Pain and trauma — The smell of freshly mown grass would be enough to trigger feelings of panic and pain in Clive. He didn’t know that this normally innocuous odour was a cue for protection and re-ignition of memories of a car accident that occurred several years before. This is a classic example of the co-existence of pain and trauma.
Equally in others the cue could be a piece of music, a particular place, a person or a taste. We are multisensory and at the time of a trauma, the context creates a multisensory (molecular) memory that has high emotional valency due to the unpleasantness of the situation. At the time of an incident we may cope but afterwards there can be a trauma response that is when the coping fails and the person becomes ridden with anxiety. The physical dimension of anxiety commonly manifests as tension, discomfort, feelings of unease and pain that can gradually become increasingly widespread. Initially localised to where an injury may have been sustained, often it does not take long for the sensitivity to increase and the pain map widen.
Post-traumatic stress disorder (PTSD) is a relatively well known term and describes how a person continues to experience the trauma despite that fact that it has passed. They continue to replay the tape and suffer the consequences: pain, tension, anxiety. The simple fact is that when we think about something, if we are embroiled with that thought, we live it out through our entire self: that is the physical feeling, the emotions and the thoughts all emerging as the one experience. The different dimensions are not in isolation to each other but rather integrated into the reality of that moment.
The problem appears to lie with the attempts to numb and avoid the trauma whilst repeatedly re-experiencing the event. This struggle causes great suffering whilst the body pain continues and often amplifies, vigilance to bodily sensations increase and other symptoms can begin to emerge: digestive problems, abdominal pain, headaches, disrupted sleep and concentration.
In essence the body is in protect and survive mode. All resources are being diverted to survival and hence the motor system is on alert ready to fight an opponent/wild animal or to run away (muscle tension, overactive muscles), the immune system is primed for healing initially but then drops off, digestion falters and vigilance is high for threat. With continuous feelings of anxiety, it seems like all life presents to you is dangerous.
Pain associated with PTSD is a good example of the need to think about the whole person and all the inter-related dimensions of pain: physical, emotional and cognitive. It is always about the individual as much as the condition, and the environment in which they reside. For pain to get better, the person must get better. There are a number of newer approaches based on top-down mechanisms (brain focused), however my belief is that we have an embodied mind. In other words, our (physical) bodies are as much the experience as the thought itself and therefore we must consider this in any treatment programme. Promising techniques may exist in reprogramming memories or learning how to re-interpret thoughts, but where do we feel the sensations? In the body.
- understand pain and symptoms—the biology of pain and stress, what influences pain and stress, what triggers pain and stress, how thoughts and feelings are part of the pain experience, other influences such as tiredness, the environment, beliefs, gender and prior experiences. Setting the scene with modern pain science reduces fear and anxiety as the patient starts to see all the opportunities for change.
- re-training body sense and normal movement that is commonly affected in pain and PTSD.
- learn skills to ease muscles tension and over-activity, how to switch from sympathetic to parasympathetic to create the conditions for change, easing out of survival and into well-being in both thought and action.
- create the vision of where the patient wants to be and plan how that will happen
- check patient’s language (verbal, body and the ‘internal voice’) and change if necessary
From the foundation the above skills are developed alongside motivation and resilience training, focused attention training for clarity of thought. The patient must be able to problem solve moment to moment and use their skills and techniques independently whilst being fully supported and progressed along, always Molina at moving forward. There may be a need to plan a return to work, return to sports or increasing other limited activities gradually.
Clearly any programme must be individualised and monitored closely alongside treatment given for the purposes of pain relief. I commonly use my hands to desensitise and reduce pain, often teaching the patient how to do this themselves or how to involve their partner. The notion that hands on therapy does not have a role in dealing with pain is wrong in my view. We need touch for normal healthy development and it plays an important social role. Judicious use of touch therapies can help to develop trust between care giver and recipient and change the processing of signals from the body, also having a top-down effect when explained.
We are complex, pain is complex, pain relief is complex; however this creates many opportunities for change. And our role is to facilitate change, to focus on our own natural ability to create health and wellbeing. We must acknowledge and validate pain, teach patients about their pain but then we must focus on moving on, so the less attention on pain the better. Let’s think about what we can do — the CAN mentality and start changing the largest global health burden. Because we can.
Contact us for details about the treatment, training and coaching programmes for pain sufferers and for clinicians wanting to become a Pain Coach (small group training and 1:1 mentoring): call 07518 445493