Up to 60% of patients seeking treatment in centers for chronic pain management have a past history of severe life trauma,
especially child abuse.
Almost all of them suffer from anxiety, social constriction, depression and sleep disturbance. Standard personality and behavioral tests usually reveal high scores in somatization, depression and emotional distress. Most chronic pain patients exhibit nonphysiologic clinical signs on neurologic examination consistent with conversion and symptom magnification. Such clinical features lead many primary physicians to attribute chronic pain to psychological causes.
Our experience with chronic pain in auto accidents and other traumatic events has led us to conclude that the phenomenon of traumatization is the primary trigger for development of persistent pain, and that associated somatic dissociation may be the driving force for its perpetuation. Incorporation of pain memory in a kindled circuit involving arousal centers of the brain and both explicit and procedural memory leads to perpetuation and worsening of pain in a pattern determined by dissociation. Applying this theory with the use of
somatically based trauma therapy combined with intensive
neuromuscular reeducation has resulted in dramatic improvement in preliminary outcomes in our chronic pain program. We will discuss theories and models of application of this technique, and welcome discussion concerning similar methods of trauma therapy.
We will review therapeutic techniques, including unique inhibitory stretching techniques, somatically based trauma desensitizing therapies, use of biofeedback both in relaxation and neuromuscular reeducation, pharmcological agents, educational programs and detoxification procedures.