About 20% of American adults live with chronic pain — and many of them are more likely to develop mental health issues like depression, anxiety and substance use disorders.
Many people with chronic pain can’t get the care they need, or if they do, it doesn’t work. Many of them are told it’s all in their heads, but it’s very real, said Yoni Ashar, co-director of the Pain Science Program at the University of Colorado Anschutz Medical Campus.
“It’s always real and it’s always miserable, frustrating and difficult, but sometimes the causes are not what we think they are,” he said.
3 questions with Yoni Ashar
How do you diagnose chronic pain?
“Let’s say you throw your back, that’s gonna develop some acute pain. But one year later, in most cases, the back is healed. So, if the pain is persisting, at that point, it’s become chronic pain, and at that point, it’s probably not the back that’s the main driver of the pain anymore. What we’re learning is that in many cases, there’s brain pathways that can change, that the brain can learn the pain, and the pain can stay on the loop in the brain even after the injuries have healed.
“So, if people have pain in multiple body sites or the pain is spreading over time, that’s a telltale sign that the brain is involved. If the pain tends to vary a lot from one day to the next, that’s another telltale sign. And a lot of times, if the injury has completed its expected healing, the course of healing, and at that point we’re just scratching our heads and saying, ‘Gosh, we really think the brain’s probably involved here because the injury should have resolved.’”
How can you retrain your brain to overcome the pain?
“Pain is an alarm system that lets us know that something is wrong in the body, but sometimes the wiring in the alarm system can get sensitized, so the alarm is going off again and again, even though there’s no fire. A false alarm is just as loud and obnoxious and annoying as a true alarm, so no one’s making it up. But just this understanding that, ‘OK, my body may actually be OK, intact, healthy and safe,’ it can be a very powerful understanding for people to start to feel safe in their bodies again.
“Getting moving again, starting to do the things that we’ve been afraid to do. If we’ve been afraid to play tennis because we’re worried it might injure the back or afraid to swim, etc. And there’s another major piece here, which is that emotions and stress can really have a major influence on pain as well.
“So, fear really limits our behavior or limits what we do often, but it’s engaging in those behaviors like going to the pool that they can do two things. One, it can help our body get strong again, and two is that it can help teach our brain that the body is safe.
“I actually had this experience where I was on crutches for months after a surgery because every time I tried to take a step without crutches, I felt pain in my leg. And I said to myself, ‘Oh, my leg, it must not have healed.’ But really, what my leg needed to heal was walking on it. It was that sensory input that would have healed the leg, but I was afraid to give my body what it needed.”
How can poor mental health worsen chronic pain?
“Being in pain is miserable and can lead to depression and anxiety, but then that creates muscle tension, depression and anxiety, [it] can also drive inflammation in the body, then these circle back and can drive pain as well.
“And so, when we feel unsafe, whether it’s due to depression, anxiety, PTSD, then that’s going to sensitize the whole pain system and turn up the volume.”
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Samantha Raphelson produced and edited this interview for broadcast with Catherine Welch. Raphelson also adapted it for the web.
This article was originally published on WBUR.org.
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