Fibromyalgia is a prevalent issue, affecting millions of people worldwide. However, what is often overlooked is the significant percentage of individuals who have a history of trauma, PTSD, or trauma-related symptoms.
These individuals may experience various behavioral, mental, and physical changes as a result of their traumatic experiences. To effectively treat fibromyalgia pain in these patients, it is essential to apply trauma-informed care principles, which have their roots in social work but have since spread across different fields. This approach increases the chances of success in managing chronic pain among patients with a history of trauma.
Fibromyalgia is a multidimensional experience that involves physical, emotional, and psychological components.
Interpersonal trauma plays a significant role in fibromyalgia pain, and understanding its nuances is crucial for providing effective care.Interpersonal trauma can have lasting effects on an individual’s life, impacting their mental, emotional, and physical well-being.
This blog post will discuss the various types of trauma, the potential consequences on brain function, and the connection between interpersonal trauma and fibromyalgia chronic pain
Understanding Trauma and Its Effects
Trauma can be defined as a deeply distressing emotional experience that overwhelms the nervous system. In other words, it is an event so distressing and upsetting that it leads to neurological changes. When individuals are traumatized, they experience an increase in activity in the limbic area of their brain, which comprises several centers and structures.
The limbic area, also known as the “reptilian” part of the brain, is responsible for reacting to threats and ensuring survival. This part of the brain is shared among all vertebrates, from reptiles to humans. When trauma occurs, the limbic area becomes more active, and its effects on the hypothalamus lead to increased production of cortisol and catecholamines. These hormonal changes can result in neurostructural alterations, which eventually cause behavioral changes.
Trauma-related behavioral changes include PTSD symptoms like intrusive thoughts, avoidant behavior, and negative self-beliefs. Patients may be unaware of their traumatic experiences or the fact that they are carrying these trauma-related symptoms. They typically seek help not because of their trauma, but because they are experiencing fibromyalgia pain and suffering.
Connecting Trauma to Fibromyalgia Chronic Pain
Patients with a history of trauma may present differently when seeking help for fibromyalgia. They may have more extreme problems, experience unique issues, or be more resistant to treatment. To effectively address their pain, it is crucial to apply trauma-informed care principles.
These principles help healthcare professionals recognize the effects of trauma on a patient’s experience of fibromyalgia and tailor their approach to provide appropriate support and treatment.
| Mechanism | Description |
|---|---|
| Neurophysiological | Changes in the nervous system which can lead to a heightened sensitivity to pain that may be triggered by trauma. |
| Psychological | Individuals may experience distress and emotional distress due to the trauma, which can influence the perception of pain. |
| Neurochemical | Brain chemical imbalances due to trauma can lead to an increase in pain sensitivity. |
| Immunological | Changes in the immune system due to trauma can lead to an increase in inflammatory responses, resulting in fibromyalgia pain. |
Trauma refers to a stressful experience that triggers feelings of hopelessness, fear, horror, injury, or the potential for injury. Traumatic experiences can range from acute events like car accidents or assaults to complex, prolonged, and repeated occurrences such as childhood abuse or intimate partner violence.
Complex trauma, a term introduced by Judith Herman in 1982, emphasizes the interpersonal nature of these experiences and the inability of individuals to escape them.
Interpersonal Trauma: Unique and Challenging
Interpersonal trauma occurs when harm is inflicted by another person, either intentionally or due to a disregard for the victim’s well-being. This category encompasses violence victimization, such as abuse, rape, and assault.
Betrayal trauma theory posits that the impact of a traumatic event is influenced by both the fear it evokes and the sense of betrayal experienced, with events involving closer relationships causing more severe consequences.
Interpersonal trauma can be experienced across various stages of life and can involve multiple forms of abuse. Its prevalence is alarmingly high, with one in four children under 17 years of age reporting some form of maltreatment. Furthermore, interpersonal traumas often co-occur, with many individuals experiencing multiple adverse childhood experiences (ACEs).
The Impact of Interpersonal Trauma
Interpersonal trauma can have long-lasting effects on individuals’ mental and physical health. Factors such as gender, developmental timing, race, and immigration status can modulate the impact of these experiences.
For example, childhood physical abuse is associated with mental health conditions and poor perceived health in adult women but not men. Conversely, sexual violence uniquely impacts men due to the violation of traditional gender roles and stereotypes.
Listening to Victims’ Voices
In order to truly understand the heterogeneity of interpersonal trauma experiences, it is essential to listen to the voices of the victims.
Their words provide a human perspective that goes beyond research numbers, emphasizing the importance of addressing these issues in clinical practice.
Types of Interpersonal Trauma
Interpersonal trauma can manifest in various forms, including abuse during childhood or adulthood, sexual assault, and domestic violence. The severity and duration of the trauma can significantly influence an individual’s experience and ability to cope with the aftermath. For example, in situations where a person cannot escape the trauma, such as childhood abuse or domestic violence, the constant anticipation of the next experience can have a significant impact on their mental and physical well-being.
Outcomes Associated with Interpersonal Trauma
Renowned trauma researcher, Bessel van der Kolk, emphasizes that trauma changes the brain, altering an individual’s perception of the world and their behavioral responses to stimuli. The brain changes observed in individuals who have experienced interpersonal trauma are considered adaptive, as they help with survival and reproduction in a dangerous environment.
Neuroimaging studies suggest that the type of abuse matters for the structural and functional differences seen in the brain. These changes help to attenuate the impact of repeated abuse, lowering the conscious perception of it to reduce distress. Additionally, they affect the way individuals perceive reminders of the event.
Brain Changes and Age
There are sensitive periods during which interpersonal trauma during childhood and adolescence has unique effects on the observed changes in the brain. These periods of heightened vulnerability depend on the brain region affected and can vary between sexes.
Interpersonal trauma is viewed as a threat to survival, sense of self, and body integrity.
Examples of Brain Changes
Brain changes in response to trauma are type-dependent, with specific alterations observed in sensory perception, auditory cortex, amygdala response, and the default network.
These changes are also associated with dysfunctional domains, including affective, social, cognitive, and physical health.
Interpersonal Trauma and Chronic Pain
Interpersonal trauma is associated with chronic pain, as evidenced by a growing body of research. Retrospective self-reporting and pain-related diagnoses suggest a strong link between abuse and pain experiences.
In particular, individuals with fibromyalgia and chronic pelvic pain conditions have high rates of reported abuse.
The Biopsychosocial Approach to Fibromyalgia Pain Management
The two main pillars of fibromyalgia pain management, beyond medical interventions such as medications, are physical conditioning and psychological training.
Physical conditioning aims to increase paced activity levels, while psychological training seeks to improve pain coping strategies, life coping strategies, and self-efficacy. Self-efficacy refers to one’s confidence in their ability to manage and cope with their pain.
Fibromyalgia management is complex and should address the associated emotional distress and behaviors, not just the pain itself. It becomes futile if pain reduction is the sole outcome sought.
Primary care providers should screen for psychological distress in patients with persisting pain and introduce the biopsychosocial model of persistent pain.
Incorporating Psychology in Pain Management
Referring a patient to a psychologist for active, goal-focused intervention should not be considered a last resort. Early involvement of psychologists in pain management can be beneficial in enhancing coping strategies, self-efficacy, and distress management.
Techniques such as psychoeducation, motivational interviewing, and cognitive-behavioral therapy (CBT) can significantly improve patients’ motivation and adherence to healthy behaviors.
Pillars of Psychological Treatment in Pain Management
- Cognitive Behavioral Therapy (CBT)
- Acceptance and Commitment Therapy (ACT)
- Mindfulness-Based Cognitive Therapy (MBCT)
- Mindfulness-Based Stress Reduction (MBSR)
These therapies primarily address cognitive distortions associated with pain, such as catastrophizing.
Understanding and addressing a patient’s beliefs about the cause of their pain can be a powerful tool in changing their perspective and improving their pain management approach.
Tried and Tested Pain Management Strategies
- Applied relaxation strategies: Progressive muscle relaxation or breathing practices can be used as helpful coping strategies when pain increases.
- Pacing activities: Teaching patients to space out activities over the day, rather than engaging in a “boom and bust” pattern, can help build endurance and tolerance.
- Desensitization: Encouraging patients to confront and relate differently to pain sensations can help uncouple the physical sensation from the emotional and cognitive reactions.
Additionally, general life strategies such as sleep hygiene, communication skills, and problem-solving can play a role in effective pain management.
Conclusion
In conclusion, understanding the connection between trauma and fibromyalgia pain is essential for providing effective care to those who have experienced deeply distressing events.
Effective pain management requires a patient-centered approach that takes into account the individual’s goals and values. Incorporating psychology and evidence-based strategies can optimize patient outcomes and enhance their overall well-being.
By understanding and addressing the cognitive and emotional aspects of pain, healthcare professionals can provide comprehensive and personalized care that empowers patients to live fulfilling lives despite their pain.
By utilizing trauma-informed care principles, healthcare professionals can better identify and address the unique needs of these patients, increasing the likelihood of successful pain management and improving their overall well-being.
Physiatrist, M.D. Pain Center of University of São Paulo