From Trauma-Triggered Pain Management to Full Recovery
By Dr. Cory Herman
Every pain specialist loves success stories. Being dedicated to helping people overcome pain often includes the need to address a trauma-triggered pain disorder.
The end goal of pain management is to see the patient experience “pain recovery”. Some people who experience trauma-triggered long-term pain management lead successful lives by many measurements; they are amazing overcomers! People can experience full or near-complete pain recovery when a pain professional diagnoses and oversees their pain management plan.
The global pandemic, and now the Ukrainian war, bring the realities of how toxic stress and anxiety impacts an individuals’ pain level and tolerance. Thankfully, a burgeoning understanding of and appreciation for the need to effectively treat the person experiencing toxic stress is on the rise. It is a beautiful thing to see a stressed-out person emerge through tough times.
Emotional pain is pain or hurt that originates from non-physical sources.
An orofacial pain specialist has additional training in how the sensory processing function of the nervous system can produce pain that is not fixed to tissue pathology. We may be more familiar with a stress-induced temporomandibular joint soft-tissue pathology due to tangible abnormalities of the jaw disc or tension headaches following an injury such as a car accident. However, it can be harder to identify and treat chronic pain that is caused by extreme emotional distress.
Think of all the faithful warriors who have returned home from battlefronts as heroes and yet face isolating depression or emotional fatigue. Think of the families who have lost loved ones, households who lost a salaried position due to COVID-related changes and are financially stressed. Think of the many people bound by a minority stigma who lack sufficient resources and struggle every day with racism and lack of opportunities. The loss of a loved one, instability without family support, shame, or the taunts of another handicap that pushes life to a brink – can all be very traumatic.
Extended Anxiety and Trauma Create Tense Muscles
Extended and intense emotional or psychological pain can lead to chronic pain.
A person who has experienced trauma may be easily startled and anxiously seek to protect themselves from potential threats (also called hypervigilance). When a person is anxious for an extended time, it becomes difficult to relax – both emotionally and physically. These over-reactive impulses can cause very tense muscles. In turn, this unnatural, tensed muscle state can become painful and contribute to chronic pain.
If experiencing trauma can lead to chronic pain, then logic says that our treatment of trauma can help relieve pain.
Traumatized persons with pain disorders often lack having someone who sufficiently explains how their trauma and chronic pain are related. It’s easy for an observer to rush to assume that the pain reported by a patient is “all in their head”. To grasp when a pain disorder is trauma-induced, one must differentiate between the somatic injury that triggers pain and the neuroperceptive process of perceiving pain.
Many traumatized persons suffer from physical trauma to their body as well as from a massive disturbance to the way they process pain stimuli. Research suggests that people with a history of developmental and adult trauma have significantly lower pressure pain thresholds and experience pain in other ways.
In fact, there are many randomized controlled trials supporting the idea that trauma recovery is necessary to obtain a recovery from pain.
“Chronic pain is the most common global cause of functional and quality of life limitations. Although there are many effective therapies for the treatment of acute pain, chronic pain is often unsatisfactory. Against this background, there is currently an urgent need to develop innovative therapies that enable more efficient pain relief. Psychosocial factors play an important role in the development and persistence of chronic pain. Especially in patients with high levels of emotional stress, significant anxiety, or relevant psychological comorbidity, classical pain therapy approaches often fail.” – Emdria on creating global healing, health, and hope.
Can pain be caused by trauma?
Chronic pain can emerge without physical injury; it can be caused by stress and emotional issues.
To be fair to patients with pain from traumatic experiences, we need to look further than for physical injury alone. Simply prescribing antibiotics or opioids falls short. Rather, healthcare providers must take the time to evaluate how a person’s mental health may be affected by past trauma.
Both chronic pain and trauma cause the nervous system to be overly stimulated, which strongly links both human experiences. The same areas of our brain which regulate emotions, store memories, and help us to focus our attention, also function for processing and regulating pain. In this manner, chronic pain and emotional trauma can directly influence one another.
Trauma-Triggered Pain is a Real State of Medical Need
The connection between pain and trauma is often missed.
The Minnesota Head & Neck Pain Clinic’s services for diagnosis and pain treatment planning begin by listening to the patient. Commonly people describe their medical needs with emotionally charged words, such as “tormenting”, “punishing”, “unbearable”, and “cruel.” Yet, the connection between their insufferable pain and trauma is too often missed.
Without recognition of the link between trauma and chronic pain, a patient may spend years visiting medical professionals who remain baffled if no tissue source for the pain is identifiable. Diagnoses such as fibromyalgia, systemic lupus erythematosus, chronic Lyme disease, an anxiety disorder, mental health condition, and multiple sclerosis can be suggested. Such patients may spend thousands of dollars on failed treatments, medication trials, oxycodone, and benzodiazepine, with little or no relief.
Pain clinics are best at identifying patients’ pain – even in the absence of physical injury, accident, or disease. People are created as emotional beings. That’s how we love, nurture, treasure someone or something, are passionate about our work or hobbies, and much more. Our emotions make life rich with meaning, connection, and purpose. But when things go wrong, persistent disappointments, estrangements, or tragedies occur, our ability to feel emotional pain may take a harmful course.
Chronic Pain and Memory Intimately Interact on Several Levels
Oftentimes, a patient’s pain syndrome may be traced back to a traumatic event. This event can lead to rewiring of the body’s nervous system which then begins to process pain differently.
The NIH December 1, 2019, Pain Pathways and Nervous System Plasticity: Learning and Memory in Pain article says; “chronic pain can be seen as the persistence of the memory of pain and/or the inability to extinguish painful memories. Ideally, pharmacologic, physical, and/or psychological approaches should reverse the reorganization accompanying chronic pain.”
Longitudinal imaging studies propose that over time, the reorganization of brain activity accompanies the changeover to chronic pain. The patient may not detect how pain gradually shifts from sensory to emotional. The part of the brain that is intimately involved with this change is the limbic system. The limbic system is the control center of our behavioral and emotional responses. Similar but different, facial nerve pain, for example, can be traced to a physical source.
While people may feel uncomfortable speaking openly about traumatic events or the source of their toxic stress to friends and family, they are often more comfortable sharing with a healthcare professional. Someone trained to identify the source of such chronic pain may make it feel worth “reliving” the traumatic experience by sharing their experiences.
What is Developmental Trauma?
Developmental trauma is a slow process that can benefit most from a trauma-pain recovery treatment plan. Whether the root is a traumatic childhood experience or adult trauma, the development of chronic pain can surface later in life.
According to the Substance Abuse and Mental Health Services Administration, more than two-thirds of children report at least one traumatic event by 16 years of age. This may include community or school violence; national disasters or terrorism; neglect; psychological, physical, or sexual abuse; and witnessing or experiencing domestic violence.
Too many people are in pain, literally and figuratively. We need to supersede mere pain management with holistic pain recovery. For many people, toxic stress is occurring at both the local and global levels. Much of our society has a sense of being totally overwhelmed and critically stressed. This then becomes a significant public health concern.
Early diagnosis and treatment are your best defense from progressive trauma-triggered pain disorders.
What is CPTSD?
Complex posttraumatic stress disorder or CPTSD represents a serious form of PTSD. It includes the symptom clusters of PTSD (Mental Disorders) but also includes people suffering from challenges in regulating their emotions, disturbances in relational capacities, and who may have an adversely affected belief system about themselves, others, or the world. When these issues are left untreated problems with sleeping or sleep apnea commonly develop.
Substance abuse and addiction are commonly connected to co-occurring disorders like PTSD, depression, and anxiety. Reliving past traumatic events, experiencing flashbacks, and having nightmares can lead to chronic pain. While several chronic physical conditions may increase the risk of chronic pain, we need to remember that pain perception is a subjective experience. It may be influenced by complex interactions of biological, psychological, and social factors.
Helping Patients Move from Pain Management to Pain Recovery
The practice of integrative pain recovery into the routine care of pain patients.
To fully assist a patient’s chronic pain recovery, a multidisciplinary approach established by our medical and dental pain specialists may include physical therapy and behavioral health services. To address the root causes of pain, an integrative treatment is typically best.
As pain professionals, we accept each individual where they are and what they are comfortable with. Once the heavy burden of trauma begins to lift, the “physical” pain may be eased with gentle pain therapy. Pain management not only leads to comfort and alleviates suffering, but it can also restore daily functions and normal activities. “Pain recovery” can give patients a life of joy, a sense of value, worth, meaning, and purpose.
When you visit our clinic, you’ll find education about how your trauma-adapted nervous system can relay pain to your brain. With a better understanding of this connection, we can partner with you and begin treating the trauma. Our goal will be to begin your pain management plan to help you gain pain recovery.
Our pain specialists are continually expanding our knowledge and chronic pain treatment modalities. We are passionate to provide the best and shortest route to your full pain recovery!
Call our clinic nearest you to schedule an evaluation:
Plymouth: (763) 577-2484
St. Paul: (651) 332-7474
Burnsville: (952) 892-6222
St. Cloud: 763-233-7252
About the Author
Cory Herman DDS, Doctor of Dental Surgery, treats adults and children with sleep issues, TMJ, and Orofacial pain disorders within the Minnesota Head and Neck Pain Clinic. He is known for his non-surgical orofacial pain management with an emphasis on collaborative, integrative, mind-body rehabilitative care.