What role does trauma play in chronic pain?

Blog

role of trauma in chronic pain

What role does trauma play in chronic pain?

Chronic pain is so complex.  Understanding the role trauma plays in chronic pain may add a little clarity.  Individual trauma can be defined as “an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”

(https://ncsacw.acf.hhs.gov/userfiles/files/SAMHSA_Trauma.pdf)

The following two explanations of chronic pain are helpful in understanding the complexity of pain:

First, the Bio-psycho-social model of pain explains that the brain is always receiving messages from the body and interpreting these signals of change as benign or as something that needs attention.  When the brain thinks these messages mean the body is being damaged, it sends pain signals out.  These pain signals are alarms that say “You are in danger, and I am going to send pain signals out until you take care of this.”  These signals are hugely important, but in chronic pain, are usually not related to actual tissue damage.  How the brain interprets these signals is so connected to the full context of our personal life and experiences.  Two people will never experience these signals the same!

Second, “the issues are in your tissues” is a popular expression of many bodyworkers.  This refers to the idea that the body holds memories of the past, and this can affect our body’s reaction to change signals.  This affects what we interpret as danger in our body and danger to our body.  Past experiences can cause our body to be hyper-aware of sensations and more readily cause the brain to send out pain alarm signals.

Both models of chronic pain allude to the role that trauma plays on the potential for someone to get chronic pain and the long-term effect chronic pain has on certain people.

Research that connects trauma to chronic pain

Sarah E.E. Mills, et. al. (2019) summarizes some of the research findings of the relationship between trauma, our interpretation of events, and chronic pain:

  • The severity and development of chronic pain experience are affected by early life factors: people who experience adversity or emotional trauma (e.g. death of parent and being raised in the care system) or physical trauma (e.g. substantial hospitalization and preterm birth) in childhood have a higher risk of chronic pain in their adult lives.
  • Young people who have experienced traumatic adverse childhood experiences (ACEs) have a greater chance of developing chronic pain than those who have not. The more ACEs, the greater the level of chronic widespread pain and psychological distress, such as anxiety and depression.
  • People who have experienced personal violence or abusive relationships are more likely to experience subsequent chronic pain.  This has been found to be true regardless of the age at which the violence or abuse was experienced, or whether it was domestic or public violence or abuse.
  • In post-traumatic stress disorder (PTSD), chronic pain is common.
  • Postoperative chronic pain is a significant complication of many surgical procedures.  Patients who were anxious about their operation, younger patients, and those who developed postoperative infections were also more likely to suffer from chronic post-surgical pain.
  • Those who are socio-economically deprived are more likely to experience chronic pain.

(Sarah E.E. Mills, Karen P. Nicolson, Blair H. Smith, Chronic pain: a review of its epidemiology and associated factors in population-based studies, British Journal of Anaesthesia, Volume 123, Issue 2, 2019, Pages e273-e283, G. Macfarlane)

If you have chronic pain and you have a history of trauma, what can you do to manage the pain?

Luckily, there is a lot of power you have to make change happen.   First, always remember the BIOLOGIC piece of the bio-psycho-social model!  Everyone’s biology is different and sometimes we do develop purely physical conditions.  For example, if you have migraines, and you have been working through past trauma, you may still have migraines.  This is NOT something that you have done wrong or something you have missed.  With work, your biologic condition may not be resolved but you may be able to hold it more gently, and with more space for other sensations and experiences.

Jonathan Foust (2017) put it this way, “Deconstructing the story around it [pain}, can soften the pain and make it easier to be with.” ( Foust, Jonathan: The Issues are in your Tissues. Sounds True. Recorded June 27, 2017.  https://Resources.soundstrue.com/podcast/Jonathan-foust-the-issues-are-in-your-tissues/)

Ways to think about the relationship between chronic pain and trauma

Other ways to describe this distinction between actual physical damage and the psycho-social weight we add to it (the story) are:

  • Pain vs suffering (check out Insight Meditation practices)
  • Clean pain vs Dirty pain (Check out “Living Beyond Your Pain- Using Acceptance and commitment Therapy to Ease Chronic Pain”)
  • Clean pain vs muddy pain (I just like this expression better.)

One way to practice letting go of the attachment to the suffering around the pain is to be present with what is happening in the moment.   Practicing with the acronym R.A.I.N. (Recognize, Accept, Investigate, non-judgement/non-attachment/nurturing) can be very helpful.  Notice when you may be “in a story” about the pain that is helping to intensify the pain.  Attaching to the “story” can strengthen, solidify, and enlarge the pain.  One way to distance yourself from the story of the pain is to work with the felt sense in your body.  In meditation, we talk about noticing what sensations are arising in your body in THIS moment.  The sensations can be identified as pleasant, unpleasant, and neutral.

Jonathan Foust discusses different body zones.  Zone 1 being the pain zone, the “unpleasant” zone and zone 2 being the  “pleasant’ and “neutral “zone.  Our mind will want to pay close attention to zone 1 (remember it thinks it helping you to stay aware of danger), but practice guiding your attention back to zone 2.  You may notice that 90% (or 50%, or 30%, or at least not 0%) of body feels OK.  The tightness around the pain may shift…may not…but you may notice more relaxation through the body.  Let the pain know you see it and be gentle and kind with it and with yourself.

When looking under the pain, there can be painful memories.  It may also be important for you to incorporate the help of a professional when working through past trauma. Ask your health care provider for a referral to a qualified mental health care provider. They can be a great addition to your care team.

What you can expect/ask from your health care team when dealing with chronic pain and past trauma:

When interacting with a health care provider, you have the absolute right to feel safe and to be the most important member of your health care team.  There are many things that your health care team can do to help you feel more comfortable. If they miss the mark on a few of these, it may be beneficial for you, and the provider, if you shared your request with them.  It may be that they are just unaware of how their actions are affecting you.  The change they make, due to your input, may be helpful for many other patients in the future.

Here are a few trauma informed ways your team can interact with you:

  • At the beginning of the appointment they should set the agenda so you know what to expect.
  • Your concerns should be validated and the provider should ask about your comfort.
  • You should be offered offer a chaperone during appropriate times
  • They should state the reason for any physical exam beforehand.
  • The provider should respect your space as much as possible, stay within eyesight, and ask permission to perform the different aspects of the exam.
  • The conversation should be collaborative.
  • There should be room for discussion and time for questions with thorough answers.

(Elisseou S, Puranam S, Nandi M. A Novel, Trauma-Informed Physical Examination Curriculum for First-Year Medical Students. MedEdPORTAL. 2019 Jan 25;15:10799.(https://www.mededportal.org/doi/10.15766/mep_2374-8265.10799))

Things you can do to help calm the nervous system to manage chronic pain

~Breathe- The breath is always there for you.  A long full exhale sends signals to the body that things are safe and it can relax. Try making your exhale longer than your inhale, maybe twice as long if that feels comfortable.