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October 22, 2014
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Past traumas and present-day pain; Traumatic stress and chronic pain are sometimes connected

By TOM RUE, MA, LMHC, CASAC

Between 2008 and 2011, the Centers for Disease Control reported on the impact of adverse childhood experiences (ACE). Collectively known as the ACE Study (www.cdc.gov/violenceprevention/acestudy/), these reports uncovered a link between childhood trauma and the chronic diseases people develop as adults, as well as a variety of social and emotional problems. This includes heart disease, lung cancer, diabetes and many autoimmune diseases, as well as depression, violence or being a victim of violence, or suicide.

Many women, and more men than might be generally assumed, who suffer chronic physical pain were sexually abused as children. Many others experienced physical or verbal abuse during their youth.

There can be little doubt that traumatic experiences in childhood invite chronic pain during later life and can lead to lasting psychiatric conditions including flashbacks to the original experience (a symptom of Post-Traumatic Stress Disorder, or PTSD), mood and anxiety disorders, sexual problems in adulthood, issues of intimacy, emotional numbness, impaired body image, or low self-esteem, made worse by a vicious cycle of negative thoughts, self-talk and beliefs. Changing these thought patterns and perceptions can lead to shifts that are both subtle and radical in how one experiences the world and relationships. Life can improve.

Addressing learned coping skills

Everyone feels pain differently. Some can readily cope with a degree of discomfort that others may find unbearably severe. It comes down to learning.

Victims of traumatic or deeply confusing events in childhood may use coping skills, whether learned in childhood or later as adults. Some may use alcohol or other drugs to numb or self-medicate feelings of sadness or pain—whether physical pain, psychological or spiritual—that otherwise seems intolerable. Alcohol or drugs may seem to work for a while, but addiction tends to spiral out of control.

Another method some survivors may have used to get through otherwise intolerable experiences is to “zone out”—a mental defense known as dissociating. One whose personhood and dignity have been repeatedly assaulted with fists, weapons, unwanted penetration or molestation, severe emotional or verbal violations, may learn to turn off cognitive process, psychologically blocking out what is occurring. This leads to a split between mind and body. These are issues that can be addressed in therapy.

Your pain is real

To say that pain’s cause may be related to learned coping skills, which were first adopted to survive trauma, does not mean physical suffering and related functional impairment are unreal or “all in the head.” Your pain is real. However, ways you used to respond to emotional or physical distress might no longer work for you as they once did. Now they may make things worse.

Tension or migraine headaches, pelvic inflammation, sexual dysfunction in women and in men, certain cancers, fibromyalgia, irritable bowel syndrome, acute anxiety attacks, to name a few, may feel excruciating and seem never to let up. Such illnesses and emotional effects can take a toll on intimate relationships, parenting, work performance and how you take care of your body and soul.

Many health problems, including those listed here—as well as obesity, addictions, promiscuity, violent behavior, and many more—can be seen as personal solutions (coping methods) to cope with unrecognized adverse childhood experiences.

But there is hope.

Treatment involves body, mind and spirit

The genuine painful consequences of abuse may present themselves differently. Health care providers who focus on curing bodily organs and systems may sometimes have trouble pinpointing the root cause of pain, paralysis, seizures, or loss of feeling or consciousness, if faulty psychological coping mechanisms learned from abuse remain unrecognized.

The spiritual and emotional injuries of sexual and physical abuse may express themselves in adults in the form of genital or pelvic pain, or other functional impairments. When recognized, these maladaptive responses can be changed. Letting go of shame and summoning the courage to talk about personal topics can start the healing of such wounds.

Medical diagnostic testing and recommended treatments are the first-line approach to chronic pain and functional disorders, and well they should be. At the same time, if one was abused as a child or not, cognitive behavioral therapy has been found to be effective in helping to cope with or manage pain. Antidepressants or other psychiatric medications prescribed by a psychiatrist or primary-care provider help some people stabilize chronic pain syndrome, but can also sometimes lead to problems themselves.

Decisions about use of medications and other methods to manage pain and mood or anxiety disorders require two-way communication between the patient and doctor, honest attention to the hazards of over-reliance on prescribed opioids or other unprescribed drugs, or abuse of alcohol. Mental health counseling around these issues can also help.

Conscious daily choices can and will bring positive changes to your life.

Choosing to do something different with yourself is the first step to healing.

[Editor’s note: The River Reporter welcomes Tom Rue, a professional counselor since 1985, to our monthly health pages. Rue is a licensed Mental Health Counselor in New York State, a certified Clinical Mental Health Counselor by the National Board for Certified Counselors, an AMHCA Diplomat and Clinical Mental Health Specialist in Substance Abuse and Co-occurring Disorders and a professional member of the American Psychosocial Oncology Society. He is also a credentialed Alcoholism and Substance Abuse Counselor with a private practice in Monticello known as Choices Mental Health Counseling PLLC. Rue is reachable at 845/513-5002 or www.choicesmhc.com.]