How is Psychological Trauma Linked to Chronic Pain?

We’re often asked: Is there a link between psychological trauma and chronic pain? The short answer is ‘yes’. Real physical pain frequently occurs following trauma, with studies showing this follow-on pain effect in up to 80% of those who have suffered or witnessed trauma[1].

Before we get into the ‘why’, let’s unpack trauma, but first, a warning: If this is something that might affect you, please take care. And if you need to talk to someone, there are links at the bottom of this article for immediate support.

Psychological trauma occurs when a person is exposed to a frightening or distressing event that threatens their sense of safety, their wellbeing, and perhaps even their connection and stability in a relationship. Trauma may include acts of violence or abuse, natural disasters, loss of a loved one, a life-threatening illness, or a severe injury. After witnessing or experiencing a traumatizing event, around a third of people will develop ongoing distressing symptoms that can be diagnosed as Post Traumatic Stress Disorder (PTSD).

How common is PTSD? Another short answer: ‘very’. Unfortunately, it’s estimated that 7 out of 10 Australian adults have experienced a traumatic event at some point in their life, with an estimated 1 out of 10 Australians diagnosed with PTSD[2].

Why are psychological trauma & chronic pain linked?

While it’s perfectly normal for the body and the brain to react to abnormal circumstances, every person will react differently. Coping with trauma can take a serious emotional and physical toll on the mind and body, and the after-effects and symptoms that follow can have a huge impact on a person’s health and wellbeing. For example, a long-term study into the impact of Adverse Childhood Events (ACEs) found higher risks of developing injury, mental health conditions and chronic disease[3] including chronic pain conditions such as fibromyalgia, back pain, headaches and pelvic pain[4].  

If we have a closer look at some of these common protective responses to trauma, we might find some more clues into why pain can develop.

Being constantly activated

We all experience highs and lows, and it’s perfectly normal when experiencing or witnessing traumatic events for a person’s nervous system to become activated. Suddenly we’re on high alert, with a sense that danger is everywhere. Once the trauma or danger has passed, it’s ideal if we can then return to feeling restful and calm. It’s actually quite important to have this balance in order to help our nervous system and emotions recover and stay healthy.

A common cycle goes like this: something happens, we get stressed, it passes, we calm down. But sometimes that ideal plan breaks down and we get stuck. Our normal stress response switch flicks to ‘on’, and when the danger or trauma has passed, it switches to ‘off’, but … it can get stuck ‘on’. This can result in feeling either too much (being reactive) or too little (feeling numb)[5]. When the ‘on’ switch is stuck, that feeling of constant agitation held within the body will often translate to pain. It's a bit like being at home alone, watching a horror film, your nerves are on edge, and the slightest noise can send you screaming. Yes, just the thought of that is enough to activate the ‘on’ switch.

Emotions & relationships

Anyone living with trauma can feel this constant activation, and it’s not something they choose to have or something they can easily get over. It’s not a choice, it’s a scientific fact.

Medical science worked out long ago that the amygdala in the brain is responsible for the processing of fear and memories surrounding emotions. When the amygdala is constantly ‘on’, the body responds by releasing fight-or-flight hormones and if there’s no let-up of the stress and hormone release, inflammation and chronic physical pain can eventually be the result. It’s hardly surprising why people with stuck ‘on’ switches find it hard to feel content when they’re constantly in pain and feeling scared and anxious.

Re-experiencing

Re-experiencing (or flashbacks) of traumatic experiences can pop up unexpectedly, and with them, their nasty cousin, those same highly distressing physical and emotional sensations we experienced at the time of the original event. This means not only a stress response is reawakened via the ‘on’ switch, but there’s an increased likelihood of a return of inflammation and chronic pain. Unfortunately, as people with pain will know, it can be difficult to find comfort, even in bed, which leads to disrupted sleep, often with nightmares triggered by reawakened memories of the original trauma. Your sleep pattern can feel more like a washing machine cycle.

Depression, fear & anxiety

People who have experienced or witnessed trauma have more chance of excessive fears and catastrophizing thoughts – by which we mean they always believe the worst will happen – which can lead to fear, depression and anxiety[6].

Fear can fuel pain for a few reasons. Firstly, if someone has experienced a traumatic event, they can develop beliefs that pain is always harmful. So, if pain occurs, it's likely that negative thoughts and worry will take over the show. This can lead to a vicious downward spiral known as the fear avoidance model [7]. It sounds a bit like this: You are scared that movement will cause pain so you avoid it altogether and rest instead. With no movement, your muscles start to weaken and become stiff (this is also called deconditioning). Over time, this lack of movement can further increase your pain, leading to more fear and negative thinking. And so it goes … all downhill.

For many years, this was my mode of operation, and as I became less active, my pain increased and so did my fear. But it was false fear because once I learned to move again, slowly, within my limits, my experience of pain changed.

Storing trauma in the body

A way of coping with strong feelings resulting from trauma can be to disassociate or essentially to ignore them, locking the feelings away in the too-hard basket. It’s a bit like saying, 'this isn't happening to me' and hoping it’s true. This sort of denial or disassociation is a perfectly valid response when something is too overwhelming. But as renowned trauma stress expert Dr Bessel van der Kolk’s best-selling book suggests, ‘the body keeps the score’. You can lose awareness of what’s happening inside your body but your body doesn’t listen[8].

Sometimes people may experience physical complaints such as stomach issues or chronic pain that are very real and debilitating, but there is no identifiable problem with the body – such pain is known as ‘somatization’[9]. There is no rash, no high temperature, no sprain or fracture, but your body hurts in all sorts of odd places. You may begin to question your own sanity when nobody seems to understand. Rest assured, your sanity is intact, and your pain is real.

At MoreGoodDays® we believe knowledge is power. Now that you know some of the common responses to trauma, there are ways to gently work towards easing some of the load. If you have a long history with trauma, your mind and body may have developed strong protective measures, so recovery may not be as simple as flicking a switch, but help is on its way.

Remember how people who have experienced trauma can get stuck ‘on’ (hyper arousal) or ‘off’ (hypo arousal)? When trauma forces you into these modes in an attempt to protect you, it doesn't take much to flick the ‘on’ switch. It can be like you are a coiled spring ready to pop and it can also mean long-term complications set in. Getting help to bring your emotions into a healthy balance of more manageable fluctuations can improve wellbeing and a sense of connection. So rather than driving full pelt up and down the mountain, you can learn to cruise a bit more on the rolling hills.

Strategies to better manage painful symptoms

Let’s go through what can help.

With any of these options, you may want to gently dip your toes in to try them out. If there is trauma in your background, try and avoid opening the floodgates. We want to make sure you retain a sense of safety as we find out what works best for you.

And the good news is … all these are great strategies for managing chronic pain too!

1.     Cognitive Behavioral Therapy (CBT)

‍We know that thoughts can lead to behavior. For example, with chronic pain it’s normal to say, ‘My pain is getting worse’ and this thought may mean avoiding situations that you think will cause pain such as movement (behavior). CBT challenges the thinking so that more helpful behavior follows. For people living with trauma, investigating unhelpful ways of thinking can offer opportunities for people to challenge previous patterns of belief so they feel more in control, and are able to increase their choices and their sense of safety.

2.     Mindfulness

Often, we don't see our own unhelpful habits. Of course, they may seem glaringly obvious to others, and we can definitely see theirs and wonder how come they don’t. Practicing mindfulness is like sitting in a drone above your experiences, observing yourself objectively. Maybe then you can see how thoughts and physical sensations show up in your body, how, when unpleasant things happen to us, we might blame and criticize ourselves.

We are often our own harshest critic, and that never feels good. Mindfulness can help offer another nurturing and healing way: through self-compassion [10]. Do you have five minutes to spare right now to try this mindful self-compassion practice?

3.     Multidisciplinary pain programs

Programs that take the whole person into consideration, for example, their history of both trauma and pain, are likely to be more successful than addressing a concern in isolation[11]. There is no one-size-fits-all approach. By providing a combination of physical and psychological therapies, there is more chance you can find your right size, the options that will work best for you, and the slightly adjusted lifestyle practices that are most likely to be sustainable in the longer-term.

Our program is an evidence-based multidisciplinary approach. Check to see if you are suitable.

4.     Trauma-informed practitioners

‍Trauma is complicated, as you already knew before reading this. There are many different reactions to, and impacts of, both trauma experience and pain, which all are normal reactions to an abnormal situation.

An understanding therapist, highly trained and skilled in working with people experiencing psychological trauma can help to untangle some of the complexities. You could ask your doctor or health professional whether they think seeing a specialized pain psychologist with ongoing support through MoreGoodDays® might be helpful for you.

5.     Support groups or social connection

‍When we are really stressed, the wiring for social connection shuts down. It makes sense: you haven’t got time to stop for a cuppa with friends when you’re running from a tiger! But the very thing that will help us calm down is the very thing we may have trouble doing to feel safe and protected and that is connecting with others.

Surrounding yourself with supportive people who understand trauma and/or people who love you just as you are, can be a way to buffer against the symptoms of trauma. And if connection with other humans may not feel safe for you, animal therapy including contact with dogs and horses has also been shown to have wonderfully similar calming outcomes[12].

6.     Movement

‍Treatments that help people experiencing trauma to reconnect with how they feel inside their bodies can be a great start towards recovery. Participating in activities you enjoy, such as gardening, walking, or yoga will help your body and mind re-establish a sense of safety and can really make you feel good about yourself too, and that there is a gold bullion bonus! Another benefit of movement is that it can help calm the nervous system, bringing that reasoning part of the brain back online.

With movement, it’s good to remember to start small and build up slowly, so that it becomes part of your regular routine (see pacing). Don’t be like a bull at a gate, and please don’t buy into that ‘no pain, no gain’ old-fashioned thinking. Onward and upward!

If you want to know more, try reading 'The Body Keeps the Score' or, if listening is more your style, maybe you would like Tara Brach's podcast: Trauma Sensitive Mindfulness - The Power of Self-Nurturing. Feel free to also check out some of the research in the resources below.

And if you want some extra support, please reach out to us at MoreGoodDays®. We’re here to help.

If any of the content of this article has raised concerns for you and you need immediate assistance, please contact:

• Lifeline - Free Australia-wide crisis support and suicide prevention service. 13 11 14 (24 hours, every day) or Text 0477 131 114 (24 hours, every day)
• Beyond Blue - Free mental health and wellbeing information and support for all in Australia. 1300 22 4636 (24 hours, every day)
• Blue Knot Foundation Helpline - Information, support or referral for adult survivors of childhood trauma and abuse. 1300 657 380 (9am to 5pm, every day)
• See here for a full international list of Crisis Support Helplines‍