。

That map is called a homunculus.

这张地图被称为“侏儒”。

It's your representation of touch, including pleasure and pain.

这是你对触摸的表现，包括快乐和痛苦。

But it's not randomly organized.

但它不是随机组织的。

It's highly organized in a very particular way, which is that the areas of your skin that have the highest density of these sensory receptors are magnified in your brain....

它以一种非常特殊的方式高度组织起来，即这些感觉受体密度最高的皮肤区域在你的大脑中被放大......

what are the areas that are magnified?

哪些区域被放大了？

Well, the lips, the face, the tips of the fingers, the feet, and the genitals.

嗯，嘴唇、脸、指尖、脚和生殖器。

And that's because the innervation, the number of wires that go into those regions of your body, far exceeds the number of wires for sensation of touch that go to other areas of your body.

这是因为神经支配，即进入你身体这些区域的电线数量，远远超过了进入你身体其他区域的触觉电线数量。

You can actually experience this in real time right now, by doing a simple experiment that we call two point discrimination.

您现在可以通过做一个简单的实验（我们称之为两点辨别）来实时体验这一点。

Two point discrimination is your ability to know whether or not two points of pressure are far apart, near each other, or you actually could perceive incorrectly as one point of pressure.

两点辨别能力是指您知道两个压力点是否相距较远、是否接近，或者您实际上可能错误地将其视为一个压力点的能力。

You might want a second person to do this experiment.

您可能需要第二个人来做这个实验。

That person would take two fine points, so it could be two pencils or pens, or the backs of pens.

那个人会拿两个细点，所以它可以是两支铅笔或钢笔，或者笔背。

If you were to close your eyes and I were to take these two pens and put their points close together about a centimeter apart, and present them to the top of your hand, you, even though your eyes were closed, you would be able to perceive that that was two points of pressure presented simultaneously to the top of your hand.

如果你闭上眼睛，我拿起这两支笔，把它们的点靠在一起，相距大约一厘米，然后把它们放在你的手顶上，你即使闭上眼睛，也能感觉到那是两个压力点同时出现在你的手顶上。

However, if I were to do this to the middle of your back, you would not experience them as two points of pressure.

然而，如果我对你的背部中间这样做，你就不会感受到它们是两个压力点。

You would experience them as one single point of pressure.

您会将它们视为一个压力点。

In other words, your two point discrimination is better, is higher, on areas of your body which have many, many more sensory receptors.

换句话说，在你身体上有很多很多感觉受体的区域，你的两点辨别能力更好、更高。

Most of us don't really appreciate how important and what a profound influence this change in density of receptors across our body's surface has.

我们大多数人并没有真正意识到我们身体表面受体密度的变化有多么重要和深远的影响。

So, you've got sensors in the skin, and you've got a brain that's going to interpret what's going on with those sensors.

所以，你的皮肤里有传感器，你的大脑会解释这些传感器发生了什么。

And believe it or not, your subjective interpretation of what's happening has a profound influence on your experience of pleasure or pain.

不管你相信与否，你对正在发生的事情的主观解释会对你的快乐或痛苦体验产生深远的影响。

There's several things that can impact these experiences, but the main categories are expectation, if someone tells you this is going to hurt, I'm going to, you know, give you an injection right here, it might hurt for a second, that's very different and your experience of that pain will be very different than if it happened suddenly out of the blue.

有几件事会影响这些体验，但主要类别是期望，如果有人告诉你这会很痛，我会在这里给你注射，可能会痛一秒钟，这是非常不同的，你对这种疼痛的体验会与突然发生的疼痛有很大不同。

There's also anxiety.

还有焦虑。

How anxious or how high or low your level of arousal, autonomic arousal.

您的焦虑程度或觉醒水平、自主神经觉醒水平有多高或低。

That's going to impact your experience of pleasure or pain.

这会影响你对快乐或痛苦的体验。

How well you've slept and where you are in the so-called circadian or 24-hour cycle.

您的睡眠质量以及您在所谓的昼夜节律或 24 小时周期中的位置。

Our ability to tolerate pain changes dramatically across the 24-hour cycle, and as you can imagine, it's during the daylight waking hours that we are better able to tolerate, we are more resilient to pain, and we are better able to experience pleasure.

我们忍受疼痛的能力在 24 小时周期中会发生巨大变化，正如您可以想象的那样，在白天醒着的时候，我们能够更好地忍受疼痛，我们对疼痛更有抵抗力，并且我们能够更好地体验快乐。

At night, our threshold for pain is much lower.

晚上，我们对疼痛的阈值要低得多。

In other words, the amount of mechanical or chemical or thermal, meaning temperature stimuli that can evoke a pain response and how we would rate that response, is much lower at night, and in particular, in the hours between 2:00 AM and 5:00 AM if you're on a kind of standard circadian schedule.

换句话说，机械、化学或热（即可以引起疼痛反应的温度刺激以及我们如何评价该反应）的数量在夜间要低得多，特别是在凌晨 2:00 至 5:00 之间（如果您采用标准昼夜节律）。

And then the last one is our genes.

最后一项是我们的基因。

Pain threshold and how long a pain response lasts is in part dictated by our genes.

疼痛阈值和疼痛反应持续多长时间部分是由我们的基因决定的。

So, we have expectation, anxiety, how well we've slept, where we are in the so-called 24-hour circadian time, and our genes.

所以，我们有期望、焦虑、我们的睡眠质量、我们在所谓的 24 小时昼夜节律中的位置，以及我们的基因。

So, let's talk about expectation and anxiety, because those two factors can powerfully modulate our experience of both pleasure and pain in ways that will allow us to dial up pleasure, if we like, and to dial down pain, if indeed that's what we want to do.

那么，让我们谈谈期望和焦虑，因为这两个因素可以有力地调节我们对快乐和痛苦的体验，让我们能够增加快乐（如果我们愿意），并减少痛苦（如果这确实是我们想做的）。

So, let's talk about expectation and anxiety, because those two things are somewhat tethered.

那么，让我们谈谈期望和焦虑，因为这两件事在某种程度上是相互联系的。

There are now a number of solid experiments that point to the fact that if we know a painful stimulus is coming, that we can better prepare for it mentally, and therefore buffer or reduce the pain response.

现在有许多可靠的实验表明，如果我们知道痛苦的刺激即将到来，我们就可以更好地做好心理准备，从而缓冲或减少疼痛反应。

Essentially if subjects are warned that a painful stimulus is coming, their subjective experience of that pain is vastly reduced.

本质上，如果受试者被警告即将发生痛苦的刺激，他们对疼痛的主观体验就会大大减少。

However, if they are warned just two seconds before that pain arrives, it does not help.

然而，如果在疼痛到来前两秒警告他们，那也无济于事。

It actually makes it worse.

这实际上让情况变得更糟。

And the reason is they can't do anything mentally to prepare for it in that brief two-second window.

原因是他们在这短暂的两秒时间内无法做任何心理准备。

Similarly, if they are warned about pain that's coming two minutes before a painful stimulus is coming, that also makes it worse, because their expectation ramps up the autonomic arousal, the level of alertness is all funneled toward that negative experience that's coming.

同样，如果他们在痛苦刺激到来前两分钟被警告即将到来的疼痛，这也会让情况变得更糟，因为他们的期望会增强自主神经的唤醒，警觉程度都会集中到即将到来的负面体验。

So, how soon before a painful stimulus should we know about it if the goal is to reduce our level of pain?

那么，如果目标是减轻疼痛程度，我们应该在疼痛刺激发生之前多久知道它呢？

And the answer is, somewhere between 20 seconds and 40 seconds is about right.

答案是，20 秒到 40 秒之间比较合适。

This can come in useful in a variety of contexts, but I think it's important because what it illustrates is that it absolutely cannot be just the pattern of signals that are arriving from the skin.

这在各种情况下都很有用，但我认为这很重要，因为它说明它绝对不仅仅是从皮肤到达的信号模式。

There has to be a subjective interpretation component, because we are all different in terms of our pain threshold.

必须有一个主观解释成分，因为我们的疼痛阈值都不同。

First of all, what is pain threshold?

首先，什么是痛阈？

Pain threshold has two dimensions.

痛阈有两个维度。

The first dimension is the amount of mechanical or chemical or thermal stimulation that it takes for you or me or somebody else to say, "I can't take that anymore.

第一个维度是你、我或其他人需要多少机械、化学或热刺激才能说：“我再也受不了了。

I'm done." But there's another element as well, which is how long the pain persists.

我已经完成了。”但还有另一个因素，那就是疼痛持续的时间。

And to just really point out how varied we all are in terms of our experience of pain, let's look to an experiment.

为了真正指出我们所有人对疼痛的体验有多么不同，让我们看一个实验。

There have been experiments done at Stanford School of Medicine and elsewhere, which involved having subjects put their hand into a very cold vat of water and measuring the amount of time that they kept their hand in that water, and then they would tell the experimenter how......

斯坦福大学医学院和其他地方已经做过实验，其中包括让受试者将手放入一桶非常冷的水中，并测量他们的手在水中停留的时间，然后他们会告诉实验者如何......

painful that particular stimulus was on a scale of one to 10.

特定刺激的痛苦程度从 1 到 10。

That simple experiment revealed that people experience the same thermal, in this case cold, stimulus vastly different.

这个简单的实验表明，人们经历相同的热刺激（在本例中是冷刺激）却截然不同。

Some people would rate it as a 10 out of 10, extreme pain.

有些人会将其评定为十分痛苦（满分 10 分）。

Other people would rate it as barely painful at all, like a one.

其他人会认为它一点也不痛，就像痛一样。

Other people, a three.

其他人，一个三。

Other people, a five, et cetera.

其他人，一个五个，等等。

In fact, there is no objective measure of pain.

事实上，没有客观的疼痛衡量标准。

Similarly, pleasure is something that we all talk about, but we have no way of gauging what other people are experiencing except what they report through language.

同样，快乐是我们都在谈论的事情，但除了他们通过语言报告的内容外，我们无法衡量其他人正在经历什么。

So, rather than focus on just the subjective nature of pain, let's talk about the absolute qualities of pain, and the absolute qualities of pleasure, so that we can learn how to navigate those two experiences in ways that serve us each better.

因此，我们不要只关注疼痛的主观本质，而是要讨论疼痛的绝对品质和快乐的绝对品质，以便我们能够学习如何以更好地为我们各自服务的方式驾驭这两种体验。

First of all, I want to talk about heat and cold.

首先，我想谈谈热和冷。

We do indeed have sensors in our skin that respond to heat and cold, and one of the best tests of how somebody can handle pain is to ask them to just get into an ice bath.

我们的皮肤中确实有对热和冷做出反应的传感器，而检验某人如何处理疼痛的最佳测试之一就是要求他们进入冰浴。

Some do it quickly, some do it slowly.

有些人做得很快，有些人做得很慢。

Others find the experience of cold to be so aversive that they somehow cannot get themselves in.

另一些人则觉得寒冷的经历非常令人厌恶，以至于他们无法融入其中。

I think it can be helpful to everyone to know that even though it feels better at a mental level to get into the cold slowly, it is actually much worse from a neurobiological perspective.

我认为这对每个人都有帮助，因为尽管慢慢地进入寒冷在精神层面上感觉更好，但从神经生物学的角度来看，实际上更糟糕。

The neurons that sense cold respond to what are called relative drops in temperature.

感知寒冷的神经元会对所谓的相对温度下降做出反应。

So, it's not about the absolute temperature of the water, it's about the relative change in temperature.

因此，这与水的绝对温度无关，而是与温度的相对变化有关。

Therefore, you can bypass these signals going up to the brain with each relative change, one degree change, two degrees change, et cetera, by simply getting in all at once.

因此，您可以通过一次简单地输入所有相对变化（一度变化、两度变化等）来绕过这些进入大脑的信号。

In fact, it is true that if you get into cold water up to your neck, it's actually much more comfortable than if you're halfway in and halfway out.

事实上，确实，如果你进入到脖子的冷水中，实际上比你半进半出要舒服得多。

And that's because of the difference in the signals that are being sent from the cold receptors on your upper torso, which is out of the water, and your lower torso.

这是因为从水面上的上半身和下半身的冷感受器发出的信号存在差异。

Now, I wouldn't want anyone to take this to mean that they should just jump into an unknown body of water.

现在，我不希望任何人认为这意味着他们应该跳入未知的水域。

People can have heart attacks from getting into extremely cold water.

人们可能会因进入极冷的水中而心脏病发作。

But it is absolutely true that provided it's safe, getting into, uh, cold water is always going to be easier to do quickly, and is going to be easier to do up to your neck.

但绝对正确的是，只要安全，进入，呃，冷水总是会更容易快速进入，并且更容易进入到你的脖子。

Now, heat is the opposite.

现在，热量则相反。

Heat is measured in absolute terms by the neurons.

神经元以绝对值测量热量。

So, gradually moving into heat makes sense, and finding that threshold which is safe and comfortable for you, or if it's uncomfortable, at least resides within that realm of safety.

因此，逐渐进入高温状态是有道理的，找到对您来说安全舒适的阈值，或者如果不舒服，至少位于安全范围内。

One of the most important things to understand about the experience of pain, and to really illustrate just how subjective pain really is, is that our experience of pain and the degree of damage to our body are not always correlated.

要了解疼痛体验并真正说明主观疼痛的真实程度，最重要的事情之一是我们的疼痛体验和身体受损的程度并不总是相关的。

A classic example of this was published in the British Journal of Medicine in which a construction worker fell from, I think it was a second story, which he was working, and a nail went up and through his boot.

《英国医学杂志》上发表了一个典型的例子，其中一名建筑工人从他正在工作的第二层楼上摔下来，一颗钉子穿进了他的靴子。

And he looked down, and he saw the nail going through his boot, and he was in absolute, excruciating pain.

他低下头，看到钉子穿过他的靴子，他感到绝对的、难以忍受的痛苦。

They took him to the hospital, and because the nail was so long, and because of where it had entered and exited the boot, they had to cut away the boot in order to get to the nail.

他们把他带到医院，由于钉子太长，而且由于钉子进出靴子的位置，他们不得不切掉靴子才能找到钉子。

And when they did that, they revealed that the nail had passed between two of his toes.

当他们这样做时，他们发现钉子已经穿过他的两个脚趾之间。

It had actually failed to impale his body in any way, and yet the view, the perception of that nail entering his boot at one end, and exiting the boot at the other was sufficient to create the experience of a nail that had gone through his foot.

它实际上并没有以任何方式刺穿他的身体，然而，钉子一端进入靴子、另一端退出靴子的景象和感觉足以创造出钉子穿过他脚的体验。

And the moment he realized that that nail had not gone through his foot, the pain completely evaporated.

当他意识到那根钉子没有刺穿他的脚的那一刻，疼痛就完全消失了。

And I want to make sure that I emphasize the so-called psychosomatic phenomenon.

我想确保我强调了所谓的心身现象。

I think sometimes we hear psychosomatic and we interpret that as meaning all in one's head.

我想有时我们听到心身学，我们将其解释为一切都在一个人的头脑中。

But I think it's important to remember that everything is neural, whether or not it's pain in your body 'cause you have a, a gaping wound and you're hemorrhaging out of that wound, or whether or not it's pain for which you cannot explain it on the basis of any kind of injury.

但我认为重要的是要记住，一切都是神经性的，无论是因为你有一个裂开的伤口并且你正在从伤口流血而感到身体疼痛，还是你无法根据任何类型的伤害来解释它的疼痛。

It's all neural.

都是神经性的。

So, saying body, brain, or psychosomatic, it's, it's kind of irrelevant, and I hope someday we move past that language.

所以，说身体、大脑或心身，这有点无关紧要，我希望有一天我们能够超越这种语言。

So, when we hear syndrome, and a patient comes into a clinic and says, uh, that they suffer, for instance, from something which is very controversial, frankly, like chronic fatigue syndrome.

因此，当我们听到综合症时，病人走进诊所说，呃，他们患有某种非常有争议的疾病，坦率地说，比如慢性疲劳综合症。

Some physicians believe that it reflects a real underlying medical condition, others don't.

一些医生认为它反映了真正的潜在健康状况，而另一些医生则不这么认为。

However, syndrome means we don't understand, and that doesn't mean something doesn't exist.

然而，综合症意味着我们不理解，但这并不意味着某些东西不存在。

Fibromyalgia, or whole body pain, for a long time was written off or kind of explained away by physicians and scientists, frankly, my community, as one of these syndromes.

纤维肌痛，或全身疼痛，很长一段时间被医生和科学家（坦率地说，我的社区）忽略或解释为这些综合症之一。

It couldn't be explained.

这无法解释。

However, now there is firm understanding of at least one of the bases for this whole body pain, and that's activation of a particular cell type called glia.

然而，现在人们对这种全身疼痛的至少一个根源有了深入的了解，那就是一种称为神经胶质细胞的特定细胞类型的激活。

And there's a receptor on these glia, for those of you that want to know, called the Toll-4 receptor.

对于那些想知道的人来说，这些神经胶质细胞上有一个受体，称为 Toll-4 受体。

And activation of the Toll-4 receptor is related to certain forms of whole body pain and fibromyalgia.

Toll-4 受体的激活与某些形式的全身疼痛和纤维肌痛有关。

Now, what treatments exist for fibromyalgia?

现在，纤维肌痛有哪些治疗方法？

There are clinical data using a prescription drug.

有使用处方药的临床数据。

The drug is called naltrexone.

该药物称为纳曲酮。

Naltrexone is actually used for the treatment of various, uh, opioid addictions and things of that sort.

纳曲酮实际上用于治疗各种，呃，阿片类药物成瘾之类的事情。

But it turns out that a very low dose......

但事实证明，剂量非常低......

has been shown to have some success in dealing with and treating certain forms of fibromyalgia.

已被证明在处理和治疗某些形式的纤维肌痛方面取得了一些成功。

And it has that success because of its ability to bind, to unblock these toll4 receptors on glia.

它之所以能取得如此成功，是因为它能够结合、解锁神经胶质细胞上的这些 toll4 受体。

There's another approach that one could take, and that compound is acetylcarnotine.

人们还可以采取另一种方法，这种化合物就是乙酰肉碱。

There is evidence that acetylcarnotine can reduce the symptoms of chronic whole-body pain, and other certain forms of acute pain at dosages of somewhere between one to three and sometimes four grams per day.

有证据表明，每天服用一到三克、有时四克的乙酰卡诺汀可以减轻慢性全身疼痛和其他某些形式的急性疼痛的症状。

Now, acetylcarnotine can be taken orally.

现在，乙酰肉碱可以口服。

It's found in 500 milligram capsules, as well as by injection.

它存在于 500 毫克胶囊中，也有注射剂。

There are a large number of studies on acetylcarnotine.

关于乙酰肉碱有大量的研究。

You can look those up on PubMed if you like, or on examine.com.

如果您愿意，您可以在 PubMed 或 exam.com 上查找这些内容。

So, it appears that L-carnitine is impacting a number of different processes both to impact pain and perhaps, and I want to underscore perhaps, but there are good studies happening now, perhaps accelerate wound healing as well.

因此，左旋肉碱似乎正在影响许多不同的过程，既能影响疼痛，也可能会影响疼痛，我想强调一下，但现在正在进行一些很好的研究，也许还能加速伤口愈合。

Now, I'd like to turn our attention to a completely non-drug, non-supplement related approach to dealing with pain, and it's one that has existed for thousands of years, and that only recently has the Western scientific community started to pay serious attention to.

现在，我想把我们的注意力转向一种完全非药物、非补充剂相关的治疗疼痛的方法，这种方法已经存在了数千年，直到最近西方科学界才开始认真关注。

And there is terrific mechanistic science to now explain how and why acupuncture can work very well for the treatment of certain forms of pain.

现在有很棒的机械科学可以解释针灸如何以及为什么可以很好地治疗某些形式的疼痛。

Now, first off, I want to tell you what was told to me by our director or chief of the pain division at Stanford School of Medicine, Dr. Sean Mackey, which was that a fraction of people experience tremendous pain relief from acupuncture, and others experience none at all or very little.

现在，首先，我想告诉你斯坦福大学医学院疼痛科主任肖恩·麦基博士告诉我的话，即一小部分人从针灸中体验到了巨大的疼痛缓解，而其他人则根本没有或很少体验到疼痛。

A number of laboratories have started to explore how acupuncture works, and one of the premier laboratories for this is Qiufu Ma's lab at Harvard Medical School.

许多实验室已经开始探索针灸的工作原理，其中最重要的实验室之一是哈佛医学院马秋福的实验室。

Now, the form of acupuncture that they explored was one that's commonly in use called electroacupuncture.

现在，他们探索的针灸形式是一种常用的针灸疗法。

So, this isn't just putting little needles into different parts of the body.

所以，这不仅仅是将小针插入身体的不同部位。

These needles are able to pass an electrical current, not magically, but because they have a little wire going back to a device and you can pass electrical current.

这些针能够传递电流，这并非神奇，而是因为它们有一根小电线返回到设备，因此您可以传递电流。

So, what Qiufu Ma's lab found was that if electroacupuncture is provided to the abdomen, to the stomach area, it creates activation of what are called the sympathetic ganglia, and the activation of these neurons involves noradrenaline and something called NPY, neuropeptide Y.

因此，马秋福实验室发现，如果对腹部、胃部区域进行电针治疗，就会激活所谓的交感神经节，而这些神经元的激活涉及去甲肾上腺素和一种叫做 NPY（神经肽 Y）的物质。

The long and short of it is that stimulating the abdomen with electroacupuncture was either anti-inflammatory or it could cause inflammation.

总而言之，用电针刺激腹部要么可以消炎，要么可能引起炎症。

It could actually exacerbate inflammation, depending on whether or not it was of low or high intensity.

它实际上可能会加剧炎症，具体取决于炎症强度是低还是高。

Now, that makes it a very precarious technique, and this may speak to some of the reason why some people report relief from acupuncture and others do not.

现在，这使得它成为一种非常不稳定的技术，这可能说明了为什么有些人报告针灸缓解了症状，而另一些人却没有。

However, they went a step further and stimulated other areas of the body using electroacupuncture, and what they found is that stimulation of the legs caused a circuit, a neural circuit to be activated that goes from the legs up to an area of the base of the brain called the DMV, and activated the adrenal glands which sit atop your kidneys, and re- caused a release of what are called catecholamines, and those were strongly anti-inflammatory.

然而，他们更进一步，用电针刺激身体的其他部位，他们发现，刺激腿部会引起一个回路，一个从腿部一直到大脑底部称为 DMV 的区域的神经回路被激活，并激活位于肾脏顶部的肾上腺，并重新释放所谓的儿茶酚胺，这些物质具有很强的抗炎作用。

In other words, electroacupuncture of the legs and feet can, if done correctly, be anti-inflammatory and reduce symptoms of pain, and perhaps accelerate wound healing, because activations of these catecholaminergic pathways can accelerate wound healing as well.

换句话说，如果操作正确，腿部和足部的电针可以具有抗炎作用，减轻疼痛症状，并且可能加速伤口愈合，因为这些儿茶酚胺能途径的激活也可以加速伤口愈合。

Now, let's talk about a phenomenon that has long intrigued and perplexed people for probably thousands of years, and that's redheads.

现在，让我们来谈谈一个可能几千年来一直引起人们好奇和困惑的现象，那就是红发。

You may have heard before that redheads have a higher pain threshold than other individuals, and indeed, that is true.

您以前可能听说过红发人比其他人有更高的疼痛阈值，确实如此。

There's now a study that looked at this mechanistically.

现在有一项研究从机制上研究了这一点。

There's a gene called the MC1R gene, and this MC1R gene encodes for a number of different proteins.

有一个基因称为 MC1R 基因，该 MC1R 基因编码许多不同的蛋白质。

Some of those proteins, of course, are related to the production of melanin.

当然，其中一些蛋白质与黑色素的产生有关。

This is why redheads often, not always, but often are very fair-skinned, sometimes have freckles, not always, and of course, have red hair.

这就是为什么红发经常（并非总是）但通常皮肤非常白皙，有时有雀斑（并非总是），当然还有红头发。

This gene, this MC1R gene is associated with a pathway that relates to something that I've talked about on this podcast before during the episode on hunger and feeding, and this is POMC.

这个基因，这个 MC1R 基因与一条通路有关，这条通路与我之前在这个播客上关于饥饿和进食的节目中谈到的一些东西有关，这就是 POMC。

POMC stands for proopiomelanocortin, and POMC is cut up, it's cleaved into different hormones, including one that enhances pain perception.

POMC 代表阿片黑皮质素原，POMC 被切割后，被分解成不同的激素，包括一种增强疼痛感知的激素。

This is melanocyte-stimulating hormone.

这是黑色素细胞刺激激素。

And another one that blocks pain, beta endorphin.

另一种可以抑制疼痛的物质是β内啡肽。

The endorphins are endogenously made, meaning made within our body.

内啡肽是内源性产生的，即在我们体内产生的。

Opioids, they actually make us feel numb in response to certain kinds of pain.

阿片类药物实际上让我们对某些类型的疼痛感到麻木。

Now, not completely numb, but they numb or reduce our perception of pain.

现在，还没有完全麻木，但它们麻木或减少了我们对疼痛的感知。

We all have beta endorphins, we all have POMC, et cetera, but redheads make more of these endogenous endorphins.

我们都有β内啡肽，我们都有POMC，等等，但红发人会产生更多的内源性内啡肽。

Now this, of course, should not be taken to mean that redheads can tolerate more pain and therefore should be subjected to more pain.

当然，这并不意味着红发可以忍受更多的疼痛，因此应该承受更多的疼痛。

All it means is that their threshold for pain on average, not all of them, but on average, is shifted higher than that of other individuals.

这意味着，他们的平均疼痛阈值（不是全部，但平均而言）比其他人更高。

And I should mention, because I mentioned the ice bath, that of course pain threshold is something that can be built up, but it does seem that certain patterns of thinking can allow us to buffer ourselves against the pain response, and that should not be surprising.

我应该提到，因为我提到了冰浴，当然疼痛阈值是可以建立的，但似乎某些思维模式确实可以让我们缓冲疼痛反应，这应该不足为奇。

Certain forms of thinking are associated with the release of particular neuromodulators, in particular dopamine, and dopamine...And it may seem, is kind of the thing that underlies everything, but it's not.

某些形式的思维与特定神经调节剂的释放有关，特别是多巴胺，多巴胺……看起来似乎是一切事物的基础，但事实并非如此。

Dopamine is a molecule that's associated with novelty, expectation, motivation, and reward.

多巴胺是一种与新颖性、期望、动机和奖励相关的分子。

We talked about this at the beginning of the episode.

我们在剧集一开始就谈到了这一点。

And the ways in which dopamine can modulate pain is not mysterious.

多巴胺调节疼痛的方式并不神秘。

It's really through the activation of brain stem neurons that communicate with areas of our body that deploy things like immune cells.

它实际上是通过激活脑干神经元来与我们身体中部署免疫细胞等区域进行通信的。

So for instance, we have neurons in our brain stem that can be modulated by the release of dopamine, and those neurons in the brain stem control the release of immune cells from tissues like the spleen, or organs like the spleen.

例如，我们脑干中的神经元可以通过多巴胺的释放进行调节，而脑干中的这些神经元控制着脾脏等组织或脾脏等器官释放免疫细胞。

And those immune cells can then go combat infection.

然后这些免疫细胞就可以对抗感染。

We've heard before that when we're happy, we're better able to combat infection, deal with pain, deal with all sorts of things.

我们以前听说过，当我们快乐时，我们能够更好地对抗感染、应对疼痛、处理各种事情。

It essentially makes us more resilient, because dopamine affects particular circuits and tells, in a very neurobiological way and a biochemical way, tells those cells and circuits that conditions are good, and it really does allow for more resilience.

它本质上使我们更有弹性，因为多巴胺影响特定的回路，并以一种非常神经生物学的方式和生化的方式告诉那些细胞和回路，条件良好，而且它确实允许更强的弹性。

So along those lines, let's talk about pleasure.

因此，沿着这些思路，我们来谈谈快乐。

With all the cells and tissues and machinery related to pain, you might think that our entire touch system is designed to allow us to detect pain and to avoid tissue damage.

由于所有细胞、组织和机械都与疼痛相关，您可能会认为我们的整个触摸系统旨在让我们能够检测疼痛并避免组织损伤。

And while a good percentage of it is devoted to that, a good percentage of it is also devoted to this thing that we call pleasure.

虽然其中很大一部分投入于此，但也有很大一部分投入到了我们称之为快乐的事情上。

And that should come as no surprise.

这应该不足为奇。

Pleasure serves an adaptive role, and that adaptive role relates to the fact that every species has a primary goal, which is to make more of itself, otherwise it would go extinct.

快乐具有适应性作用，而这种适应性作用与每个物种都有一个主要目标这一事实有关，即使自己变得更多，否则就会灭绝。

That process of making more of itself, sexual reproduction, is closely associated with the sensation and the perception of pleasure.

有性生殖是自我创造更多的过程，与快乐的感觉和感知密切相关。

And it's no surprise that not only is the highest density of sensory receptors in and on and around the genitalia, but the process of reproduction evokes sensations and molecules and perceptions associated with pleasure.

毫不奇怪，不仅生殖器内部、表面和周围的感觉受体密度最高，而且生殖过程也会唤起与愉悦相关的感觉、分子和感知。

And the currency of pleasure exists in multiple chemical systems, but the primary ones are the dopamine system, which is the anticipation of pleasure, and the work required to achieve the ability to experience that pleasure, and the serotonin system, which is more closely related to the immediate experience of that pleasure.

快乐的流通存在于多种化学系统中，但主要的是多巴胺系统，它是对快乐的预期，以及实现体验这种快乐的能力所需的工作，以及血清素系统，它与那种快乐的直接体验更密切相关。

And from dopamine and serotonin stem out other hormones and molecules, things like oxytocin, which are associated with pair bonding.

多巴胺和血清素会产生其他激素和分子，例如催产素，它们与伴侣关系有关。

Oxytocin is more closely associated with the serotonin system, biochemically and at the circuit level, meaning the areas of the brain and body that manufacture a lot of serotonin usually, not always, but usually contain neurons that also manufacture and make use of the molecule oxytocin.

催产素在生化和回路水平上与血清素系统的关系更为密切，这意味着大脑和身体中产生大量血清素的区域通常（并非总是）但通常包含也制造和利用催产素分子的神经元。

Those chemicals together create sensations of warmth, of, uh, wellbeing, of safety.

这些化学物质一起创造温暖、呃、幸福、安全的感觉。

The dopamine molecule is more closely associated with hormones like testosterone and other molecules involved with pursuit and further effort in order to get more of whatever could potentially cause more release of dopamine.

多巴胺分子与睾酮等激素和其他涉及追求和进一步努力的分子的关系更为密切，以获得更多可能导致更多多巴胺释放的物质。

So, if levels of serotonin and dopamine are too low, it becomes almost impossible to experience pleasure.

因此，如果血清素和多巴胺水平太低，几乎不可能体验到快乐。

There's a so-called anhedonia.

有一种所谓的快感缺失。

This is also described as depression, although it needn't be long-term depression.

这也被描述为抑郁症，尽管它不一定是长期抑郁症。

So, certain drugs like antidepressants, like Wellbutrin, bupropion, as it's commonly called, or the so-called SSRIs, the serotonin selective re- top- reuptake inhibitors, excuse me, like Prozac, Zoloft, and similar, will increase dopamine and serotonin respectively.

因此，某些药物，如抗抑郁药，如通常所说的维布特林、安非他酮，或所谓的 SSRIs（血清素选择性再摄取抑制剂），例如百忧解、左洛复等，会分别增加多巴胺和血清素。

They're not increasing the peaks in those molecules, the, what we call the acute release of those molecules.

他们并没有增加这些分子的峰值，即我们所说的这些分子的急性释放。

What they're doing is they're raising the overall levels of those molecules.

他们正在做的是提高这些分子的总体水平。

They're raising the sort of foundation or the tide, if you will.

如果你愿意的话，他们正在建立某种基础或潮流。

Think about it as your mood, or your pleasure rather, is like a boat, and if it's on the shore and it can't get out to sea unless that tide is high enough.

想象一下，你的心情，或者更确切地说，你的快乐，就像一艘船，如果它在岸上，除非潮水足够高，否则它无法出海。

That's kind of the way to think about these tonic levels of dopamine and serotonin.

这就是思考多巴胺和血清素的补品水平的方式。

Now, most of us, fortunately, do not have problems with our baseline or our tonic levels of dopamine and serotonin release.

现在，幸运的是，我们大多数人的多巴胺和血清素释放的基线或补品水平没有问题。

The brain and body use these common currencies for different experiences.

大脑和身体使用这些共同的货币来获得不同的体验。

So yes, if your dopamine and serotonin, or o- or I should say, if your dopamine and/or serotonin levels are too low, it will be very hard to achieve pleasure, to experience physical pleasure or emotional pleasure of any kind.

所以，是的，如果你的多巴胺和血清素，或者我应该说，如果你的多巴胺和/或血清素水平太低，那么就很难获得快乐，体验任何形式的身体快乐或情感快乐。

That's why treatments of the sort that I described a minute ago, um, might be right for you.

这就是为什么我刚才描述的那种治疗方法可能适合你。

Obviously we can't determine if they're right for you.

显然我们无法确定它们是否适合您。

It's also why they have side effects.

这也是它们有副作用的原因。

If you artificially increase these molecules that are associated with pleasure, oftentimes you get a lack of motivation to go seek things like food.

如果你人为地增加这些与快乐相关的分子，你通常会缺乏动力去寻找食物等东西。

People don't get much interest in food, 'cause why should they if their serotonin levels are already up?

人们对食物不太感兴趣，因为如果他们的血清素水平已经升高了，为什么还要对食物感兴趣呢？

Again, there's a ton of individual variation.

同样，个体差异很大。

I don't want to say that these antidepressants are always bad.

我不想说这些抗抑郁药总是不好的。

Sometimes they've saved lives.

有时他们拯救了生命。

They've saved millions of lives.

他们拯救了数百万人的生命。

Sometimes people have side effects that make them not the right choice.

有时人们会产生副作用，这使得他们不是正确的选择。

So, it has to be determined for the individual.

因此，必须根据个人情况来确定。

Just briefly, 'cause it's relevant to the conversation that we've been having, you might want to be wary of any experience, any experience, no matter how it arrives, chemical, physical, emotional, or some combination, you might want to be wary of letting your dopamine go too high, and certainly you want to be wary of it going too low, because of the way that these circuits adjust.

简而言之，因为它与我们一直在进行的对话有关，你可能想要警惕任何经历，任何经历，无论它是如何到来的，化学的、物理的、情感的或某种组合，你可能想要警惕让你的多巴胺过高，当然你也希望警惕它过低，因为这些电路的调整方式。

Basically, every time that the pleasure system is kicked in in high gear, an absolutely spectacular event, you cannot be more ecstatic, there is a mirror symmetric activation of the pain system.

基本上，每当快乐系统高速运转时，这是一个绝对壮观的事件，你会非常欣喜若狂，因为疼痛系统会镜像对称地激活。

And this might seem like an evil curse of biology, but it's not.

这看起来像是生物学的邪恶诅咒，但事实并非如此。

This is actually a way to protect this whole system of reward and motivation that I talked about at the beginning of the episode.And it might sound great to just ingest substances or engage in behaviors where it's just dopamine, dopamine, dopamine, and just constantly be motivated.

这实际上是一种保护我在本集开头谈到的整个奖励和动机系统的方法。仅仅摄入物质或从事只有多巴胺、多巴胺、多巴胺的行为，并且不断受到激励，听起来可能很棒。

But the system will eventually crash.

但系统最终还是会崩溃。

And so what happens is when you have a big increase in dopamine, you also will get a big increase in the circuits that underlie our sense of disappointment, and readjusting the balance.

因此，当你的多巴胺大量增加时，你的失望感背后的回路也会大幅增加，并重新调整平衡。

And with repeated exposure to high levels of dopamine, not naturally occurring, wonderful events, but really high chemically induced, uh, peaks in dopamine, high magnitude chemically induced peaks in dopamine, what happens is those peaks in dopamine start to go down, and down, and down in response to the same what ought to be incredible experience.

随着反复暴露于高水平的多巴胺，不是自然发生的奇妙事件，而是真正的高化学诱导的，呃，多巴胺峰值，高强度的化学诱导的多巴胺峰值，发生的情况是，这些多巴胺峰值开始下降，下降，下降，以响应相同的令人难以置信的经历。

We start to what's called habituate or attenuate, and yet the pain increases in size.

我们开始所谓的习惯或减弱，但疼痛却越来越严重。

And this has a preservative function in keeping us safe, believe it or not.

不管你信不信，它具有保护我们安全的防腐功能。

But what I just described is actually the basis of most, if not all, forms of addiction, something that we will deal with in a future episode in depth.

但我刚才描述的实际上是大多数（如果不是全部）成瘾形式的基础，我们将在未来的剧集中深入讨论这一点。

So, today we talked about the pathways in the skin and in the brain, and elsewhere in the body that control our sense of pleasure and pain.

所以，今天我们讨论了皮肤、大脑以及身体其他部位控制我们的愉悦感和疼痛感的通路。

We described a number of different tools ranging from different supplements to, uh, electro-acupuncture and various other tools that one could use to modulate your sense of pleasure or pain.

我们描述了许多不同的工具，从不同的补充剂到呃电针以及各种其他可以用来调节愉悦感或疼痛感的工具。

And of course, in thinking about pleasure, we have to think about the dopamine system and the serotonin system, and some of the related chemical systems.

当然，在思考快乐时，我们必须考虑多巴胺系统和血清素系统，以及一些相关的化学系统。

I realize that today's podcast had a lot of scientific details.

我意识到今天的播客有很多科学细节。

I don't expect that everyone would be able to understand all these details all at once.

我不指望每个人都能一下子理解所有这些细节。

What's more important really is to understand the general principles of how something like pleasure and pain work, how they interact, and the various cells and systems within the brain and body that allow them to occur, and that modulate or change their ability to occur.

更重要的是要了解诸如快乐和痛苦之类的东西如何运作、它们如何相互作用以及大脑和身体内允许它们发生以及调节或改变它们发生的能力的各种细胞和系统的一般原理。

And of course, your subjective experience of pleasure or pain.

当然，还有你对快乐或痛苦的主观体验。

So, I do hope that this was on whole more pleasureful than painful for you.

所以，我确实希望这对你来说总体上是快乐的而不是痛苦的。

And last but not least, I thank you for your time and attention, and thank you for your interest in science.

最后但并非最不重要的一点是，我感谢您的时间和关注，并感谢您对科学的兴趣。