By: Jenna Csont
Exploring the link between persistent pain, trauma, and the vital need for a whole-person approach to healing.
*This blog does not override advice or recommendations from your medical team. In the case of ongoing pain or persistent trauma symptoms, it is vital to check in with qualified healthcare professionals to guide your course of treatment.
Challenging our Understanding of Pain
One area I became fascinated with learning more about during my training to become a Yoga Therapist was working with those in pain. Early in my teaching career, I noticed that in almost every class I taught, someone would approach me asking about their pain and whether certain movements were safe.
As a non-medical professional, it felt entirely out of my lane to make any recommendations other than “stop if you feel discomfort.” It was an uninformed and unsatisfactory answer that neglected inclusivity, especially as I began reflecting on the indisputable fact that it’s a universal experience that we all go through at some point, whether it be physical or emotional. The challenge in working with it, and maybe wherein some of the answer lies as well, is that we only ever see it through our own unique perception.
The western medical model has historically looked at pain primarily through a physical and diagnostic lens. We injure ourselves or fall ill and receive a step-by-step guide of what we need to do to feel better. But what happens when we follow those steps only to discover that our pain is still there, has traveled, or maybe even intensified long after our tissues heal? And what happens when we have pain and there’s no root cause to be found?
It’s essential to see specialists and to rule out any underlying conditions, but what happens when pain is still there, you’ve run all the tests, and there’s still no explanation in sight?
This is where I found Pain Care Aware. PCA was founded by Neil and Lisa Pearson, an amazing duo who have dedicated their lives to helping individuals thrive in the presence of ongoing pain (www.paincareaware.com). Their mission is to educate people from a whole-person perspective that recognizes the biological, psychological, emotional, and social factors that can all play into how our nervous system perceives and consequently responds to the experience of pain. Through training and mentorship with them, I came to realize yoga teachers could have a fundamental role in helping those who live with pain.
What exactly is pain? Well, it’s complicated. It’s an incredibly complex process involving hundreds of areas of the brain, including parts linked to our emotions. In essence, pain is a warning sign from the nervous system. It demands our attention so we can respond accordingly–by stopping or changing what we are doing. It’s a highly automatic and intelligent design aiding in our survival.
Think about when you touch a hot stove with your hand. When you contact the stove, nerve signals move from the body’s periphery to the brain via the spinal cord. However, you don’t feel pain until the brain decides this is important enough that you need to do something about it. There is a certain level of excitement nerves have to reach to respond and continue sending messages along to reach the brain (think about touching a warm stove vs. a really hot one). Once the brain registers that sensation is hot enough to pay attention to, you retract and move away from the heated surface. This all happens instantaneously without having to put much thought into it.
This fast response system serves us well in the case of acute pain caused by an injury or illness; however, when pain turns chronic, the story can sometimes start to change.
When Pain Turns Persistent
Chronic Pain is pain that goes on for a prolonged period, whether it be intermittent or continuous during that time. The timeline can be anywhere from 3 months to many years. It may sometimes stem from an initial injury or illness; however, it is also possible to experience prolonged pain without any apparent physical cause present. How does this happen?
There is an old saying, “what fires together wires together.” Every habit we learn anchors in the autonomic nervous system. When we repeat a pattern over and over, the brain learns to trigger the same neurons together and gets really good at repeating that pattern more readily. Think about learning to ride a bike. A lot of conscious energy goes into the initial process of learning.
Eventually, after practicing for long enough, you can hop on your bike and take off without thinking about each step involved. So when pain continues over a long period, it’s possible for pain receptors, also known as nociceptors, to become increasingly more sensitive and responsive over time. As sensitivity increases, the nervous system can keep sending danger signals to the brain or increase the frequency at which it’s happening long after the initial cause or threat has passed. When the nervous system continues to sense danger, and that pattern gets reinforced, it’s possible to experience pain with less and less stimulus over time, or maybe even when there is no stimulus at all.
What’s Most Important to the Nervous System?
Here’s a curveball, though–the spinal cord can allow messages to reach the brain, but did you know it can also block messages? The nervous system works on a priority basis, meaning it will pay attention to whatever it perceives as the most important thing at that moment.
For example, let’s take the classic hunched-over ‘desk posture’ we sometimes see if we have to sit at a desk for long hours during the day. We might not notice much while working, but later that evening, we find our back feels sore and achy. How does this happen? The priority of our nervous system may have been our work during the day rather than the posture we were holding ourselves in.
In similar fashion, someone who obtains a finger injury and is a professional piano player will most likely experience pain stemming from it much differently than someone who doesn’t rely on their finger dexterity for their livelihood. Our feelings and relationship towards our pain can play a huge role in how we experience it.
While going into the extensive science of pain is beyond the scope of this blog, it’s important to understand that several areas of the brain linked to emotional processing and our perception of the world and the self can play a role in how we experience it.
One such area is the thalamus. This area of the brain acts as a relay station for sensory information–it receives sensory information from other parts of the body and then sends it to other areas of the brain for further processing. It is also involved in our ability to regulate our emotions and can function much like a boom gate while communicating with other brain areas. It can help dampen our emotions so they don’t overwhelm us.
However, in the presence of persisting pain, it can misfire and become less effective in emotional regulation, leading to overwhelm. I’ve also seen this firsthand with so many of the individuals I’ve worked with over the years, where the experience of pain becomes so consuming that they start to identify with it. It becomes who they are instead of an experience they are having. Studies have also shown that physical and emotional pain can operate similarly in the brain.
Functional brain scans have shown that once pain signals reach the brain, 3 specific areas light up simultaneously: the limbic system (the emotional center), the sensory cortex (which governs sensation), and the cerebral cortex (which organizes thoughts and beliefs. (Source pg. 23-24 Freedom from Pain).
Think about it, how challenging is it to have pain without some emotional experience attached to it? This might look like “numbing out” and feeling like we need to ignore or push through pain signals. It might also look like fear and avoidance–immediately moving away from or avoiding anything that has the potential to increase discomfort. This dysregulation can keep us trapped in an all-or-nothing fear-driven approach that pulls us from being with our experience in the here and now.
When there is a threat to our survival our amygdala, sometimes referred to as the ‘fear center’ of our brain, lights up–often resulting in bracing actions or increased tension in the body caused by our fight or flight response–our response that mobilizes us into action when we need to defend ourselves or escape from a situation. When tension is persistent over time, it can start to perpetuate the very pain that we try to move away from. In the book Freedom from Pain, Peter Levine and Maggie Phillips discuss what they call the “pain trap”. They state, “First, we brace against the threat that caused the pain and then eventually against the threat of pain itself.” This can lead to a vicious cycle of our pain increasing our emotional experience and our emotional experience increasing our perception of pain.
We can see now that so many facets of our experience are involved in the picture of pain that gets created. We are complex! And we need to work not just with the pain itself but also with the beliefs and emotions we learn to embody over time as well.
So what does any of this have to do with trauma?
As Peter Levine also states, “Whenever chronic pain is not resolved even when reasonable treatment has been used, inevitably trauma is the missing link.”
Let’s pause there for a moment. First, it’s important to note that trauma and chronic pain are NOT one and the same. Having trauma does not automatically mean you will develop pain or vice versa, and yet research now supports that susceptibility to developing chronic pain conditions increases significantly in those who have experienced ongoing trauma. Chronic pain itself can also become a traumatizing experience.
What is Trauma?
Learning to better serve students experiencing persistent pain naturally coincided with expanding my understanding of trauma and the profound effects it can have on the body and mind. The more I worked with students on both a group and individual level, the more I saw the necessity to acknowledge and discuss the relationship between these very human experiences that so often go hand-in-hand—a common thread in all of their complexities: a dysregulated nervous system.
Through the study of ancient yogic philosophy and the works of modern-day somatic pioneers like Peter Levine, Stephen Porges, and countless others, I learned that we have to zoom out the lens and look at all of the layers of the self and how they interplay on our journey towards regulation.
Just like chronic pain, there are nearly endless emotional, psychological, and physiological factors to consider when defining trauma.
Trauma is a Complex Internal Experience
It is influenced by our external circumstances where we are brought (sometimes continuously) outside of our capacity to cope in response to a threat and are rendered unable to return to balance in the nervous system after the threat passes. During times of danger, we again see the amygdala (that fear center we mentioned) go into hyperdrive.
Stress hormones and muscular tension may increase as the body prepares to fight or flee. We may curl inward in fear and adopt a closed-off protective stance. At the same time, we see reduced activity in the prefrontal cortex, an area linked to our logical thinking brain and our ability to form cohesive memories and make sense of the world around us.
Ideally, once the nervous system recognizes a threat has passed, the body can metabolize our stress response and return to balance.
However, during traumatic experiences where we can not escape the threat, or we are exposed to threats over a prolonged time, we can get a build-up of the stress response in our nervous system, leaving us stuck in either an over-active or under-active state. We might notice bracing or tension; this might lead us to our next line of defense over time–immobility. This might feel like you are stuck in a frozen state, feeling numb or having an absence of sensation altogether.
Remember when we said the nervous system is incredibly good at recognizing and repeating patterns? When we are continuously pulled outside of our capacity to cope and cannot return to balance, whether from a single event or repeated instances, the nervous system can become increasingly more sensitive to stimulus over time–whether it’s a real or perceived threat. Sound familiar?
Let’s revisit that desk posture example one more time and look at how the nervous system can perceive it. While working, you might take on rounded shoulders, the head might float forward, and you may collapse inward, altering your center of gravity.
This description might also be resonant of the protective posture we take on when our defensive responses kick into high gear. Our nervous system notices patterns and tries to keep us safe; however, it doesn’t always know the difference between being under threat or being hunched over because we are doing work all day. Along with pain we might notice an increase in agitation, anxiety, or depression. The cycle of bracing, increased emotional response, more bracing, and more discomfort continues…
Breaking the Cycle
So how do we start to break out of this cycle? With so many options and at times conflicting information, figuring out where to start can be overwhelming. Body-based mindfulness invites us to start with compassionate awareness and discernment so we can start to challenge the generalizing that can happen within our nervous system. Remember, these responses happen automatically and it’s all in an effort to keep us safe! Compassionate awareness is shifting our judgments to curiosity and starting to name and label that which has often historically had no words.
Why Yoga Therapy?
The International Alliance of Yoga Therapists defines Yoga Therapy as “the professional application of the principles and practices of yoga to promote health and well-being within a therapeutic relationship that includes personalized assessment, goal-setting, lifestyle management, and yoga practices for individuals and small groups.” What initially drew me to Yoga Therapy was the whole-person perspective it emphasized. When creating wellness plans for individuals, YT asks that we consider not just the physical body, but also our energetic, emotional, intellectual, and spiritual body.
We acknowledge that all of these layers are in a constant state of flux and interconnection, each layer ultimately affecting all of the others. Trauma and pain can leave us feeling broken and needing to be fixed. YT reminds us that we are already whole and complete; sometimes we just have areas that need more attention.
Power in Connection and Community
1000’s of hours of training and 100’s of clients later, there is one crucial element I found when it comes to healing: we can not do it alone.
Nearly one year ago, I started working at Skyway. What drew me initially was the idea of working in a collaborative care facility where clients would have the opportunity to have a unique treatment plan comprised of many different treatment modalities to fit their specific needs. This opportunity has allowed me to see the direct impact and profound leaps collaborative care offers to those suffering; we are not one-size-fits-all, and there is no one right way.
We are also designed for connection. The idea of ‘every person for themselves’ has been packaged and handed to us for so long that we lose sight of our evolution towards social engagement. We are designed to lift each other up and lead each other back home in our darkest moments. There is infinitely more spaciousness and capacity for healing in the presence of a supportive community.
We can see now that there is no easy answer regarding the relationship between chronic pain and trauma or how we manage them; this is why it’s essential to have an individualized approach to healing that works with the sensations, emotions, behaviors, and core beliefs that envelop our experience. When we start to acknowledge that we are dynamic and complex individuals who are so much more than separate pieces, parts, and diagnoses, we open the window to true holistic change.