“What I can’t understand,” says Michael, a 42-year-old letter carrier from San Bruno, California, “is why my pain is getting worse. It’s been two years since the car hit me. They tell me the X-rays and CAT scans are normal. I’m on three medicines. I tried chiropractic. I’ve had physical therapy. My neck pain should be getting better, but it’s not. In fact, it’s spreading to my back and shoulder.”
You may have heard stories like Michael’s. You may be living one yourself. Psychologist Maggie Phillips, Ph.D., author of Freedom from Pain, says that when a person is sent from doctor to doctor, treatment to treatment, and doesn’t get better, something other than the initial diagnosis is at work. “Almost invariably,” she says, “that missing link is a history of trauma.”
Some people who live with pain don’t want to hear about trauma, for two good reasons. Some think they are being told that their pain is all in their minds. Others don’t want to look at their trauma history because they fear reliving painful and frightening experiences.
Both fears are reasonable, but the reality is different. “Most people think of trauma as a mental problem, even a brain disorder,” says psychologist Peter Levine, Ph.D., author of Waking the Tiger: Healing Trauma. “However, trauma is something that happens in the body.”
Trauma is frightening; that’s what makes it trauma. But by focusing on the body, trauma can be released without being relived. Releasing trauma in a safe way is often crucial for healing chronic pain. For millions of people, chronic pain is a symptom of post-traumatic stress disorder (PTSD). “Once unreleased trauma is liberated from the body,” says Phillips, “most conditions begin to resolve.”
What Is Trauma?
Different experts define trauma differently, but all include these elements.
- An injury to body, mind, or emotions from an outside force.
- A threat perceived as a danger to life.
- A fear response that turns on the fight-or-flight system. Heart rate and blood pressure go up, and the whole body tenses. If trauma is not released, this stress reaction may never go away. “After trauma, the body is permanently changed into a stressed state where it can’t heal,” writes osteopath Maud Nerman, D.O., in her book, Healing Pain and Injury.
- An inability to respond by evasive action or fighting, causing a feeling of helplessness. “When the threat is perceived as inescapable, the third natural response, the freeze response is evoked,” Phillips says. “Our bodies, particularly our muscles, tighten and brace.” We become like a possum playing dead or a turtle pulling into its shell. We cannot move forward in our lives or heal.
Bessel Van der Kolk, M.D., author of The Body Keeps the Score, explains how helplessness causes trauma: “When the brain senses threat, it immediately sends out chemicals telling the body to run, hide, fight, or on occasion, freeze. If these responses are blocked, for example, if people are held down, trapped, or otherwise prevented from taking effective action, be it in a war zone, a car accident, domestic violence, or a rape, the brain keeps secreting stress chemicals and the brain circuits continue to fire in vain. Long after the actual event has passed, the brain keeps sending signals to the body to escape a threat which no longer exists.”
In the wild, animals are exposed to trauma almost every day, threatened by predators and competitors. Yet they don’t develop PTSD, because they have inborn ways to release the trauma when the threat has passed. They shake, they tremble, they run around, they yowl, and they rest. Then they can go on with their lives.
Humans have forgotten or suppressed those instincts, but we also face potential trauma throughout our lives. Sources of trauma include:
- war. Thousands of veterans come home with PTSD and chronic pain;
- accidents. These include car or bike crashes, falls, and other unpredictable causes of injuries;
- assaults by people or animals;
- sexual assault. This often leads to PTSD and chronic health problems, including pain.
- sports injuries;
- abuse during childhood, either physically or mentally. Includes abandonment and neglect. Typically makes later trauma and pain more severe;
- surgery and invasive medical procedures. One study showed more than 50 percent of orthopedic surgeries resulted in symptoms of PTSD;
- parental divorce;
- loss of job (self or parent);
- intergenerational trauma. In his book It Didn’t Start with You, Mark Wollen, founder of the Family Constellation Institute, reports dozens of cases of people living with symptoms related to their parents’ or other family members’ trauma. The traumas can be passed down genetically, through stories, or some other way; and
- trauma of being born, especially in a difficult delivery.
Pain itself can become traumatic. It can seem out of our control; we may try many things without relief. It can cause fear, anger, and grief, but we can’t take effective action. “We can get really entrenched in feeling afraid of pain,” says Phillips. “Our fear is that we won’t get better, that we’ll never get rid of it.”
Observe that almost everyone has suffered at least one of these traumas. How many have you experienced? You may not remember them in words. Traumas often cannot be put into words, but they still may be present in your body.
How Trauma Can Cause Chronic Pain
Phillips describes how traumatic experience can lead to lasting pain: “Once the fear response is activated, the body begins to brace itself against threat. Bracing [constantly protecting yourself] can trigger chronic constriction. If this constriction persists, it creates pain. Eventually, we brace against the pain itself, which triggers further constriction and more pain.”
Nerman says trauma can affect the whole body in several ways. It might interfere with breathing by tightening the diaphragm (the breathing muscle) and injuring ribs. The spine may be pushed out of line, compressing nerves and pressing on organs. The nervous system’s normal pulsations may become weak and chaotic, affecting the senses.
Trauma can accumulate over a lifetime until it overwhelms our defenses and causes pain. In treatment sessions, Michael, the letter carrier with neck pain, remembered injuries playing football and falling down stairs as a toddler. Although he had almost forgotten the injuries, the traumas worked together to give him terrible neck and back pain. As psychiatrist Sigmund Freud said, “The mind may have forgotten, but the body always remembers.”
Michael had also been abused as a child by his alcoholic father. Nonphysical traumas like the death of a parent or a history of verbal abuse can also add to trauma by making the world a scarier place, increasing stress.
Painful traumatic events are remembered more intensely than other events. “At one time, survival depended on quickly remembering lessons from life-threatening events,” says Levine, founder of the Somatic Experiencing Trauma Institute in Boulder, Colorado. So traumatic pain is stored for easy recovery “where it can be triggered by any encounter with stress or helplessness.” It becomes a chronic warning of threats that are no longer there.
Trauma creates permanently high stress levels. The body feels constantly threatened until the trauma is released, always ready to fight, flee, or freeze. This stressed state makes pain more intense.
Treating Traumatic Pain
Levine says we get stuck in pain because we haven’t released the trauma that caused it. He, Phillips, and Van der Kolk suggest several methods for releasing trauma. All of them involve both body and mind.
– Osteopathy and other physical treatments. Physical therapy, body manipulation by an osteopath or body worker, movement therapies, and medications can help with current trauma. Nerman describes ways of freeing patients’ diaphragms and unwinding their tightened ribs. Osteopaths also work with heads, necks, and abdominal organs. These treatments can also be used on older traumas that are awoken by new events.
– Somatic Experiencing (SE). Levine and Phillips talk about “re-inhabiting the body.” They teach SE, a process that brings people back to their bodies as safe places that can defend themselves. After establishing trust and safety, a therapist will help a client find places in the body that don’t hurt, so he or she can get comfortable feeling them. Then the therapist helps the client experience a tiny fragment of the trauma, before being brought back to the comfort zone.
Levine calls this “pendulation.” Clients learn to find a rhythm by which they can move from threat to safety and release the fear by taking physical action. They may be asked to imagine running away from a threat, for example.
A big part of SE is breathing. “People have disconnected from their bodies because of pain, and this cuts them off from the healing resources they need,” says Phillips. She teaches how to breathe to develop a rhythm and says “the body will gently shift and transform as we learn to accept it and acknowledge it.”
“When we resist life as it is, when we can’t bring our compassion toward our pain, it becomes more painful,” explains SE practitioner Rik Center, director of San Francisco’s Mindfulness Care Center. “The body is saying, ‘notice me,’ and we push it away. But once we get more awareness of our bodies, things start to change.”
– Eye Movement Desensitization and Reprocessing (EMDR). Psychologist Francine Shapiro developed EMDR, which involves moving the eyes back and forth, following a moving electric light or a therapist’s finger, while remembering something painful. “EMDR enables people to observe their experiences in a new way, without verbal give and take with another person,” says Van der Kolk. He suggests that the eye movements may put us into a dreamlike state in which memories change from present stressors to things that are in the past and no longer hurtful.
“EMDR is a powerful treatment for stuck traumatic memories,” he says. In one of his experiments, “After eight weeks of EMDR, about half of the adult-onset group scored as completely cured of PTSD. After eight months, 73 percent scored as cured.” Child abuse survivors did not recover nearly as well and usually need more time for treatment of any kind.
– Emotional Freedom Technique (EFT). Also called “tapping,” EFT is a self-care trauma treatment. You simply identify and repeat the problem that is troubling you while tapping a series of acupuncture points on your head, hand, and chest.
It sounds too easy to be true, but many swear by it. It has helped me with back pain. Van der Kolk says, “EFT has been shown to help patients stay within the window of tolerance and often has positive effects on PTSD symptoms.”
– Mindfulness meditation. Mindfulness means paying full attention to what is happening here and now, and not thinking about the past, future, things that are wrong, or those that could go wrong. Mindfulness meditation, where you focus on your breathing, on your body, or on a single sound or image, can help you re-inhabit your body and release your trauma. Studies of prisoners have shown that their stress symptoms and behavior improved greatly after a week of meditation.
– Psychotherapy. Talk therapy has been effective for many types of chronic pain. It can help you change the way you think about the pain. For example, a psychotherapist can help a person stop believing that his or her pain will last forever. Talk therapy doesn’t seem to help as much in trauma, however, because trauma is stored in the body. “Talk alone is not able to change the deeper underlying structures [of trauma],” says Levine.
– Antidepressant medication such as Prozac or Zoloft. Van der Kolk says antidepressants can be helpful as long as you take them, but as soon as you stop, the benefits are lost.
– Yoga movements and poses can help heal traumatic pain. Yoga actually changes brain anatomy, reducing the volume of pain-sensing structures. Studies show that yoga can reduce the hyperarousal of trauma. Some studies have shown that yoga was more effective than any drug tried for PTSD. The Chinese health practice of tai chi has also proven helpful for arthritis, fibromyalgia, and back pain, though not as much for other types of pain.
If you have chronic pain that has resisted treatment, it may be time to try healing traumas you may have experienced. For more information on these treatments, see the list of resources below.
Resources for Treating Traumatic Pain
Eye Movement Desensitization and Reprocessing
Website: Read about the basics and the science, find a therapist or a training program at www.emdr.com.
Book: EMDR: The Breakthrough Therapy for Overcoming Anxiety, Stress, and Trauma,
Second Edition, by Francine Shapiro, Ph.D., Basic Books, 2016.
Emotional Freedom Technique
Website: Learn about the basics, history, and research, and view training videos at www.emofree.com.
Book: EFT for PTSD by Gary Craig, Energy Psychology Press, 2009. There are dozens of other books on EFT. This one is by the original developer.
Website: Find an osteopath at http://doctorsthatdo.org. Be aware that not all doctors who call themselves osteopaths actually practice osteopathy. When considering a doctor,
ask if they have a Certification of Special Proficiency in Osteopathic Manipulative Medicine (CSPOMM).
Book: Healing Pain and Injury by Maud Nerman, DO, CSPOMM, CA, Bay Tree Publishing, 2013.
Website: Read articles and find a practitioner at https://traumahealing.org. Mostly for providers, but also for people seeking help.
Book: Waking the Tiger: Healing Trauma by Peter Levine, Ph.D., North Atlantic Books, 1997
More about trauma
Freedom from Pain: Guided Practices to Overcome Physical Pain by Peter Levine, Ph.D., and Maggie Phillips, Ph.D., Sounds True, 2012.
The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk, M.D., Penguin Books Reprint, 2015.