Living with pain is tough. If the only time you don't feel the pain is when you're asleep you never get a break. I had a car accident over 20 years ago giving me neck pain which never fully recovered but did it impact massively on my life? Not really. I had another car accident 3 years ago aggravating my previous neck pain and giving me a new injury in my back. Did it impact massively on my life? For a while yes....I saw a chiropractor, physiotherapist, osteopath and had a surgical procedure...it improved. I get the odd niggle, and I have to keep on top of my exercises but I can do most things I ever used to. Can I run as fast as I did? No. Can I run at all? Yes. I am one of the lucky ones.
Imagine changing the word pain with trauma at the start of the above paragraph...only even in sleep the trauma can come out in nightmares so the rest may never come. Now imagine the trauma is the pain and the pain is the trauma. I am working with a few clients at the moment who have chronic pain. They all have their own pain journey, but all having undergone medical interventions, they are now seeking psychological support.
The National Institute for Health and Care Excellence recognises Acceptance and Commitment Therapy (ACT) in supporting individuals through their pain management and this is certainly one approach I take. Sometimes the brain is finding pain where pain should no longer be, or making the pain feel worse than it is. The brain can get it wrong sometimes. Take phantom limb syndrome, where people have lost a limb yet they still feel pain...this is the brain ‘finding’ the pain because it expects to. The brain is where the conscious recognition of pain occurs, not the area of the body where we ‘feel’ the pain.
Is it all in my head? Some people ask...well yes and no. There is usually a very real basis for the pain such as an injury, the brain is the part of you that knows this....but the brain is part of a human, and therefore sometimes gets it wrong. Sometimes it gets it wrong because of trauma the person experienced, whether this was the trauma leading to the injury or from events years before is what we need to find out to help you move forward. Let me tell you a few stories (names have been changed).
Alison was bullied at school but sometimes her bully was her friend. When she was friendly they would sit together, Alison on the left, bully on the right. When they were friends they would link arms, Alison on the left, bully on the right. Alison mentioned in passing she had a long standing pain in her right arm and no one could find the cause of it. We were working on past traumas using Eye Movement Desensitization and Reprocessing (EMDR) therapy. I noticed that during some memories around school her pain became worse, I also noticed when talking about current friends she was having trouble with her pain increased. The day we processed the bully the pain in her right arm increased to a really high level. It was then that she realised that the bully was linked to her right arm. The brain remembered. The body keeps the score (I stole that from the title of a book about trauma BTW!)
Claire was in a car accident and was reporting a pain level of 5/10 at the start of one session, saying it never went below this post accident. She was fed up with how different her life was compared to prior to her accident. We processed how she was feeling about her situation, her pain increased during the session but then she started to think of the positives that had happened since her accident...her pain level started to reduce. At the end of the session she was reporting 3/10 pain level. By the next week the pain was at 2/10 and so far has remained...we are still working together. Claire has told me about traumas unrelated to the accident, we plan to work on those too...it may be that it is these traumas holding the pain.
David has had multiple injuries throughout his life. Initially sceptical about psychological therapy, specifically with regards to pain management, he said he’d only come because his partner said he needed help. He said he spent most of the time at home and the pain was unbearable. He was worried about going on a pre booked holiday as ‘there was no point’. Prior to his holiday I had carried out the assessment and given him some exercises to try to refocus his mind away from the pain. When he returned he said the pain hadn’t been as bad on holiday as normal and this helped him open up to the possibility that his brain was sabotaging him (being at home with nothing to focus on but pain was different to being on holiday with others doing different things). Around the time of each of his physical injuries there was also a psychological trauma, we discussed the possibility that these traumas were impacting on his physical recovery. We are working through the psychological trauma. The pain hasn’t gone, medical intervention is ongoing so this wasn’t expected, but the outlook is positive, the physical pain is reducing and so is the psychological pain.
I don’t work magic but psychological therapy can compliment other treatments when managing pain. The body may keep the score but sometimes the brain’s scoreboard has a fault!
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