Trauma and Chronic Pain (Part II)

One of Mindfully Alive’s specialty ares is in the emotional/psychological roots underlying chronic pain and a condition called Mind Body Syndrome (MBS). MBS is characterized by the emergence of physical maladies that may be a reflection of psychological suffering from trauma, stress or other factors. As an example of how trauma and chronic pain manifestations are linked together, consider this: 90% of patients with depression present physical symptoms! In this context, one’s back pain, headaches or gastrointestinal issues may be viewed as a manifestation of psychological tension and chronic pain and previous experiences of trauma. 

How Does Trauma and chronic pain connect?

Joyce McDougall, a prominent psychologist, theorist and researcher of the mind-body interface, called this phenomenon Theaters of the Body . She states that the body takes the center stage in order to divert attention away from the conscious mind and arising threatening feelings. The individual with MBS is totally unaware of these internal processes.

Psychosomatic medicine deals with disorders that APPEAR to be purely physical but which may be rooted in deep-seated unconscious emotions.

The concept is fairly simple:

1.  The mind-brain has great power over the body and
2. Human physiology is intimately connected to emotions and feelings.

We experience that connection daily. Blushing when embarrassed or ashamed, perspiring when nervous or stressed, feeling butterflies in the stomach when excited, are some examples of physical reactions generated by emotions.

These sensations are benign, automatic (happen without thinking) and usually disappear as soon as trigger situations pass. But what happens to the body when more intense, deep-seated, painful negative feelings “store up” in our system? What if the feelings are too embarrassing or too dangerous to process consciously so they need to be repressed and buried in the unconscious brain? The link between trauma and chronic pain is now established.

 Dr. Sarno – Professor of Rehabilitation Medicine, Director of NYU Rusk Institute of Rehabilitation and a pioneer in the field of Mind Body ailments – posited that the mind, powerful enough to make decisions we are unaware of, acts as a protector. Its goal is to “hide” unconscious emotional pain, rage, profound sadness, shame, guilt, etc. and save our rational, thinking part of the brain from experiencing those devastating emotions. This is necessary for survival and functioning and at times very beneficial so we can keep going after a traumatic experience.

Although somatic reactions are intended to protect the individual from psychological damage, paradoxically, they may also put his life in danger. This can occur in certain cases of asthmatic, gastric or cardiac conditions. Additionally, the mind-body symptoms can affect virtually any organ or part of the body. Conditions like chronic pain, migraines, irritable bowel syndrome (IBS), insomnia, chronic fatigue and skin rashes are just a few of the very real physical illnesses that can be diagnosed as Mind Body disorder or mind-body being a significant contributor. You may be surprised to learn how long the list of MBS-related symptoms actually is! According to Psychophysiologic Disorders Association, they include, but not limited to (since the research is ongoing) disorders listed below:

Many people have been looking for help with their physical pain and other MBS symptoms without finding the cure.

In fact, one in six adults in the U.S. suffers from chronic pain or chronic functional symptoms. A sheer number of medical professions and services tending to those patients demonstrates the extent of the chronic pain problem. Many medical practitioners treat conditions that fall into the psychophysiological category, however, the lack of knowledge and training in the American Medical community in mind-body interaction may be affecting the quality and success of treatment. Otherwise, a large number of the patients would have likely received an MBS diagnosis which, to reiterate, implies that certain physical and chronic pain maladies experienced by the person are, in fact, a manifestation of psychological conflict, trauma or emotional tension. It follows that a change in focus and attention is required – it’s NOT (or not solely) a medical issue. 

Is it possible that the physical symptoms you are experiencing could be caused by a Mind-Body disorder? It’s worth exploring the chronic pain and trauma connection.

The following diagnostic factors seem most “telling” and, in retrospect, could have helped me (had I known and paid attention to them) shift from a physical to a psychological focus and stop the vicious cycle of trauma and chronic pain.

• You have done your due diligence! You’ve gone to multiple specialists and they ruled out serious physical issues. You DO NOT have a fracture, impinged nerve, cancer or any other physical or structural pathology! You should be HAPPY to hear this! However, I remember being disappointed with my neck MRI results that didn’t reveal anything major. Pain is real, it hurts terribly, and knowing the cause gives one hope that it can be cured. When doctors sound uncertain or confused by your symptoms, this in itself intensifies feelings of anxiety, fear, and gloom and brings more mind-body symptoms. 
• Like me, you have tried various treatments, both mainstream and alternative, with maybe temporary relief or no results whatsoever. At one point in my journey I went to a wonderful energy healer who used a combination of massage and energy healing and after a few visits the symptoms were gone!!! I was pain-free for a few months and happy I had found THE treatment that helped. As mysteriously as the symptoms disappeared, they reappeared a couple of months later, and even more bothersome. The next round of visits with the same healer, unfortunately, did not result in any improvement of my condition. 

In general, the MBS diagnosis is suited to cases where patients have been suffering for a while and their multiple attempts at physically-based treatments didn’t succeed. 

• You experience a cluster of conditions that have been associated with psycho-somaticism. Your physical symptoms DO NOT fit into a frame of signs and diagnostic criteria that point to one particular disorder. The more symptoms you have, the more likely it is to be a mind-body disorder. Over the years, in addition to neck and lower back pain, I’ve suffered from TMJ, headaches and blurry vision, difficulty breathing, nausea, GERD, allergies, tingling and burning sensations, chills and sweating, joint pain and eczema. I also have an autoimmune disorder. 
• You have a tendency to pay a lot of attention to “body talk” and get emotionally involved in it to the point of adjusting your lifestyle and restricting your activities due to physical distress. You live cautiously and in a pretty constant fear of certain movements, foods, social situations, etc. which can aggravate the pain. 

• Your symptoms are inconsistent. They may move to different organs or body parts over time. They vary in intensity depending on the time of day, time of year, level of stress, environment, and activity. For example, your symptoms become less severe or less frequent while on vacation or at a party. Or they increase in the evenings or before a stressful meeting or after exercise (but not during). Your symptoms wax and wane and you suspect that certain foods, smells, sounds, movements or weather changes trigger them. 
• Additionally, certain personality traits can contribute to developing a mind-body disorder. Certain characteristics like being overly critical of oneself, being highly responsible and perfectionistic make the body more prone to retain tension. People with these traits are also very nice, orderly and sensitive to other people’s feelings and opinions of them; they feel more inclined to want to please and give to others but struggle with receiving in return. 
• You’ve experienced traumatic events either in childhood or in your adult life. 

Certainly, an MBS diagnosis requires a thorough assessment of your medical and psychosocial history. The first necessary step in your healing process is to rule out serious medical conditions with your doctor. If diagnostic testing didn’t reveal a clear biochemical and physical cause for your symptoms, the next step is to open your mind to a new way of looking at your condition- the trauma and chronic pain connection. Your symptoms are REAL despite the fact that your body seems to be working normally and most likely, the reasons are psychological, not medical.

Our constitution is not as disjointed, linear or one-dimensional as we may have been led to think. We are in fact, a complex, interconnected, multi-dimensional, vibrant interplay design taking in experiences and integrating them into our inner landscape which in turn uses the language of biochemistry to communicate with itself without our conscious awareness. However, we can learn to tune in. 

The final step would be consulting with a therapist familiar with Mind Body disorder to thoroughly assess, diagnose and devise an MBS treatment plan that address the trauma and not only the chronic pain. With advances in neuropsychological research, there is now plentiful evidence that mind-body symptoms can be treated without medication or surgery. Perhaps emotional trauma and chronic pain are interconnected through a bio-chemical process and the relief from physical symptoms actually lies in unlocking and exploring emotional and psychological terrains.