The Intersection of Trauma and Chronic Pain: A Deep Dive
When it comes to discussions on the internet, ‘trauma-informed’ care is a hot topic, and chronic pain management is no exception. In this series of articles, we will explore the complex relationship between trauma and chronic pain, starting with a brief overview of trauma and its impact on pain. We will also touch on current research findings and delve into therapy recommendations for both therapists and individuals living with chronic pain.
Defining Trauma
Trauma can be defined as an event or set of circumstances that an individual experiences as physically or emotionally harmful, leading to lasting adverse effects on their overall well-being. This definition emphasizes the subjective nature of trauma, as one’s individual experience determines whether an event is traumatic. Trauma can be direct, experienced directly by the individual, or indirect, witnessed by the individual on another person and experienced as trauma personally.
There is often confusion surrounding the definition of trauma, with distinctions between PTSD as defined in DSM5 and broader terms like adversity, which encompasses a range of potentially distressing or traumatic experiences throughout life. While trauma with a capital ‘T’ is more restrictive, adverse childhood experiences are widely studied as contributors to chronic pain.
It is important to note that the discussion will not touch on whether pain is ‘psychogenic’ in individuals who have experienced trauma, as there are ethical limitations on experimental studies in humans. The focus will be on longitudinal and correlational studies that provide insights into the complex relationship between trauma and pain.
The Influence of Trauma on Pain
Research has shown a clear relationship between childhood trauma and chronic pain, with specific studies linking childhood maltreatment and neglect to higher reports of chronic pain. Adverse childhood experiences (ACEs) have been associated with increased prevalence and intensity of chronic pain in adulthood. There is a ‘dose-response’ relationship between exposure to ACEs and higher pain intensity, interference, anxiety, and depression.
The biological mechanisms underlying the relationship between ACEs and chronic pain involve neuroendocrine dysregulation, altered stress reactivity, and immunological changes. Prolonged exposure to trauma can result in epigenetic changes in stress response systems, cortisol dysregulation, and structural brain alterations, impacting threat detection and pain modulation.
Psychologically, exposure to trauma can lead to maladaptive coping strategies like catastrophizing and pain-related avoidance. These psychological factors contribute to the experience of chronic pain in individuals with a history of trauma.
Looking Ahead
As we continue to explore the intersection of trauma and chronic pain, it is essential to consider the implications for therapy and pain management. Understanding the complex relationship between trauma and pain can inform more effective treatment approaches for individuals living with chronic pain.
Stay tuned for more insights and recommendations on trauma-informed care and chronic pain management. In the meantime, check out the blog post by MelloJonny for further reading on this topic.
References:
- Karimov-Zwienenberg, M., Symphor, W., Peraud, W., & Decamps, G. (2024). Childhood trauma, PTSD/CPTSD and chronic pain: A systematic review. PLoS ONE, 19(8), e0309332. Link
- Stromberg, E. (Ed.). (2023). Trauma-Informed Pedagogy in Higher Education: A Faculty Guide for Teaching and Learning (1st ed.). Routledge. Link
- Tidmarsh LV, Harrison R, Ravindran D, Matthews SL and Finlay KA (2022). The Influence of Adverse Childhood Experiences in Pain Management: Mechanisms, Processes, and Trauma-Informed Care. Front. Pain Res. 3:923866. doi: 10.3389/fpain.2022.923866
- Vlaeyen, J. W. S., & Crombez, G. (2020). Behavioral Conceptualization and Treatment of Chronic Pain. Annual Review of Clinical Psychology, 16, 187-212. Link
