Injury and pain

Life can be limiting when you have experienced an injury and acute pain. Some people don’t fully recover from the pain and develop chronic pain. This can occur long after the injury has had an opportunity to heal. Sometimes the mind and body bounces back quickly and at other times it doesn’t.

Not all pain is related to an injury but can be connected to auto immune disorders such as fibromyalgia, rheumatoid arthritis, Crohns disease, lupus erythematosus (lupus), multiple sclerosis (MS), psoriatic arthritis, irritable bowel disease (IBS) and celiac disease. Not all pain is related to injury or surgery.

Pain is a very common disabling condition. It consists of physical, psychological, social, emotional, and cultural factors. Pain is unique to you.

Pain is historically linked to protection and safety. It is a perception that occurs in response to what the brain judges to be a threatening situation. To evaluate potential threats, the brain uses information from the body, along with previous beliefs and memories. In this way, pain is a protective response that can trigger useful changes in behaviour that protect from tissue damage or limit further harm. However, for some people, when pain persists for longer than the usual healing time, pain does not perform a useful function. This is thought to be driven by unhelpful adaptations in the pain producing system, for example, the brain.

Acute pain lasts for a short time (less than 3 months) and usually occurs following injury or surgery. Chronic pain is pain that continues beyond expected tissue healing time (usually 3 months) even after injured tissues are healed.

Physical pain usually begins with an injury (but not always), for example a ruptured disc in the back or neck, a torn muscle, a fracture or a significant ligament or tendon tear. Unfortunately, I can totally relate to this type of pain as I have ruptured a disc in my lower back, whiplashed my neck, fractured my ankle and foot, experienced grade three ligament tears of my feet, dislocated my shoulder more times than I want to think about and the same for my wrist.

I know and understand acute and chronic pain intimately. I also know that when my body and mind is under too much stress it responds by increasing my pain which in turn increases my fear of more pain which then increases the pain. I am aware that I need to unconsciously and consciously act to lessen both the pain and the fear.

I also witness this with clients who are experiencing significant emotional distress in their lives. Their pain increases in their body with the common places being in the jaw, neck, shoulders and back as well as the tummy.

In recent years there has been an understanding that stress has a significant role in chronic pain. Pioneering theorists and practitioners such as, Levine, Engel, Scaer and Rothschilds believe that one of the most common and damaging type of chronic stress is childhood abuse and neglect. However, it can occur in supposedly ‘normal’ families where everything may appear normal and happy on the surface but there is no real intimacy.

Another form of stress can come from witnessing or experiencing life threatening situations such as medical interventions, motor vehicle accidents, drownings or near drownings, sexual abuse during childhood, rape, assault, war, combat and being diagnosed with a life-threatening illness. The event usually involves intense fear, helplessness or horror. They may also be felt a long time after the event.

Those people who experience PTSD (Post Traumatic Stress Disorder) re-live the symptoms which can include physical pain. PTSD can also happen after non-life-threatening stressors such as being sued, emotional abuse and neglect, workplace bullying, an unexpected or expected death of a loved one. PTSD has also been linked to Fibromyalgia, Complex Regional Pain Syndrome and Temporomandibular disorders.

There are two things that stand out about chronic pain from research. If you have experienced severe stress, you are twice as likely to have health problems (e.g. heart disease, diabetes, fractures and occupational health problems). They also discovered that the more stressful events a person has experienced the greater the risk of pain and illness. Stressed people experience greater levels of pain compared to non-stressed people. In summary, traumatic stress contributes to pain.

Severe stress is much more common than was previously believed and traumatic stressors are found in approximately 50% of people. Chronic pain is also stressful as it impairs so much of daily life.

One of the strongest forms of stress involved in pain is psychological trauma. Traumatic stress involves symptoms of physical and emotional distress which can include physical pain. The more traumatic events you experience, especially if combined with childhood neglect, the more likely you are to develop chronic pain.

Many injuries are related to an event that has caused the injury and pain in the first place. These events can be traumatic. One of my clients fell down a flight of stairs and sustained serious injuries. After the physical injuries were healed, he experienced life-limiting/work limiting fears of heights, stairs, lifts, escalators and anything new. His body had stored the trauma of the event and the following pain and distress, as well as helplessness and fear.

His nervous system had learnt to adapt by avoiding any situation that caused fear like the emotions and pain he felt when the event occurred. Over time, with EMDR (Eye Movement Desensitization Reprogramming), EMIT (Eye Movement Integration Therapy) and Clinical Hypnotherapy he gained the confidence to challenge the fears and returned to work able to perform his role. I have worked with many clients who have been in major motor vehicle accidents, slipped near trains, fallen off motor bikes, fallen from a helicopter, fallen from roller skates/skateboards and do very similar work to support them to recover from their fear and pain.