Chronic Pain, Trauma and EMDR

It is a powerful word that triggers strong emotions such as pain, fear, helplessness, panic and even grief. If you are one of the millions of patients struggling with pain as you read this sentence, you are definitely not alone. Two-thirds of people today live in significant amounts of pain for more than five years. The highest percentage of all doctor visits are made in search of pain relief. But this salvation is often not easily found.

In its purest form, pain and suffering are part of our natural survival system; it warns us that something is wrong and makes us pay attention to our body. That is, pain is a signal that first and foremost informs us that we are injured or sick. Pain also results from tension and discomfort about how we respond to a stressor or threat. When we are physically, emotionally or mentally threatened, our nervous system automatically kicks in to protect us from injury and harm.

When it comes to pain, we can talk about three basic pains; physical, emotional and post-traumatic. Physical pain is caused by an injury or damage to tissue. Emotionally based pain is caused by strong, unresolved emotions; we store them in our body and cannot express them in a healthy way. Finally, post-traumatic pain results from our stronger responses to distressing, frightening, and painful events. While these three classifications have visible differences, one of the keys to coping with pain requires recognizing that these three basic types are intermingled. Therefore, pain is multidimensional.

You may be surprised to discover that emotional and physical pain work the same way in the brain. Functional brain scans (MRIs) measure brain activity and have shown us that when the pain signal reaches the brain, three specific areas light up simultaneously: the limbic system (emotional center), the sensory cortex (governs the senses), and the cerebral cortex (thought regulates beliefs). That is, an ongoing pain has an emotional component, a sense, and physical pain/pain, thoughts and beliefs that interfere with healing, and these often increase the pain.

What has not been adequately addressed in solving the pain puzzle is unresolved trauma in the body. According to research, physical pain/pain occurs not only as a result of a physical injury, but also as a result of stress and emotional problems. Post-traumatic stress disorder (PTSD) patients are prime candidates for developing chronic pain.

There are many theories about what trauma is. Many definitions focus on the traumatized person’s encounter with one or more real (or perceptual) events that threaten their survival or physical integrity, and their responses include strong negative emotions such as fear, helplessness, loss of control, and/or horror. Traumatic events are simply of two types; a single event (an accident or injury) or multiple and ongoing events, such as those who experienced emotional, physical, sexual abuse and/or neglect as a child.

The difference between wild animals and humans, expressed in trauma terms, is that animals complete their flight-or-fight response so that they either fight the threaten or flee from the source of the threat. Then, right after that, they get rid of the effects of stress residues with shaking and shaking movements. We humans, by contrast, cannot usually run or fight and are conditioned not to give our bodies time to “empty” after the threat. That’s why we often freeze. When the remnants of the fight-flight or freeze responses are not discharged from the body, it leaves us in that elevated and inhibited physiological state. We suppress our need to fight or flee in order to reintegrate into society (society often gives us the message of “get over it”). This avoidance creates more physiological blockage, psychological disconnection, and these are the basis of many pains.

An important aspect of trauma is the threat response. The threat of danger calls us to action and activates the classic flight-or-fight systems we talked about earlier. If this threat is potentially deadly or impossible to escape, our third natural response to the threat is to freeze. When we are stuck in this situation, we feel stuck in our lives, unable to move forward. The rupture does not remove fear or pain, but it erects protective walls for us to feel them. It also reduces our capacity to feel pleasure and think clearly. Disconnection prevents us from being in the here and now.

When working on chronic pain, it is useful to look at the interaction of trauma with pain in two main ways. One is to focus on trauma that may have started with the pain problem; this could be an accident, injury, assault or illness. The important thing here is to realize that the pain itself can be traumatic, which is the second important way. One of the worst things in the human experience is pain, and accordingly fear can be endless and very disturbing.

So how does normal, necessary pain turn into chronic pain?

Self-regulation is not achieved through the following mechanisms after the three major trauma responses, flight, fight, and freeze:

  • Rupture

  • Anxiety, fear and panic

  • helplessness and despair

  • Anger, rage and irritability

In our experience, the first antidote for people struggling with pain and trauma is learning how to regulate emotional and sensory experiences and minimizing the effects of these emotions on their bodies by allowing the limbic fear and anger systems in the amygdala to calm themselves, that is, by regaining their ability to self-regulate.

So how do EMDR and chronic pain intersect? First of all, I would like to start with a brief explanation of the EMDR process.

Eye Movement Desensitization and Reprocessing is one of the therapy methods that has attracted a lot of attention in recent years. EMDR is an innovative therapy method that facilitates information processing and integrates parts of traumatic memories. EMDR is an innovative therapy method that combines well-known different approaches such as psychodynamic, cognitive, behavioral and client-centered approaches. It is listed among the first-line treatments for PTSD in various guidelines.

By applying the Adaptive Information Processing model with EMDR, the disrupted processing of memories is overcome, by facilitating the information processing processes, the integration of traumatic memory fragments is ensured, and the situation causing psychopathology is improved.

The Adaptive Information Processing model is based on the non-functional storage of unprocessed information in the brain. Information unchanged in the ‘frozen’ memory system; It has been stored at the neurobiological level without any connection or adaptation to any other information. The aim of this process; It is the coding of previously experienced traumatic experiences by linking them with the current problem.

Since Engel (1959) stated that traumatic experiences are permanently recorded in the person’s body as memories of pain, it has been accepted that pain and trauma are related. Successful EMDR studies have been published, especially for phantom pain in war veterans (Wilensky 2006). Studies in war veterans have emphasized the improvement of PTSD symptoms and pain, as well as recovery towards loss and grief (Schneider J 2008).

The trick to healing pain is to understand and work with body responses. By cultivating body awareness and maintaining your sense-based focus, you learn to become familiar with and move between trauma-based senses. This “familiarity” is an important capacity, as those dealing with pain and trauma often see their bodies as the enemy – it also provides opportunities for our vitality. Embodiment creates connection, reducing your need to disconnect and escape from your body.

Trauma is considered the fourth path to enlightenment after meditation, sex, and death. When you are freed from the clutches of suffering and the traumas of past events, we regain all instincts and energies that are trapped in the prison of collapse and limitation are released. Healing from trauma means rediscovering the lost parts of ourselves that allow us to feel more complete and whole; maybe we’ll discover it for the first time. Then we come alive and begin to struggle, we can be liberated from the suffering of being broken.

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