Physical pain is a universal human experience. And for many of us, it’s a constant one. Roughly 20 percent of American adults — some 50 million people — suffer from a form of chronic pain. For some, that means having terrible days from time to time. For others, it means a life of constant suffering. Either way, the depth and scale of pain in our society is a massive problem. But what if much of how we understand pain — and how to treat it — is wrong? Rachel Zoffness is a pain psychologist at the University of California, San Francisco, School of Medicine and the author of “The Pain Management Workbook.” We tend to think of pain as a purely biomechanical phenomenon, a physical sensation rooted solely in the body. But her core argument is that pain is also produced by the mind and deeply influenced by social context. It’s a simple-sounding argument with vast implications not only for how we experience pain but also for how we treat it. She points to numerous underused tools — aside from pills and surgeries — that can help lessen our pain. We discuss how pain serves as “the body’s warning signal”; how our mood, stress levels and social environment can amplify or dial down our pain levels; what phantom limb syndrome says about how the brain “makes pain”; how our emotions and trauma influence our pain levels; the crucial difference between “hurt” and “harm”; why studies on back pain have yielded such bewildering results; how to figure out and improve your personal “pain recipe”; the roots of our chronic pain crisis; how our health care system could be better set up to treat chronic pain; why Zoffness says, “If the brain can change, pain can change”; and more.

Dr. Nadine Burke Harris’s pioneering work on how childhood trauma shapes adult outcomes led to her being named the first surgeon general of California. That was in 2019. And then, of course, the novel coronavirus hit. The job of California’s surgeon general in 2020 was not what it was in 2019. But in some ways, Burke Harris’s expertise was more necessary than ever. This conversation is about the growing evidence that difficult experiences we face as children reverberate in our lives decades later. It’s profound research that should reshape how we think about social insurance, public morality and criminal justice. But it’s also a conversation about what the coronavirus has done to children — whether this year will be a trauma that marks a generation, and remakes their lives. How has it changed socialization for toddlers — like my 2-year-old son? What has it meant for children who can’t go to school, who watched their parents lose work or who had family members die alone in a hospital? How do we help them? How do we even understand what they’ve gone through, particularly when they can’t tell us? We also discuss the lessons California learned from the early difficulties in its vaccine rollout (“simplicity saves lives,” Burke Harris says), why we need to be investing a lot more in mental health therapeutics, the debate over universal child allowances, how to address racial and income disparities in vaccine distribution, the drivers of vaccine hesitancy in Black and brown communities, what a safe path to post-pandemic reopening would look like, why Covid-19 cases have been declining across the country, and much more. This is one of those conversations that will leave you looking at vast swaths of public policy differently. Don’t miss it. Mentioned in this episode: The Deepest Well: Healing the Long-Term Effects of Childhood Adversity by Nadine Burke Harris “Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health” “Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study” “The prevalence of Adverse Childhood Experiences (ACE) in the lives of juvenile offenders” “Adverse childhood experiences and the risk of premature mortality”