Chronic pain is not merely a symptom. The many years of working within the mental health and mind-body sector has revealed to me that people who struggled with chronic pain tend to report much higher rates of having experienced trauma in their past. This is a consistent finding within research and something that I have been a witness of in my own life and the life of the clients I have worked with in the last twelve years. A history of trauma makes an individual more prone to developing chronic pain and health related issues. This is mainly due to a process that’s called central sensitization. When central sensitization occurs, the nervous system goes through a process called wind-up and gets regulated in a persistent state of high reactivity. Like a faulty alarm system, the system is sending out messages in reaction to perceived threats. This is what we call an overly active nervous system. This persistent, or regulated, state of reactivity lowers the threshold for what causes pain and subsequently comes to maintain pain even after the traumatic incident or injury is over. Central sensitization has two main characteristics which involve a heightened sensitivity to pain and the sensation of touch. For example, many of my chronic pain clients experience pain even a simple touch or a gentle massage. In such cases, the nerves in the area send signals through the nervous system to the brain. Because the nervous system is in a persistent state of heightened reactivity, the brain doesn’t produce a mild sensation of touch as it should, but rather produces a sensation of pain and discomfort.
Trauma does not merely have a toll on us emotionally but also physically. While the incident of trauma itself doesn’t directly cause chronic pain, it certainly weakens the nervous system. According to The Institute for Chronic Pain up to 90% of women with fibromyalgia and up to 60% of patients with arthritis report trauma at some stage in their lives. The common denominator between chronic pain and trauma is the nervous system. Trauma can make the nervous system persistently reactive, sensitive, and overprotective. Once an acute painful injury or illness occurs, people with an already reactive nervous system are more prone to develop chronic pain.
Many people misunderstand the concept of trauma. According to the American Psychological Association (APA), trauma is “an emotional response to a terrible event like an accident, rape, or natural disaster.” However, a person may experience trauma as a response to any event they find physically or emotionally threatening or harmful. Trauma includes, but is not limited to:
- Illness or injury
- Violent assault
- Sexual assault/abuse
- Traumatic loss
- Mugging or robbery
- Being a victim of or witness to violence
- Cultural and/or environmental shaming
- Emotional neglect & unavailable parenting
- Parental pressure to achieve.
- Dismissal of one’s reality (during childhood)
- Childhood physical neglect
- Experiencing natural disaster (including loss of home and security)
- Road accident
- Military combat incident
- Childhood emotional neglect (CEN)
- Medical trauma
- Suicide attempt
- Long term misdiagnosis of a health problem
- Bullying at home, school or at work
- Life threatening illness or diagnosis
- Sibling abuse
- Childhood emotional abuse
- Domestic violence
- Attachment trauma
- Verbal and psychological abuse
- Parental divorce
- Sexual abuse
- Parental substance abuse
Overly strict upbringing (i.e. religious)
I am yet to come across a client who has not experienced one or several of the examples mentioned in the above list. When we don’t get a chance to process our childhood related traumas, we will continue to unconsciously live our lives based on the old trauma narratives. Particularly when our emotional childhood wounds get triggered. Hence why many people ‘re-live’ and re-experience certain aspects of their trauma. This is when they are taken back to that heightened emotional state again which in turn places their nervous system into a state of fight, flight, freeze and frawn. This regular return to such a heightened stress response commonly worsens their chronic pain experience, including sleep disturbances, emotional numbing, hyperarousal and depression, anxiety, adrenal exhaustion and an inability to regulate one’s emotions. When trauma is experienced in childhood, both the mental and physical effects can last way into adulthood. The prolonged ‘fight or flight’ response can be highly detrimental to a child’s developing body and mind. This article from Harvard Medical School explains that, “when this response remains highly activated in a child for an extended period of time without the calming influence of a supportive parent or adult figure, toxic stress occurs and can damage crucial neural connections in the developing brain.”
Emotional reactions to trauma can vary greatly and are significantly influenced by the individual’s sociocultural history. Many people find it difficult to identify feelings and emotions associated with trauma, including suppressed anger, sadness and toxic shame. Too often, there is a lack of experience (and resources) or previous exposure to healthy emotional expression and a safe attachment style. Commonly there is a fear of “losing control” or “going mad” or being rejected by others it authentic emotions were to be revealed. This is why most people tend to numb their emotions (or lack of emotions) and have difficulty regulating emotions such as anxiety, sadness, anger and shame. Particularly if the trauma occurred at a young age (van der Kolk, Roth, Pelcovitz, & Mandel, 1993).
Our brains come equipped with a “default-mode network” (DMN) that allows for rest. In this mode, our brain sorts out what is relevant and/or deserving of our attention and plans for what needs to happen next. Chronic stress and trauma during childhood disrupt the functioning of this default-mode network, weakening the connection between the prefrontal cortex and the amygdala. This explains why people with a history of childhood trauma often perceive non-stressful or mildly-stressful events and changes in their lives as a threat. Their brain misinterprets neutral events (i.e. loss of a job, a breakup, poor academic or physical performance etc.) as threatening, which triggers a heightened physically aroused state, such as anxiety.
Resolving childhood trauma can ease chronic pain. According to Dr. Howard Schubiner, who is a clinical professor of internal medicine at Michigan State University and has studied the connection between trauma and pain for decades. The first step is ruling out a physical condition (such as cancer or an infection), and then ruling in a neural circuit disorder. Often the people he sees have chronic pain due to a learned association between pain and trauma, even after the injury has healed. “Pain that is highly localised in a person without a history of trauma is likely to be a tissue problem”, says Schubiner. An example of this could be slipped disc pressing on a nerve in someone’s back. But when the tissue is healed and the pain persists, it could be due to hyperarousal, something that Schubiner says can be calmed in time. Pain that shifts to different places in the body, or pain that fluctuates based on an emotional experience, may be a neural circuit disorder. When a person is exposed to their trauma and continually given messages of safety, the association between emotion and pain starts to unravel.
Steps to resolve childhood trauma & Chronic Pain:
- Acknowledge and recognize your trauma with the help of counselling and psychotherapy. People who have experienced childhood trauma, such as abuse and emotional neglect, are more likely to develop chronic pain as adults. But it isn’t just major trauma that can lead to neuroplastic pain. Anything that made you feel unsafe growing up can predispose you to chronic pain.
- Reclaim self-control and self-empowerment by educating yourself on chronic pain and TMS. There are certain personality traits that are common in people with neuroplastic pain, such as people pleasing, perfectionism, lack of boundaries, a need to control outcome, fear of emotional discomfort etc. Each of these traits puts the brain on high alert, in different ways.
- Take care of your health through good nutrition (steering away from alcohol and drugs including over working), introducing gentle daily exercise and making time for play and enjoyment, including art therapy, creativity, quiet reflection time (i.e. journaling, meditation and time spent in nature).
- Learn the true meaning of acceptance and letting go. Diminish anxiety through acceptance of life’s various events. It is only through the acceptance of our lives as it is that our anxiety reduces and eventually dissipates. What I am suggesting is not passivity but rather a state of befriending our lives.
- Learn to re-parent yourself by building a relationship with your inner child. Reparenting is the act of giving yourself what you didn’t receive as a child.
- Be patient with yourself and learn to deal with anger, (which is a big contributor to Psycho-phyisologic Disorders – PPD) in a healthy way by neither repressing it nor projecting it.
- Cultivate self-compassion.This loving act helps us become aware of our pain by recognizing how often we judge ourselves.
Sarah is a Psychotherapist, Mental Health Social Worker, Art Therapist, Artist and Writer. She is also the Practice Manager at Mental Awakening.