Chronic pain is defined as prolonged physical pain that lasts for longer than the natural healing process should allow. This pain might stem from injuries, inflammation, or neuralgias and neuropathies (disorders of the nerves), but some people suffer in the absence of any of these conditions. Chronic pain can debilitate one’s ability to move with ease, may hinder their normal functioning, and the search for relief can lead to pain medication addictions, which compound the problem. Chronic pain is also often accompanied by feelings of hopelessness, depression and anxiety.

Many people are already familiar with the fact that emotional stress can lead to stomachaches, irritable bowel syndrome and headaches, but might not know that it can also cause other physical complaints and even chronic pain. One logical reason for this: studies have found that the more anxious and stressed people are, the more tense and constricted their muscles are, over time causing the muscles to become fatigued and inefficient. More subtly, one might develop psychosomatic symptoms or stress-related symptoms because of unresolved emotional issues. These are not new discoveries; researchers have studied the mind/body interrelationship for several decades because of the importance of this link.

Experts have noticed that experiencing a traumatic event can have an impact on the development of pain. In fact, approximately 15-30% of patients with chronic pain also have PTSD. Peter Levine, an expert on trauma, explains that trauma happens “when our ability to respond to a perceived threat is in some way overwhelming.” Most researchers disagree on a precise definition of trauma, but do agree that a typical trauma response might include physiological and psychological symptoms such as numbing, hyperarousal, hypervigilance, nightmares, flashbacks, helplessness, and avoidance behavior.

During a traumatic event, the nervous system goes into survival mode (the sympathetic nervous system) and sometimes has difficulty reverting back into its normal, relaxed mode again (the parasympathetic nervous system). If the nervous system stays in survival mode, stress hormones such as cortisol are constantly released, causing an increase in blood pressure and blood sugar, which can in turn reduce the immune system’s ability to heal. Physical symptoms start to manifest when the body is in constant distress.

If someone has experienced a trauma prior to their current injury or trauma, old memories can potentially be triggered, exacerbating the effects of the newer trauma. Dr. Bessel van der Kolk, a well-known trauma researcher, explains; “Research has shown that, under ordinary conditions, many traumatized people, including rape victims, battered women and abused children, have a fairly good psychosocial adjustment. However, they do not respond to stress the way other people do. Under pressure, they may feel (or act) as if they were traumatized all over again.”

Often, physical pain functions to warn a person that there is still emotional work to be done, and it can also be a sign of unresolved trauma in the nervous system. Even if one has grieved and processed the emotional impact of a trauma, the nervous system might still unwittingly be in survival mode.

Maggie Phillips, author of Reversing Chronic Pain, writes: “Whether or not trauma was connected to the event or condition that originated their pain, having a chronic pain condition is traumatizing in and of itself.”

Since trauma has been found to have a strong correlation to chronic pain, a combination of psychotherapy and physical therapy would be the most logical pain management option for stress and chronic pain relief. Maggie Phillips states that imagery is a more effective intervention than verbal therapy, because trauma tends to impair the language and the mind’s organizational capacities. Psychotherapy that uses imagery, addresses the nervous system, and facilitates cognitive behavioral therapy is recommended.

To tackle the physical aspect of chronic pain, Mindy Marantz, director of the Healthwell clinic in San Francisco, suggests focusing on alignment in the body, as well as posture that supports organized alignment. Additionally, she advises to address potential inflammation, and provides strategies to help calm the nervous system such as Craniosacral therapy or Feldenkrais Movement Re-education. “These both will help ‘stoke’ the lymphatic system, which in turn helps diminish the effects of fluids that pool as a result of injury. Lymphatic massage as well as compression wraps and education help bring this often overlooked pathway to recovery to patients’ attention.”

Beginning a daily program of walking can help to mobilize the muscles and is the best way to stimulate the lymph system to do its job and oxygenate injured muscles. The International Association for the Study of Pain concluded that acupuncture is also effective in long term chronic pain reductions related to musculoskeletal pain.

PTSD and chronic pain are often connected, and both must be addressed in order to help a person be fully functional again. Although one might not be aware of the lingering effect of the trauma, or believe that the traumatic event has been put behind them, the body could be clinging to unresolved issues. Relevant psychotherapy can help to resolve the physical problems.

What does psychological stress do to you physically?

Studies have shown that chronic pain might not only be caused by physical injury but also by stress and emotional issues. The more anxious and stressed you are, the more tense and constricted your muscles can become. As a result, they may fatigue and be inefficient over time. For that reason, just stretching or massaging your muscles may not accomplish the goal of being active without underlying muscle tension….treating the whole person is important.

Peter Levine explains: “The rain of pain is mainly in your brain.”

Many people are already familiar that emotional stress can lead to stomachaches, irritable bowel syndrome, and headaches but might not know that it can produce other physical complaints and chronic pain. However, these are not new discoveries; researchers have studied the mind body interrelationship for several decades because they saw the importance of this link.
One might also develop psychosomatic symptoms or stress-related symptoms because of unresolved emotional issues that they have not dealt with and which are causing physiological as well as mental health issues.

Unresolved memories might hinder the healing of physical injuries or medical procedures as well. Additionally, stress hormones such as cortisol increase your blood pressure and blood sugar which can reduce your immune system’s ability to heal. For example, one woman, who already felt emotionally stressed due to a break-up with her boyfriend, found that when she had a car accident she could not find relief from her pain until she dealt with her emotional loss as well.

Often, pain has the function of warning a person that there is still something to work on. It can point to a need for emotional healing.

When your body is in pain and you are not healing the way you should, there might be emotional issues, waiting to be resolved.

Therefore, a combination of psychotherapy and physical therapy might be the best pain management option to reduce stress and recover from your chronic pain when nothing has worked so far.

Please, read the following interview with Mindy Marantz:

Mindy Marantz is the director and clinician at the Healthwell Physical Therapy Group in San Francisco and is currently active in the National Pain Foundation.

Dr. Babbel:
Mindy, your clinic has been very successful addressing chronic pain when people thought there was no way out. What have you noticed that makes it easier or more difficult for people to recover?

Mindy Marantz:
First of all, when an individual picks up the phone to call for help, recovery has begun. Our initial job at Healthwell, as I see it, is to help guide the individual through the biomechanical mechanisms which help the body heal. This is relatively easy. We help focus on alignment and the postural attitudes that support organized alignment. This can very quickly reduce pain intensity.

We also address inflammation, and we immediately provide strategies to help calm the nervous system, like Craniosacral therapy or Feldenkrais Movement Re-education.

These both will also help “stoke” the lymphatic system, which in turn helps diminish the effects of fluids that pool as a result of injury. We use lymphatic massage as well as compression wraps and education to help bring this often overlooked pathway to recovery to our patients’ attention.

Beginning a daily program of walking and helping to mobilize the muscles is the best way to stimulate the lymphatics to do their job and oxygenate injured muscles!

Finally, we help our patients reflect on their lifestyle, and the things that contribute to their wellness, and those habits which will tend to slow their recovery.

Our care is about them, carving out a time frame to focus on their well-being and health. This is the realm where recovery occurs best. Optimally, a patient will be fortunate enough to find concomitant care by a somatic psychologist to help dissipate the deeper impact of trauma, which is why our clinic often works with Dr. Babbel.

Please e-mail or call Dr. Babbel at Susanne@bodyconversations for a FREE handout on “Specific Techniques and Resources to Help you Ease your Pain.” This handout was prepared in collaboration with Mindy Marantz.

If you have further questions for Mindy Marantz please visit her website www.healthwellpt.com

Emotional Reactions:

_    You feel shame and not worthy
_    You overreact or are overemotional
_    You feel great sadness or anxiety on a regular basis
_    You have a very strong inner critic
_    You are afraid to be abandoned and feel lonely
_    You avoid certain situations
_    You can not feel emotions and are often numb
_    You lack confidence and self esteem
_    You have mood swings

Physical Symptoms:

_    Your body may stay in alert and stress mode until it knows it is safe (Hyperarousal)
_    You have a hard time relaxing and do not know how to settle down (Constriction)
_    You have difficulty sleeping and have nightmares
_    You have body image and weight problems
_    Your memory is not fully functioning
_    You feel numb and cannot feel your body (dissociation)
_    You are suffering from chronic pain
_    Skin disorders
_    Constipation

Relationship Patterns:

_    You may have developed specific patterns that you keep repeating
_    You try to control your partner, friends and family
_    You have a hard time saying no, setting limits or boundaries
_    Relationships can be difficult for you
_    You feel disconnected and detached

If you recognize yourself in these examples, you might have an unresolved traumatic experience.

Trauma symptoms can be expressed days, months, or even years after the traumatic event. Symptoms may suddenly arrive through a trigger in the environment and might appear as emotional, cognitive, or physical reactions. Sometimes the mind is not able to make sense of the internal signals, especially when the person has experienced an overwhelming event or stressful situation. The mind might continue to communicate to the nervous system the necessity to prepare to flee, fight, or freeze. Adrenaline is disbursed and the cycle might perpetually continue until the body-mind perceives that it is safe and recognizes it can rest.

If not addressed these can turn into long-term symptoms such as:

•    Panic attack
•    Avoidance behavior
•    Addictions
•    Risk taking behavior
•    Constant dissociation
•    Memory loss
•    Midlife crisis and fear of dying
•    Self-harming behavior
•    Obsessive or lack of sexual feelings
•    Feeling disconnected