About % of American adults live with chronic pain 鈥� and many of them are like depression, anxiety and substance use disorders.
Many people with chronic pain can鈥檛 get the care they need, or if they do, it doesn鈥檛 work. Many of them are told it鈥檚 all in their heads, but it鈥檚 very real, said Yoni Ashar, co-director of the at the University of Colorado Anschutz Medical Campus.
鈥淚t鈥檚 always real and it鈥檚 always miserable, frustrating and difficult, but sometimes the causes are not what we think they are,鈥� he said.
3 questions with Yoni Ashar
How do you diagnose chronic pain?
鈥淟et鈥檚 say you throw your back, that鈥檚 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鈥檚 become chronic pain, and at that point, it鈥檚 probably not the back that鈥檚 the main driver of the pain anymore. What we鈥檙e learning is that in many cases, there鈥檚 brain pathways that can change, that the , and the pain can stay on the loop in the brain even after the injuries have healed.
鈥淪o, if people have pain in multiple body sites or the pain is spreading over time, that鈥檚 a telltale sign that the brain is involved. If the pain tends to vary a lot from one day to the next, that鈥檚 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鈥檙e just scratching our heads and saying, 鈥楪osh, we really think the brain鈥檚 probably involved here because the injury should have resolved.鈥欌��
How can you retrain your brain to overcome the pain?
鈥淧ain 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鈥檚 no fire. A false alarm is just as loud and obnoxious and annoying as a true alarm, so no one鈥檚 making it up. But just this understanding that, 鈥極K, my body may actually be OK, intact, healthy and safe,鈥� it can be a very powerful understanding for people to start to feel safe in their bodies again.
鈥淕etting moving again, starting to do the things that we鈥檝e been afraid to do. If we鈥檝e been afraid to play tennis because we鈥檙e worried it might injure the back or afraid to swim, etc. And there鈥檚 another major piece here, which is that emotions and stress can really have a major influence on pain as well.
鈥淪o, fear really limits our behavior or limits what we do often, but it鈥檚 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.
鈥淚 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, 鈥極h, my leg, it must not have healed.鈥� 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.鈥�
How can poor mental health worsen chronic pain?
鈥淏eing 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.
鈥淎nd so, when we feel unsafe, whether it鈥檚 due to depression, anxiety, PTSD, then that鈥檚 going to sensitize the whole pain system and turn up the volume.鈥�
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produced and edited this interview for broadcast with . Raphelson also adapted it for the web.
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