I hear this all the time; someone shares a story from their past that they feel may not be important, but worth mentioning. The funny thing is, it's always important and so yes, please mention it! When people share these stories in my office, they describe past physical traumas, injuries, surgeries, and accidents. There are also funny bodily quirks and habits they may have noticed overtime. They are all unique histories that paint a picture of the individual.
What often goes without mentioning is what is happening on the inside. How do you feel about yourself? How is life at home? Are you able to speak your mind or stand up for yourself or say "no"? How do you handle stress? What are some beliefs you've held onto since childhood? What are past traumas or stressful events in your life that you feel are significant or affect you today? Are you an active player of your life or a passive recipient? Do you believe you have the potential to get better? Are you able to self soothe when you feel anxious or depressed? When an injury or incident occurred that started a painful response, were you scared, angry, or resentful at the time? Are those emotions still raw today?
Yes, these insights are out of my wheelhouse...but not completely. You see, well-discussed in the research is the relationship between chronic pain and trauma. The majority of research specifically focuses on childhood trauma or Adverse Childhood Experiences (ACE) and its relationship to chronic pain. Our brains and bodies have a wonderful gift of being able to modulate pain, meaning it can dampen down the pain response with good coping mechanisms, but we aren't great at doing that if we are chronically in a flight-fight-freeze response with increased levels of cortisol for prolonged periods of time. This is also affected by poor quality of sleep (which often comes with stress) and inflammatory lifestyle habits but that is for a different blog post. What can poor pain modulation look like physically? Some examples are IBS, autoimmune diseases, chronic pain, chronic fatigue syndrome, pelvic pain, neck pain, and fibromyalgia.
Let me emphasize that there is never one explanation for everything. We are much too interesting and complicated for one explanation. An old ankle sprain might continue hurting for years not because you lost your childhood dog just before it happened but because the proper biomechanics were never restored. What is important to note is that we mustn't forget the entirety of ourselves, even when symptoms are manifesting as physical.
Western Medicine is getting better at respecting this concept of the mind/body connection with a push to treat patients using the "biopsychosocial model". This means treating the whole person and not just the area of concern. Sadly, the most this gets discussed is usually with a question about depression or suicidal thoughts on an intake form and then never addressed further. Short appointment visits do not leave room for the hard talks that take more time.
There are clues that people exhibit when they are not necessarily living in a state of thriving such as poor eye contact, closed-off or protective posturing or body language, poor vocalization, chest breathing, and using a certain type of language when they describe themselves or events. When I see these clues, I gently recommend patients to seek therapy from a therapist or counselor alongside physical therapy, specifically someone who practices cognitive behavioral therapy (CBT) or if trauma is in their past (and let's be honest, we all have it), someone who practices Eye Movement Desensitization and Reprocessing (EMDR). Both of these treatment techniques have favorable outcomes in the research. Whether someone is actually receptive to this recommendation has its own challenges. Many people would rather avoid this type of work, which may be the most important work of their lives. It's not a matter of IF you have had trauma in your past but your thoughts and beliefs around the event that are still with you today.
In the bodywork world, we talk about the potential for clients/patients to have something called an emotional release. An emotional release can be crying, a deep sigh, laughing, or having a thought or memory that seems to come out of no where. This happens more often than you may think and it's nothing to be ashamed of. Anyone that has provided hands-on care for many years can tell you stories about emotional releases they have witnessed. One theory is that these are suppressed emotions or memories that are spontaneously released when a particular area of the body is touched. This area of the body is different for everyone. When this happens, it is incredibly important to have a therapist or counselor you can contact so that these releases can continue to be addressed in a safe and professional way.
All of this is to say, if you have chronic symptoms with minimal resolution, perhaps the psychosocial component is the missing link to be addressed.
Would you like to learn more? Three great books about this topic are The Body Keeps the Score: Brain, Mindy, Body in Healing of Trauma by Bessel van der Kolk, When The Body Says No: The Cost of Hidden Stress by Gabor Mate, MD; Cured: Strengthen Your Immune System and Heal Your Life by Jeffrey Rediger, MD
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