Psychological trauma plays a significant role in the development and persistence of chronic pain and classic psychotherapeutic approaches are often inadequate to treat these conditions.
The psychotherapeutic interventions usually used with patients affected by chronic pain had long focused mainly on dysfunctional coping strategies and maladaptive behavioral patterns. This left completely unseen the influence that distressing or traumatic life events and emotional distress can have on the sensation and processing of pain.
Physical pain is not just about the sensitive experience of pain but generally comes with a significant emotional dimension. This is because the neuronal systems involved in pain perception and processing are entrenched with emotional information.
This emotional charge not only determines fundamental aspects such as how severe or distressing a pain is felt, but also significantly influences its persistence.
What emotions have to do with physical pain?
There is a strong overlap between the pain network with the emotional processing regions of the brain. In fact, the experience of pain is the resulting from the activity of the cells that transmit the pain signal (the nociceptors) to the brain and emotional processes together.
The sensation of pain can also be triggered by other types of information, such as feelings, attention, memories, and we can still feel pain even in the absence of a physical stimulation to pain receptors.
Let’s think for a moment at phantom limb pain: this is the case where a person continues to be in pain years after an amputation, and the pain comes from a body part that no longer exists.
Nevertheless, due to the longstanding and profound prior experience of pain, a kind of “pain memory” has remained unprocessed, and now continuously “recalls” the pain.
Along with the pain-processing system, the human nervous system also possesses a complex of endogenous pain regulation system.
This system is able to block the perception of pain and act as a filter for informations coming from the body, so that we don’t perceive pain as we stand, sit, or jump, and in extreme situations we are temporarily unable to feel pain.
This system can be disrupted with an extreme amount of stress or a trauma, and lead to the situation that stimuli that aren’t usually painful can no longer be filtered out and thus become painful.
This is why after psychological trauma, chronic pain is a common symptom.
What chronic pain has in common with PTSD:
Chronic pain is highly comorbid with PTSD. Chronic pain is reported by 25 to 93% of patients with PTSD which is 2 to 5 times the rate of chronic pain in the general population. In addition, high rates of PTSD ranging between 22 and 49% are found among patients with chronic pain which is 2 to 4 times the rate of PTSD in the general population.
In other words, post-traumatic stress disorder and chronic pain syndromes coexist beyond the simple random datum, which means that there is a very close link between these two syndrome.
Pain represent a somatosensory symptom of PTSD, like a pain-flashback, in the same way the disfunctional or incomplete processing of traumatic episodes in PTSD manifests through flashbacks.
The fact that pain can become chronic through maladaptive or incomplete emotional processing of traumatic experiences, or even memories of physical traumas, has stimulated the research in the use of EMDR therapy in the treatment of chronic pain syndromes and phantom limb pain syndromes and the results are remarkable.
How EMDR therapy works with chronic pain?
The brain’s information-processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of pain memories, the pain can stick, causing intense suffering.
The memories of distressing and painful events often appear as “frozen” in the nervous system. All the images, thoughts, feelings, body sensations, sounds or smell that one has recorded during the distressing situation appear as they were still happening.
Bilateral stimulation, that represent the core of EMDR therapy, allows the brain to unblock the incomplete processing and proceed in the functional storage of these memories, reducing the emotional and physical edge that characterize them.
EMDR therapy for chronic pain starts with a thorough history taking, to assess and identify any traumatic event in the past, particularly if pain-related.
Many cases of chronic pain result from surgical procedures from accidents, life saving surgeries, cancer treatments, etc…
During this phase the patient is provided with plenty of informations about the connections between trauma, pain, and emotional response.
After that, reprocessing of those experiences starts.
At first we will be targeting the most emotionally distressing memories until the amount of distress related to these memories drops down and reach the miminum/zero level.
At this point the patient is already perceiving the benefit from EMDR therapy, in many aspect of life. Afterward, current or remaining pain sensations are targeted and reprocessed.
EMDR will stimulate the pain-processing system in a way that dysfunctional pain memories will be adaptively resolved. At the end of this stage, pain will be significantly reduced or dissipated, and the primary goal of therapy will be achieved.
For completing the treatment and reassure for future relapses, a final stage will focus on future templates: how the patient will be facing future issues and potential pain triggers.
This part of EMDR therapy is very important to develope functional coping strategies for the future and to consider therapy really closed.
It is important that you always keep in mind that when using EMDR, your own brain causes the
healing. Your nervous system knows just what to do and what it needs. It is therefore not necessary to do or change anything actively!
Just let whatever happens, happen!