When Chronic Pain is Trauma: Processing Chronic Pain Memories from a Trauma Framework

The Last Days 506

This past December, I spent a long time processing the year 2014. One of my intentions was to think through my best and worst memories from the year, but when the time came to process everything and write about it, I felt stuck. I have said it before, 2014 was a rough year. Processing everything that happened felt overwhelming, and I didn’t know how to start.

After some thought, I am seeing the benefit of processing chronic pain memories from a trauma framework. To be honest, I have not found any empirical research to support this. When connecting chronic pain and trauma, almost all of the literature is solely related to traumatic events that directly or indirectly lead to chronic pain.

But, I have always seen another correlation. I believe that chronic pain can be trauma in and of itself.  Sometimes trauma does not create chronic pain; sometimes chronic pain is the trauma.

In her landmark book Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror, Judith Herman defines psychological trauma in the following way. Bold parts are my own, indicating what also seem to describe the experience of severe physical pain.

“Psychological trauma is an affliction of the powerless. At the moment of trauma, the victim is rendered helpless by overwhelming force. When the force is that of nature, we speak of disasters. When the force is that of other human beings, we speak of atrocities. Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection and meaning.

Traumatic events are extraordinary not because they occur rarely, but rather because they overwhelm the ordinary human adaptations of life. Unlike commonplace misfortunates, traumatic events generally involve threats to life or bodily integrity, or a close personal encounter with violence and death. They confront human beings with the extremities of helplessness and terror, and evoke the responses of catastrophe. According to the Comprehensive Textbook of Psychiatry, the common denominator of psychological trauma is a feeling of ‘intense fear, helplessness, loss of control, and threat of annihilation.’”

I believe there are strong correlations between the actual experience of trauma and the actual experience of chronic pain. There are times when chronic pain is trauma, and this correlation can help us understand how to better process chronic pain memories. When it comes to difficult or traumatic events, the manner in which we remember things and the way in which we process memories can make the difference between remaining stuck and moving forward. Put in simplistic terms, there are three tasks that must be accomplished to effectively process difficult memories.

Task 1: We Must Find Balance by Remembering Both Good and Bad Memories.

Are you a glass half full or a glass half empty kind of person? Some people seem to approach life with an overflowing level of optimism. Looking back, these optimistic folks are keen to remember the good times and the blessings. They tend to ignore, push aside, forget, or diminish the bad things that happened. This often works well for a time, but the bad memories can only be pushed down for so long. They eventually resurface with the realization that they were never dealt with.

Other people approach life with a constant and underlying sense of pessimism. The only memories they naturally recall are the bad ones, and they become bogged down in a pit of darkness and depression. They begin to believe that nothing good ever has and ever will happen to them. They leave out important aspects of their story, rewriting history to include only the bad and only the painful.

The first goal is for our memories to be balanced and to align with reality. It is dangerous to remember just the bad, and equally dangerous to remember just the good. To move forward, we must see things as they are.

Task 2: We Must Connect Events, Emotions, Physical Sensations, and Core Beliefs 

One of the hallmarks of trauma is its tendency to separate various aspects of our being and experience in such a way that we are unable to connect what we are feeling with what we have experienced, what we believe with what we physically felt. And ultimately, we are unable to bring all four of these pieces into an integrated whole.

This is the reason traumatized individuals will sometimes speak of horrific experiences with no emotion. The experience and the feelings have not been integrated. Or perhaps they remember the physical sensation of terror, the way in which the hair on their neck stood on end, but are unable to tell you an actual narrative of what happened. At times, they are able to state exactly how they felt and what they experienced, but are unable to fit these into a framework of what they believe about life.

In the process of healing and remembering, somehow, each of these aspects of our being and experience must come together as a collective whole. 

Task 3: We Must Create and Process Meaning 

Finally, to move forward, we must be able to create and process meaning from our integrated memories. We can only get so far by being able to simply state what happened, what we felt, what we believed, and how these all connect. If we can do all these things but are unable to move forward in meaning, we will remain stuck.

The individuals who are more often able to process, heal, and eventually move forward are the ones who experience what is sometimes termed post-traumatic growth. This is the experience of taking our trauma and pain, and instead of allowing it to break us, we use it as a stepping stone to move forward in ways that would never have been possible if the trauma had not occurred. This does not make the trauma a good thing, an easy thing, or a quick fix. It is not an attempt to minimize the pain or belittle the traumatic experience.

It simply means that we take what is horrible and use it in ways that empower and help ourselves and others.  It is a process of taking all of the muck and garbage of our lives and somehow recycling it into something new, useful, and perhaps even good.

For many who experience ever-present and reoccurring trauma – which will often be the case in traumatic pain and illness – these three tasks must be continually addressed and readdressed, as we constantly deal with new aspects and perhaps progressively severe manifestations of traumatic pain.

An Example of Moving through the Tasks 

I will use a simple illustration as an example – my experience with work in the midst of chronic pain. I would not label this particular example traumatic – difficult would be a more appropriate term. But, I do believe it is a good example to illustrate my point so it can be used to process other difficult and traumatic memories.

Task 1: When I look at my job situation last year, both good and bad things happened. 

The Bad: I had to quit a job that I loved because it became too physically difficult for me to sustain. I agonized over the decision for weeks. When I eventually decided to quit, I remember sitting in my boss’s office, telling her I was quitting and the look of disappointment on my face. I drove home in tears, certain I had made the wrong decision.

The Good: I was able to keep my other job, and I can still work a few hours each week. The work that I do is much less than I desire, but it is also meaningful.   

Task 2: When I think through everything that happened, I recognize clear events, emotions, physical sensations, and core beliefs. 

Events: I quit one job, but kept the other for a few hours a week. 

Emotions: I felt heartbroken that I would need to leave my clients, especially several children who had grown quite attached to me. I felt guilty for leaving when the clinic was short on staff, and also general guilty that my pain was keeping me from working. I felt sad because I was leaving a job that I loved. I felt relieved that I didn’t have to quit both of my jobs and that I would have a break from so much work. 

Physical Sensations: The weeks before making the decision, my muscles felt tense from anxiety and feeling uncertain of the right decision. I felt flushed when I told my boss I needed to quit and cried on my way home from work. 

Core Beliefs: If I quit my job, I will be a failure. I should be able to do more, so maybe I am not trying hard enough. To be happy, I have to be able to work like other people do.

One Integration of Many: My guilt, belief that I was a failure, muscle tension, and quitting my job were all connected. Because I believed that quitting my job would make me a failure, I felt guilty, which also led to the physical response of my muscles tightening and becoming tense. 

Task 3: To move forward, I am working on creating meaning. 

Meaning 1: I don’t have to work to be valuable. My core belief that I am a failure needs to change, which in turn can alleviate my guilt and begin to release my muscle tension.

Meaning 2: I can find other means of work that I am physically capable of doing. Right now these include maintaining this blog, writing a book, doing freelance work online, and creating a facebook page for other chronically pained individuals who are seeking to figure out this same path.

I hope this can be a helpful tool for you in processing your own chronic pain memories. Events that can be especially important to work through for many chronically pained and ill individuals can be hospital stays, surgeries, unsuccessful treatments, flares and relapses, abandonment by family and friends, and events that lead to worsening of your condition.

If you are processing events that are especially traumatic, have experienced flashbacks, or are prone to dissociation or suicidal thoughts, this exercise should only be completed with the help and approval of a trained professional.

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16 responses

  1. A very intelligent and interesting post. I couldn’t agree more with you about pain itself being a traumatic experience. Since being disabled I have read numerous books on trauma and, like you, quickly recognized that pain itself is a trauma. As you identified the challenge with pain and illness is that it is an ongoing trauma that has to be continually worked through…as if living with the pain isn’t enough! Thanks for this post.

    • The more I read peoples’ stories the more I am convinced of this connection. I wish mental health professionals would recognize this because it could be one step in chronic pain and illness being taken more seriously.

  2. I also feel that chronic pain can create trauma – especially if it’s invisible and everyone has been telling you that you’re just making it up!

    Also, the process of having to give up your previous “life” is a HUGE loss. Just because it’s not be from a crippling car accident doesn’t make it less traumatic, just less sudden.

    I know there are a few specialized “Pain Psychologists”, but this field needs to get far more attention. In a misguided attempt to “help” them, some pain patients on opioids are sent to “addiction specialists” or “recovery centers” instead, .

    • Hey, nice to hear confirmation that others feel the same way.

      In terms of the field needing more attention, I can say that in grad school (I have my MA in Counseling) the only thing we learned about chronic pain is that it can be the result of somatization. We learned about all the somtization disorders, and were basically set up to assume that chronic pain is always the result of emotional issues. I believe this is likely typical of counseling grad programs. Schools need to take a more balanced approach and at least mention that actual physical pain and illness oftentimes needs mental health treatment due to the loss, stress, physical pain, and following emotional anguish it brings. But that is just not what is taught.

  3. You make so many good points that I don’t even know where to start! My psychiatrist said that my chronic pain has left me like a physically abused person. I had never thought about it that way, but it makes sense, especially in light of your writing.
    I love the way you followed it up with the strategies and how you worked through them. My doctor didn’t do anything but make a passing comment and hand me pills. I am definitely going to journal through some of those things as I work with a new counselor–as soon as I can get off a waitlist!

    • Hey Sarah, thank you so much for your kind words. I have to say I am really impressed that your psychiatrist recognized the correlations between chronic pain and physical abuse. I think that is the first time I have heard an instance of that correlation being recognized by a mental health professional.

      I have found journaling through some of these things really helpful personally. I hope it is also helpful for you!

  4. What a great post! “This is the experience of taking our trauma and pain, and instead of allowing it to break us, we use it as a stepping stone to move forward in ways that would never have been possible if the trauma had not occurred.” I love that sentence. I fully believe that I would not have written The Last Cherry Blossom, had I not experienced the trauma of a blood clot that would lead to RSD 14 years ago!

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