Putting neuroscience in the hands of people with pain: An interview with Dr. Vania Apkarian

“The foundation of my research is listening to people with pain. Your perception of your pain is the only objective measure that matters, and we have the science to prove it.”

-Dr. Vania Apkarian

‍

People who live with chronic pain can spend years trying to convince their doctors that their pain is real. Our science shows that your pain is real, because you feel it.

Aivo Health co-creator and Chief Scientific Officer Dr. Vania Apkarian has pioneered a new field of neuroscience revealing that chronic pain is maintained by the emotional brain.  Dr. Apkarian is a tenured Professor of physiology, anesthesiology and physical medicine and rehabilitation at Northwestern University in Chicago. He co-created Aivo with pain patients and neuroscientists to bring insights from his peer-reviewed research directly into the hands of people living with chronic pain. Based on sophisticated brain imaging, his work not only shows that all chronic pain has a real, biological basis in the brain, but the key to successful treatment is new emotional learning that is built into the Aivo Program.

‍

Creating a New Neuroscience of Chronic Pain

Dr. Apkarian recalls, “When I began studying chronic pain, I noticed that all the researchers were trying to understand it backwards. They would put an acute painful thermode on someone’s arm and pretend it had something to do with chronic pain!” He chuckles, “So I decided to turn the field on its head. I simply asked chronic pain patients to rate their naturalistic pain—the pain they feel in their bodies, at each moment—while in the brain scanner. I never anticipated this approach would redefine how we understand the biology of chronic pain.”

By peering into the brains of thousands of people with chronic low back pain, osteoarthritis, fibromyalgia, pelvic pain, irritable bowel syndrome, complex regional pain syndrome, and postherpetic neuralgia, Dr. Apkarian realized that brain anatomy and activity reorganizes around the experience of chronic pain.

He explains, “The brain adapts to the chronic pain state through learning. You learn to move differently, to avoid situations that might make pain worse, and negative emotions start motivating your decisions and actions.” Dr. Apkarian’s research shows that this new learning is focused in the brain’s emotional learning and reward pathways. In other words, pain becomes an emotionally-maintained state of consciousness.

“Chronic pain is a learned state, and there is no shame in this. Your body did everything right. Your nerves properly sent danger signals to your spinal cord. Your spinal cord enhanced those danger signals because they were important. And your brain attached emotional weight to the danger signals because all pain is important to the brain. The challenge is that the brain adapts in a way that no longer becomes helpful over the long term.”

“The beautiful thing is that the brain is constantly learning,” Dr. Apkarian explains.  “Brain imaging research shows that the brain can also unlearn chronic pain, and it does this through new learning.” New learning can be challenging when pain has become a centerpiece in daily life. The Aivo Program, which is delivered through the Aivo app, was created to help forge new learning pathways in the brain by encouraging new thoughts, emotions, movements, and experiences.  

‍

‍

How Aivo Supports the Emotional Brain

The Aivo Program uses algorithms based on Dr. Apkarian’s research to select a personalized roadmap of 3-5 day behavioral interventions called tracks. Aivo tracks create opportunities for rewiring emotional brain circuits through pain education, gentle exercise, sleep hygiene, enhancing positive mood, short guided meditations, soothing the nervous system, and shifting your pain mindset. By reporting your pain intensity, mood, and sleep each day, Aivo algorithms identify which types of tracks maximize your pain relief so you can focus on treatment elements that are ideal for your recovery.

The program acts as a compass that helps identify and guide people toward their optimal treatment pathways. As Dr. Apkarian explains, “Pain care has to be personalized. Your pain is utterly unique in this universe, which means your treatments must be unique to your experience of pain. We have put a lot of intention and care into creating a program that helps introduce more and more opportunities for pain relief into your daily life.”

‍

Science Validating Chronic Pain

The amount of scientific evidence Dr. Apkarian has amassed to support this view is staggering. He has literally shaped the field of chronic pain neuroscience with his landmark discoveries:

·       In 2004, he was the first person to discover that chronic pain changes brain anatomy.

·       In 2006, he first measured how chronic pain creates spontaneous fluctuations of brain activity that closely match a person’s perception of their pain.

·       In 2008, he first mapped new brain network communication patterns in the brains of people with chronic pain.

·       In 2009, based on mounting evidence he theorized that chronic pain is maintained by emotional learning and memory.

·       In 2012, he found that emotional brain circuits predict who will develop chronic pain in the future.

·       In 2014, he confirmed that emotional brain circuits also predict chronic pain development in animals and pinpointed the exact brain circuits responsible for these changes.

·       In 2016, he discovered that brain markers can predict who will experience placebo analgesia in the future.

·       In 2019, he identified clusters of psychological traits that become “hardwired” in chronic pain.

·       In 2022, he discovered that personality patterns can point to optimal treatment pathways for chronic pain.

Despite these impressive accomplishments, Dr. Apkarian remains humble and acknowledges that his research is a co-creation with the chronic pain patients who participate in his research. “Look, I have not done anything more revolutionary than listen to people with pain. That’s it. That’s the secret to success. Listen to people with pain and you will be amazed at the truths you uncover.”

‍