Trauma and Pain
Are you tired of the narrative that says those of us that have survived traumas are superheroes? I am. I really really am tired of this idea we are stronger than the rest of the world. We aren’t. We are survivors. Some of us have thick skin, some are more emotional, some withdraw, and some become more overwhelmed by the small things. There is no wrong way to survive. We have all been through something.
Before you run away and think this post isn’t for you I’d like to define trauma for the purpose of this post. Trauma is simply a deeply distressing or disturbing experience. It doesn’t have to be a made-for-TV movie like my life. I was really surprised by the amount of research that has been done on the topic of trauma and pain. It’s worth talking about.
Many of us underestimate the fact our pain stories are often traumatic. Not to mention all the things that have often happened before the pain.
Research on Trauma and Pain
The research available indicates that while trauma may not directly cause chronic pain, it certainly makes people more vulnerable to developing chronic pain. ( Darn nervous system!) There are many studies that link trauma and pain. The Institute for Chronic Pain states that up to 90% of women with fibromyalgia and up to 60% of patients with arthritis report trauma at some stage in their lives. As a point of comparison, people with chronic pain typically have at least double the rate of previous trauma as compared to the general population.
10 years ago that would have surprised me, it doesn’t anymore. Because we underestimate or misunderstand the role of the nervous system, we ignore elements of our past that contribute to a highly aware system. We do ” all the things” and can’t figure out why they don’t work.
I offer the connection between trauma and pain as a possible portion of your puzzle. If pain as a warning has anything to do with not being safe, then we can’t ignore disturbing experiences that have made us feel unsafe in our bodies or our minds, or our surroundings.
What is Trauma
As I mentioned trauma is a deeply distressing or disturbing experience: can be defined as any unresolved autonomic nervous system response. It’s about the nervous system’s response to an event, not necessarily the event itself. Trauma is any deeply distressing event that overwhelms the nervous system and because of that neurological changes occur, traumatic events tend to overwhelm a normal person’s ability to cope with them.
Examples:
- Neglect from loved ones: emotional, physical, sexual
- Abuse: emotional, physical, sexual, spiritual
- Not being understood
- Unpredictable parenting
- Bullying
- Car Accident
- Injury
- Witnessing the abuse of others
- Death of a loved one
- Fear of harm
- High-Stress Environments
The mind and emotions and body are all connected
Our mind and body are connected. They can influence each other in many ways. We also know that stress and pain create a cycle, perpetuating one another. There are many ways in which stress worsens pain, including causing tense muscles and increasing inflammation. Trauma and unresolved emotional issues cause stress, and, therefore, contribute to the pain and stress cycle.
This means that when we experience trauma which takes its toll on us emotionally, it can also have physical effects. I’ve talked often about the chemical effects of stress. This doesn’t make our chronic pain any less valid or mean that it’s ‘all in our head’ as stigma so often dictates. Chronic pain is just as valid and real as acute pain or any other physical health condition.
Many people are already familiar with the fact that emotional stress can lead to stomachaches, irritable bowel syndrome, and headaches, but might not know that it can also cause other physical complaints and even chronic pain. One logical reason for this is: Studies have found that the more anxious and stressed people are, the more tense and constricted their muscles are.
Experts have noticed that experiencing a traumatic event can have an impact on the development of pain. In fact, approximately 15 to 30 percent of patients with chronic pain also have PTSD.
What happens to our systems with trauma?
Peter Levine, an expert on trauma, explains that trauma happens “when our ability to respond to a perceived threat is in some way overwhelming.” Most researchers disagree on a precise definition of trauma but do agree that a typical trauma response might include physiological and psychological symptoms such as numbing, hyperarousal, hypervigilance, nightmares, flashbacks, helplessness, and avoidance behavior. Sound familiar?
During a traumatic event, the nervous system goes into survival mode (the sympathetic nervous system) and sometimes has difficulty reverting back into its normal, relaxed mode again (the parasympathetic nervous system). When the nervous system stays in survival mode, stress hormones such as cortisol are constantly released, causing an increase in blood pressure and blood sugar, which can, in turn, reduce the immune system’s ability to heal. Physical symptoms start to manifest when the body is in constant distress.
Overly active nervous system
Trauma causes the nervous system to become overreactive, meaning that it is stuck in a state of stress and persistent arousal. When we look at chronic pain, we can see that the same overactivity occurs.
Chronic pain changes our brain and nervous system. The nervous system becomes oversensitive (just like with trauma) and overprotective. Often called central pain sensitization.
Central sensitization means that your nervous system is stuck on high alert. Like a faulty alarm system, it’s sending out pain messages in reaction to perceived threats, even when no real threat is present. For example, allodynia is a symptom of a sensitized system. It means that things that shouldn’t cause pain (such as me scratching an itch) can cause extreme pain. So, both chronic pain and trauma cause the nervous system to be overly active, which strongly links both experiences. Research into this link suggests that patients with a history of trauma may be more predisposed to central sensitization.
Disturbed sleep
Patients who have experienced trauma often find it difficult to have restful sleep. This is often due to the re-experiencing we discussed. Those with chronic pain also tend to struggle with insomnia and non-restorative sleep. Lack of sleep exacerbates chronic pain symptoms and makes it harder to cope effectively.
Hyperarousal
Those who have experienced trauma may be easily startled, and constantly on the lookout for potential threats (also known as hypervigilance). They may be very anxious and find it difficult to relax. These hyperarousal symptoms can cause very tense muscles which can be painful and contribute to chronic pain. This state of hyperarousal also perpetuates the stress and pain cycle. Pain hypervigilance is a common symptom of chronic pain and can wire the pain response deeper. By being hypervigilant about our pain, we are feeding back to our brain that it should continue producing pain messages. Since those who have experienced trauma are already hypervigilant, they’re more inclined to become hypervigilant about their chronic pain. Fun stuff, I know. Don’t worry, there are ways to help with all this stuff!
Inability to regulate emotions
The same areas of the brain which regulate our emotions, form memories, and help us to focus our attention, are also used for processing and regulating pain. So, you can see how chronic pain and emotions can directly influence one another. The inability to regulate emotions (particularly negative emotions) is commonly seen in those who have experienced trauma. These difficulties can lead to maladaptive (unhelpful) coping behaviors with mental health and physical health. A great deal of research has shown that maladaptive coping behaviors worsen chronic pain and fuel the chronic pain cycle.
Depression and anxiety
Mental illness is common both as a result of trauma and as a symptom of chronic pain. Patients may not practice self-care or proactively manage their pain when they are in a negative mental state. This study on the link between PTSD and chronic pain explains that “the biopsychosocial model postulates that depressive symptoms can exacerbate or lead to increased pain and impaired function”.
This in-depth study on the comorbidity of PTSD and chronic pain states that anxiety is in fact the biggest factor in linking the two. The hyperarousal we discussed earlier and the increased risk of anxiety make chronic pain patients more likely to develop catastrophizing and fear-avoidance behaviors, as this study concluded. Catastrophizing means that patients are more likely to think negatively and excessively worry about their pain, therefore contributing to high-stress levels. Fear-avoidance means that pain patients are avoiding activity for fear of worsening their pain symptoms.
Withdrawal from activity
Withdrawal from activity can cause the body to become deconditioned and lose fitness. This makes it more painful when patients try to be active. For example, if you are used to walking and you’ve built up a level of fitness, but then become inactive for a long period of time, the next time you try to go walking you are likely to feel stiff and out of breath. The same can be said for any activity in life. If the body is not being used actively, it loses fitness.
Is anyone feeling the reality of that whole section? I know I do.
Adrenal exhaustion
When you are stuck in a prolonged state of stress, your adrenal system is producing a higher volume of stress hormones than it is designed to. These hormones include cortisol and adrenaline. Just like other areas of your body which become worn out through overuse, your adrenal glands can become exhausted. This can happen with both chronic pain and chronic stress, such as in those with PTSD. Our bodies are not meant to be in states of prolonged stress. It is no surprise that our bodies show signs of disrepair with chronic stress.
What can you do if you struggle with trauma and chronic pain?
If you struggle with trauma and chronic pain, there are lots of ways you can help yourself:
Talk to someone you trust
Expressing your feelings to someone you trust, whether this is a loved one or even using a helpline, can help you to feel supported and less alone. They may be able to help you in seeking treatment and finding better-coping strategies. Helping you find strategies for coping is one of my favorite things to help clients with.
Do your research
Learning how trauma and chronic pain influence each other, and the science behind pain will help you to get a better understanding of how to manage your symptoms.
Practice adaptive self-management
There are plenty of ways you can learn to actively reduce your stress levels in your day-to-day life. You can learn to self-manage your chronic pain and your mental health.
Seek treatment
There are a wide variety of treatments available for both trauma and chronic pain. The treatments we mentioned are just a few options. Talk to your doctor or specialist and advocate for yourself. You could access treatment for your chronic pain online through a chronic pain relief app. You can even find psychological therapy options online to help address your trauma. Take your time, do your research, and pick the right option for you. Check out ways we can work together here.
Be kind to yourself
Don’t be too hard on yourself. Learning how to live well despite past trauma and chronic pain is a delicate balancing act. It takes time. You will make mistakes along the way and not everything will be perfect. Praise yourself with every step you take and celebrate your wins, even if they seem small. You can get through this and come out of the other side feeling stronger and more empowered.
