Some hurts last a lifetime. Recently, when I asked a 52 year old woman about her childhood, she started to cry. Like so many victims of child abuse, her hurts are lasting a lifetime. And she is not the only one. One in fifty-eight children are victims of neglect, physical abuse, sexual abuse or emotional abuse. All of these adverse experiences are frequently historical features of those with chronic pain; particularly those with the diagnosis of fibromyalgia, interstitial cystitis, chronic fatigue syndrome, irritable bowel syndrome, or migraine headaches. Does childhood maltreatment increase the risk of developing chronic pain? Yes, childhood abuse is significantly related to pain. In fact, the incidence of childhood abuse in some painful conditions has been reported to be as high as 40%. If upwards of 40% of those with chronic pain have a history of abuse, we need to know why and we need to know how to break the link.
Some scientists have focused on physiology to help understand the link between childhood abuse and pain. After an incident of abuse takes place, permanent changes in the way the body responds to stress might occur. Of particular importance is the hypothalamic-pituitary-adrenocortical activity. In plain terms, the hormonal response to stress, particularly the cortisol response, may be altered in those with a history of abuse. Furthermore, using fMRi techonolgy, physical changes are also seen in brain function in those with abuse history when compared to those with no abuse history. What do these physical changes mean and will these discoveries lead to different treatments? These questions have yet to be answered.
However, this bio-medical approach to breaking the link between childhood abuse and pain may not be enough to explain everything. Physiology alone cannot explain why those with a history of childhood abuse are more likely to experience pain. In a recent prospective study that followed several court-documented victims of abuse, researchers found that the risk of developing a chronic painful condition was significantly higher than in those victims who also have Post-Traumatic Stress Disorder (PTSD) as opposed to those who did not have PTSD. Without experiencing PTSD, victims of abuse had only a small likelihood of experiencing a chronic painful condition. Thus, their conclusion was that PTSD was the major link between childhood abuse and pain.
In fact, PTSD is probably the cause of both the psychological and physical changes that take place after a childhood experience of maltreatment. So, in order to break the link between childhood abuse and chronic pain, the focus needs to be on diagnosing and treating PTSD.
Lately, PTSD has been closely examined because of the growing number of Veterans who are being diagnosed with PTSD. In fact, many Veterans have both PTSD and chronic pain. Because of the growing need for adequate treatment of an individual with both PTSD and pain, a treatment model for this dual diagnosis has been established by the Department of Veterans Affairs. This model relies heavily on cognitive therapies for both the pain and the PTSD. Most experts would agree that integrative treatment plans are needed because medications alone are not going to untangle the complex relationship between PTSD and chronic pain.
Most experts would also agree that identifying PTSD in chronic pain patients can lead to improved treatments and a greater ability to break the link between childhood abuse and chronic pain. Treatment may come in the form of correcting hormonal imbalances. Treatment may also come in the form of cognitive-behavioral therapy. All treatments should be focused on stopping the cycle of victimization. Because when a hurt is lasting a lifetime, something needs to be done. Hurts should not have to last a lifetime.
Please take this opportunity to use a PTSD screening tool developed by the Department of Veterans Affairs, just ignore the word “military” in order to make this tool more applicable to you. If you think you have PTSD, please find professional help because this is not just a matter of letting go.
Specialist in Pain Management and Spine Rehabilitation