Video and Transcript: The Connection Between Trauma and Chronic Pain

Hi everyone! My name is Dr. Orit Hickman and I am from Pain Science Physical Therapy. And I'm here today to talk to you a little bit about, “How do nerves become sensitive?” 

One of the things that we know about pain is that it is produced in the brain. And, in order for it to switch over to becoming chronic, there has to be a few things that are happening around you that we know will lead to a higher incidence of somebody developing chronic pain. We do know that one in four people who start having pain, that pain can just become chronic and there doesn't have to be any obvious reason. A couple of things we know about pain is that if your pain happens as a result of a trauma, it's much, much more likely to become chronic. 

So, what kind of traumas? 

The most common is a car accident. If you've been in a car accident and you've developed neck, low back pain, any other types of pain in your body because of the car accident, it's much more likely that your pain will stick around. And again, it's because you were involved in a trauma. Most of us don't get in the car and hope that we get into a car accident, so typically takes us by surprise. There is usually a claim. The car gets damaged. Sometimes, the car is completely totalled. Maybe you were on your way to work at the time that this happened, so this is a pretty high stress and a high threat type of trauma that can happen. So, we do see that no matter the actual damage or intensity of the car accident, just being in a car accident makes it much more likely that you will end up with chronic pain. So, that's the first situation or context. 

The second is a work injury. A work injury is another type of trauma. So, being involved in an injury on the job means that you will probably have a claim. People that don't know you will be making decisions about you and about your care. And this can impact your ability to do your job, the ability to maintain your job, changes your relationship with your employer. It's pretty high, high stress, so it's another type of trauma in which we’re much more likely to see people end up with chronic symptoms. So, a work injury. 

And the third is just a history, whether recent or past, of physical or emotional stress or trauma. So, if you have had trauma in your lifetime, then it is much more likely that your pain, no matter when it happens, can be many many many years later. Your pain is much more likely to become chronic. And the reason for this is that if you've been through trauma, you have a nervous system that is much more likely to go very, very quickly to Fight-Flight-Freeze because it's been trained to do that over repeated stressors over time. 

So, we do know that those three situations are much more likely to lead to somebody ending up in chronic pain. And so I hope that this helps because, again, it's a little bit of a shift from our understanding of pain in the sense that we used to believe that if somebody had, you know, significant amounts of tissue injury, it was much more likely that they would end up with chronic symptoms just because of the severity of the injury. And if you didn't have that severe an injury, wouldn't expect it to be that your pain would stay chronic. But, we know that there is not a direct link between how much pain someone is experiencing and how much tissue has actually been injured. And, as a result of this, this is when the neuroscientists and the scientists that study pain started looking a little bit more at what’s happening around you. What's much more likely is there is there a situation that's occurring that could lead you to chronic pain. And that's when they saw these links between car accidents, work injuries, and just a history of trauma. 

I hope this helps understand a little bit more about context and pain. If you have any questions, definitely feel free to, you know, type them below. Give me a thumbs up if you like this video and share it. We'd really appreciate that. Thanks! Have a great day!