Trauma is an under-recognized risk factor for chronic pain, whether that pain is associated with a chronic illness such as rheumatoid arthritis or fibromyalgia, or is an isolated or primary symptom such as migraine headaches, stomach pain or low back pain. What’s helpful and encouraging about knowing there is a connection between chronic pain and trauma is that there are ways of working with the long-term impacts of trauma. This includes adverse childhood experiences (ACEs), described below. Many of us with chronic pain may have been working diligently without making much headway and understanding the role of trauma provides a whole new set of powerful tools, including trauma therapies that incorporatethe body to help reduce and shift the body’s danger signals that can drive pain in the first place (see more in 16 Tools for Healing and Find a Therapist and at the bottom of this post).
I was invited to speak as part of a Pain Education webinar series hosted by Madeleine Eames, MSW of the Bill Nelems Pain and Research Center in British Columbia. A focus of theirs is on educating about a more comprehensive paradigm that recognizes chronic pain as being associated with a central sensitization that links to the nervous system rather than to the specific area of pain. They are clear about how trauma is not “in your head” and is a real phenomenon. Over 70 people attended the webinar live, and engaging with those of you in the chat was fantastic. You can watch or listen to the webinar below and also on their website.
In the video I share
- some of my story
- an example of chronic pain that my husband worked through and was surprised with what he discovered
- a few slides that help make sense of onset triggers
- the concept of “latency periods”
- the importance of learning how to listen to our bodies
The information below is a supplement to the video addressing some of the questions I didn’t get to.
Supplemental Information
Trauma and Chronic Illness
The link between trauma and chronic illness is something I share throughout my blog and has a surprising amount of research supporting it. This also validates the role of trauma in chronic diseases that have an important component of pain, such as autoimmune diseases like rheumatoid arthritis and lupus (1)Ploesser, M., Silverman, S., Diaz, J. D. L., Zincke, M. T., & Taylor, M. B. (2024, Sep 21). The link between traumatic stress and autoimmune rheumatic diseases: A systematic scoping review. Seminars in Arthritis and Rheumatism, 69, 152558. https://doi.org/10.1016/j.semarthrit.2024.152558, and fibromyalgia (2)McBeth, J., Macfarlane, G. J., Benjamin, S., Morris, S., & Silman, A. J. (1999, Jul). The association between tender points, psychological distress, and adverse childhood experiences: a community-based study. Arthritis and Rheumatism, 42(7), 1397-1404. Military veterans with PTSD also have a higher risk for chronic illness (3)Ploesser, M., Silverman, S., Diaz, J. D. L., Zincke, M. T., & Taylor, M. B. (2024, Sep 21). The link between traumatic stress and autoimmune rheumatic diseases: A systematic scoping review. Seminars in Arthritis and Rheumatism, 69, 152558. https://doi.org/10.1016/j.semarthrit.2024.152558.
Chronic Pain and Trauma: OVERT Events
Adverse Childhood Experiences (ACEs)
There is a clear association between chronic pain and trauma. There were a number of questions in the chat by those attending the webinar who wondered whether specific types of experiences in childhood might be considered traumatic or a risk factor for chronic pain. Below are examples of what can constitute trauma. If you had experiences that felt overwhelming, that felt wrong and that you could not escape, or where you did not have enough support or someone who believed you and protected you, this was likely a traumatic event.
Trauma in childhood includes the 10 Adverse Childhood Experiences also known as ACEs before your 18th birthday (4)Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998, May). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245-258. https://doi.org/10.1016/s0749-3797(98)00017-8:
- any form of abuse (physical, emotional, sexual)
- emotional or physical neglect
- loss of a parent
- a parent or other adult caregiver with a mental illness, including depression
- an adult caregiver who abuses alcohol or drugs
- witnessing violence between your caregivers
- someone in the household being incarcerated
Other Overt Adverse Childhood Experiences: ACEs +107
A common question during the webinar was whether adverse experiences other than the 10 ACEs might be risk factors. I felt this way when I first took the ACE survey and thought my ACE score was 0 out of 10. There are all kinds of other experiences that can be traumatic for a child. I referred to these in the video as “Missing ACEs.” I have created a detailed new survey I call “ACEs Plus 107” that currently has 77 other kinds of adverse experiences that influence health.
The following are examples of these other Overt types of trauma in childhood:
- bullying
- witnessing death
- death of a parent or someone else close to you
- natural disasters
- accidents
Chronic Pain and Trauma: COVERT Events
Developmental trauma, which I refer to as adverse childhood relationship experiences (ACREs), is the most invisible kind of trauma. It can be easy to dismiss or overlook and is about experiences that were missing such as protection, comfort, safety, nurturing kindness. ACREs are a risk factor for chronic illness (5)Ploesser, M., Silverman, S., Diaz, J. D. L., Zincke, M. T., & Taylor, M. B. (2024, Sep 21). The link between traumatic stress and autoimmune rheumatic diseases: A systematic scoping review. Seminars in Arthritis and Rheumatism, 69, 152558. https://doi.org/10.1016/j.semarthrit.2024.152558, and chronic pain (6)Nicolson, K. P., Mills, S. E. E., Senaratne, D. N. S., Colvin, L. A., & Smith, B. H. (2023, 2023/06/01/). What is the association between childhood adversity and subsequent chronic pain in adulthood? A systematic review. BJA Open, 6, 100139. https://doi.org/https://doi.org/10.1016/j.bjao.2023.100139.
Experiences of developmental trauma include (7)Nicolson, K. P., Mills, S. E. E., Senaratne, D. N. S., Colvin, L. A., & Smith, B. H. (2023, 2023/06/01/). What is the association between childhood adversity and subsequent chronic pain in adulthood? A systematic review. BJA Open, 6, 100139. https://doi.org/https://doi.org/10.1016/j.bjao.2023.100139:
- emotional neglect
- “affectionless parenting”
- loss of a parent
- overprotective parenting
Attachment trauma and ACREs increase risk for experiencing pain such as the following (8)Puig, J., Englund, M. M., Simpson, J. A., & Collins, W. A. (2012, Jul 23). Predicting adult physical illness from infant attachment: A prospective longitudinal study. Health Psychology, 32(4), 409-417. https://doi.org/10.1037/a0028889:
- chest pains
- dizzy spells or fainting spells
- migraine headaches
- persistent skin troubles
- recurring stomach trouble, indigestion, diarrhea
- sciatica, lumbago, or recurring backache
Discrimination and Chronic Pain
Approximately 25% of children experience chronic pain in the US. The strongest associations between chronic pain and trauma in children were for 3 kinds of experiences in particular, all of which are easy to overlook given how common they are (9)Groenewald, C. B., Murray, C. B., & Palermo, T. M. (2020, Sep-Oct). Adverse childhood experiences and chronic pain among children and adolescents in the United States. Pain Rep, 5(5), e839. https://doi.org/10.1097/PR9.0000000000000839:
- financial instability in the household (this is an ACE)
- discrimination based on race
- living with an adult that has a mental illness (this is an ACE)
Dose of Trauma Affects Severity of Chronic Pain
Dose refers to the amount of exposure one has, such as to trauma. Studies have learned the following about chronic pain and trauma (10)Ploesser, M., Silverman, S., Diaz, J. D. L., Zincke, M. T., & Taylor, M. B. (2024, Sep 21). The link between traumatic stress and autoimmune rheumatic diseases: A systematic scoping review. Seminars in Arthritis and Rheumatism, 69, 152558. https://doi.org/10.1016/j.semarthrit.2024.152558:
- Higher “dose” of adversity links to more pain sites and greater severity of pain
- 75% of adults with chronic pain experienced childhood adversity
- Pain is a common symptom after experiencing violence in childhood
- Sexual abuse can be associated with pelvic pain in adults (and other pain)
Healing Chronic Pain and Trauma
The important takeaway from understanding the role between chronic pain and trauma is that it offers a whole set of new tools and a huge context for beginning to make sense of symptoms as well as flares. This makes it easier to more effectively use all the other tools that you have likely gained for working with symptoms, from mindfulness to nonjudgment, to yoga or relaxation exercises or stress reduction or all of these together. There are a large number of ways of working to heal trauma and the process is to find what resonates best with you.
The process leading to chronic pain and chronic illness takes place over many years and often decades, likely beginning in our earliest years and possibly initiated even in the womb or when we were just toddlers. Our health is also influenced by our parents’ trauma and trauma in our lineage (the Holocaust, enslavement, genocide and more). As such, do not get discouraged if this process of healing takes time. It likely took a long time to evolve and it can take time to begin to heal and shift.
Take your time. Learn. Be compassionate with yourself. Give yourself space to find your way.
- 16 trauma informed tools for healing nervous system perceptions of threat
- Books on Trauma and Chronic Illness (see also John Sarno for chronic pain)
- Find a therapist and learn about therapies for healing trauma
- A Guide to Nervous System Perceptions of Threat, which drive symptoms
- You can explore the role of trauma in chronic pain in a Consult with me
References
Thank you very much for an informative interview!
Your extension of the original ACEs is invaluable. Psychologist Janina Fisher points out that trauma is relative to an individual’s vulnerability. It therefore makes sense that babies and children are affected more intensely by events or living conditions that they perceive as threatening.
My sister, who had suffered childhood and adult trauma, was diagnosed with fibromyalgia in her late thirties, then rheumatoid arthritis, and finally also Sjögren’s disease. She finds TRE (Tension and Trauma Releasing Exercises – developed by David Berceli) useful to down-regulate the stress response in the body. It evokes an involuntary trembling in the muscles that is very relaxing.
Wishing you the best with your important work and own healing process!
Hi Katriena,
I’m so glad it felt so helpful! Yes to what Janina Fisher says and the role of these early adversities. It’s really great that there are so many tools available, including TRE. Thank you for the best wishes and I send you / your sister the same!