“Trauma is perhaps the most avoided, ignored, belittled, denied, misunderstood and untreated cause of human suffering.”
– Peter Levine, PhD, Developer of Somatic Experiencing Therapy
One frequent cause of treatment-resistant chronic pain is unresolved trauma, yet few health care providers and patients are aware of the connection, and, as a result, it is rarely addressed. This leads to considerable unnecessary suffering and misguided attempts at pain treatment that often do more harm than good.
In 1998, Kaiser Permanente HMO conducted an adverse childhood experiences (ACE) survey to determine the relationship between childhood trauma and poor health in adulthood. A questionnaire about adverse childhood experiences was completed by 9,508 adults. Seven categories of adverse childhood experiences were studied: psychological, physical, or sexual abuse; violence against the mother; or living with household members who were substance abusers, mentally ill or suicidal, or ever imprisoned. They found the higher the number of categories of childhood exposure, the more adult health risk behaviors and diseases the person had (p < .001).
Exposure to trauma also increases the risks of conventional pain treatment. Unhealed trauma survivors are especially susceptible to opioid misuse and addiction since their chronic, emotionally distressed state is temporarily relieved by taking opioids.
One study found that the more childhood trauma a patient had, the higher the unsuccessful lumbar spine surgery rate. Study participants were evaluated to determine the presence of five types of childhood trauma: physical abuse, sexual abuse, alcohol or drug abuse by a primary caregiver, abandonment, and emotional neglect or abuse. Patients with no childhood trauma had a surgical success rate of 95 percent. Patients with one type had a success rate of 75 percent. With two types of trauma, patients’ surgical success rate declined to 43 percent. Those with three types of childhood trauma had a 20 percent success rate; with four types, 7 percent; and with five, 0 percet. Yet few orthopedic surgeons screen for trauma.
How trauma causes pain
A traumatic event is one in which a person has been exposed to actual or perceived threats to his survival or physical wholeness, leading to intense fear, helplessness, or loss of control. Trauma can involve a single incident, such as a physical or sexual assault or a car accident, or ongoing threats, such as childhood physical or emotional abuse. Among injured people, those with post-traumatic stress disorder experience more pain and respond less well to medical interventions than those who do not have the disorder.
Psychologists Peter Levine and Maggie Phillips, coauthors of Freedom from Pain: Discover Your Body’s Power to Overcome Physical Pain, believe that pain that did not respond to the usual treatments could be traced back to unprocessed accumulated stress and trauma. Unresolved trauma from childhood can get stirred up by a current event, including the onset of pain. Levine and Phillips found that most people in unrelenting pain never learned how to deal effectively with distressing experiences, either because of neglect or because they were abused when they expressed distress.
In 1950, Dr. Hans Selye identified what he called the general adaptation syndrome in response to stress. It has three stages:
1. The alarm reaction stage. The body goes into fight-or-flight as physiological changes prepare the person to fight or flee. This includes increased muscle tension, heart rate, respiration rate, blood pressure, and cortisol release. In addition, digestion, immune response, and bodily repair are decreased so the body can devote all of its energy to immediate survival.
2. After the initial shock of the event, physiology starts to return to normal but remains on high alert for a while.
3. If the stressful situation continues for an extended period or the individual’s trauma is unprocessed, the person remains on high alert, which leads to the exhaustion stage, characterized by fatigue, burnout, depression, anxiety, decreased stress tolerance, and susceptibility to a wide range of chronic illnesses, including chronic pain.
How to heal trauma
The way out of pain for traumatized individuals is to learn how to calm themselves after disturbing experiences. Most traumatized people who seek help get talk therapy or medication. Neither of these approaches is very effective at resolving trauma. Dr. Bessel Van der Kolk, psychiatrist, brain researcher, and author of The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma, discovered that when a person talks about their trauma, they get emotionally triggered, which blocks trauma processing and causes more distress. Medication temporarily alters brain function, sometimes muting some symptoms, but does nothing to address the underlying trauma.
These two techniques are extremely helpful in resolving trauma and associated pain:
Energy psychology (EP) is based on the theory that psychological problems are caused by disturbed energy patterns in the mind/body communication system. More than 155 studies have documented that EP effectively resolves trauma, according to the Association for Comprehensive Energy Psychology (ACEP).
EP techniques combine focused awareness with stimulation of the human energy field. Acupuncture points are tapped or held while the patient focuses on a disturbing feeling or memory. FMRI studies have shown that stimulating these acupuncture points affects the release of brain chemicals in ways that reduce pain and shut off the fight-or-flight response.
Energy psychology techniques are easily learned and can be self-administered. If the person has been severely traumatized, working with a mental health professional trained in EP is advisable.
A good resource for learning about EP for pain is The Tapping Solution for Pain Relief: A Step-by-Step Guide to Reducing and Eliminating Chronic Pain by Nick Ortner.
Neurofeedback, a.k.a. brainwave biofeedback or neurotherapy, uses sensitive electronic instruments to monitor the brain’s electrical activity and feeds that information back to the patient so control of the brain can be learned and functioning improved. The brain is chronically overactivated with trauma and chronic pain and over-sensitized to emotional and physical stimuli. This can be reversed with neurofeedback treatment. When this reversal occurs, the trauma survivor is calmer overall and less likely to be triggered. Emotional and physical symptoms subside.
Trauma is often the root of chronic pain and can be healed with the right interventions. Before prescribing high-risk medications or surgery for pain, the patient’s trauma history and level of ongoing stress need to be evaluated and treated.
Cindy Perlin is a licensed clinical social worker, chronic pain survivor, and author of The Truth About Chronic Pain Treatments: The Best and Worst Strategies for Becoming Pain Free. She is founder and CEO, Alternative Pain Treatment Directory and can be reached on Facebook.