A single traumatic experience can set off many different levels of pain, whether emotional or physical, acute or chronic.
But can PTSD affect how the brain processes pain?
Marla Mickleborough, MA, of the University of British Columbia and Judith Daniels, PhD, of the University of Western Ontario, wanted to find out whether the brain might actually mitigate pain in the presence of trauma.
They gathered an experimental group of patients with PTSD and a control group of people who had experienced trauma but had never developed PTSD.
Researchers placed the subjects in a functional magnetic resonance imaging (fMRI) scanner while having them listen to either an emotionally neutral or trauma-related script.
After subjects heard the script, researchers administered either a warm, non-painful stimulus, or a hot, painful stimulus and had subjects rate the pain and unpleasantness.
And what they found seems counterintuitive.
After listening to the trauma-related script, the PTSD group rated the painful stimulus as significantly less intense and less unpleasant than did the control.
Next, researchers analyzed the brain data. They found that the PTSD group had greater activation in regions of the brain associated with pain relief including the caudate, insula, and thalamus.
In fact, the more PTSD symptoms a subject had, the stronger these signals were.
These subjects’ brains appeared to be minimizing pain signals after being exposed to traumatic script-driven imagery. Researchers also found that the more dissociative traits a subject displayed, the less activation there was in emotion processing centers like the amygdala.
Of course we need to be cautious about generalizing these results across all types of trauma – for instance, the two groups were not matched for traumatic experiences or gender.
But because these findings give us a better understanding of what can happen inside the brain of someone with PTSD, they could lead to more targeted interventions for trauma treatment.
If you’d like to see the full study, this paper was published in Journal of Psychiatry and Neuroscience, volume 36.
How have you helped a patient deal with emotional or physical pain stemming from trauma? Please share a comment below.
I had extensive physical, sexual, and emotional abuse as a child.(50 years ago). I have always had an extremely high tolerance to pain. Is this common? The studies i read state otherwise. Does that depend on how detached i became from what was happening?
Not a patient, but some old guy who just found out that Russian soldiers are raping Ukrainian women. He earnestly wanted to show me the news articles about those stories, I brushed him off, saying that rape has always been a weapon of war throughout the ages.
On the cognitive level, I can fully understand why he was upset. His ex-girl friend is in Ukraine and shortly after the Russians arrived, he lost contact with her. But, I could not muster an ounce of affective empathy for him. I do have complex PTSD, but I am not a rape victim, although, I have held the hands of those who had been raped.
Must be why I watch shows with serial killers and it doesn’t bother me. But if I watch a sitcom where the dad left an important sweater in the dryer I freak out. When I’m on the terror wavelength nothing gets to me. I handle the bad easily but the tender stuff freaks me out.
Is the result really so counterintuitive? The more severe the PTSD, the more likely dissociation will be present. The function of dissociation is to numb psychological pain and therefore physical pain would be less too?? I would expect people with PTSD symptoms to have more physical conditions, however.
Hi,love the features and research you do.
I am struggling with the opposite to disassociate behaviour,I find through all my trauma and history I’m feeling everything so much more and my hypervigilance is exceptionally aroused.
How do I get this to settle,have tried so much and nothing is helping,I do, however, believe it has a lot to do with my central nervous system and am trying some natural ways to alleviate the extreme but can’t seem to find a genuine therapist who is empathetic or altruistic enough to help me,and no one around me seems to try understand my issues.
Hello, Kim. I can’t give you therapeutic advice, but I can share what has worked with me. Guided imagery and breathing meditations have helped tremendously in quieting my hyper-reactivity to sensory inputs. One group therapist assigned Mark Williams meditations, which you can find easily on YouTube. Belleruth Naperstek developed Guided Imagery, and you can find CD’s of her guided meditations through her own website; a few are available on YouTube.
My hope for you is that you will find a therapist who can give you the support you need.
Somatic experiencing therapy and vagus nerve stimulation help us regulate and calm our nervous systems. I too have hypervigilence from so much trauma. Processing it in a safe relationship with an enlightened witness who really cares can help.
Very supportive and compassionate, able to put myself in their shoes. Intermittent support calls and text messages to enforce my presence and availability.
I found it useful. site
I’d like to see more done on this. I have had PTSD/CPTSD since I was quite young, and even in a non-heightened state I always seemed to have a high tolerance for pain. I do not bruise easily at all, but I could rarely recollect how I came by some pretty impressive bruises.
This is a survival mechanism, I would postulate, since a child in an abuse situation learns quite quickly to stem the natural feelings of pain, fear, and disassociate rather than feel them. The trauma and pain stopped sooner if you could manage not to react.
Unfortunately, when this is the case over time, all those disassociated and repressed emotions have to go somewhere, and they frequently get expressed by the body in the form of pain that cannot be assuaged until the root cause of trauma is addressed.
Thus the brain’s shutting off the pain sensors in one regard might actually result in its becoming hyperactive in another form as it screams for its pain to be heard and resolved. And no amount of drugs, surgeries, or normal interventions will stop it for long because the root is not physical but emotional.
Hi, I would just like thank you NICABAM. My daughter sent me the link to your page and I was blown away as I read the information on your webpage. What you are addressing and researching is amazing and I identify with many of objectives of your research.
I am a 49 yr old Australian woman who has CPTSD and a chronic pain condition called CRPS. I have spent much of my life seeking help to address the traumas I was subjected to as a child and the last 15 yrs dealing with chronic pain as well. I have believed for some time in the inter-connectedness of my traumas and my pain, but have not found professionals that do more than just believe in it too. NICABAM does just that.
As someone with PTSD and chronic pain as well as a family history of high pain threshold. I would like to say that I block out physical pain by numbing and taking my focus off. I would say it’s a survival technique to block it out. Similar to a person with broken bones walking away from a car accident. It could be related to that same response/mechanism. I invite your comments/thoughts!
Very interesting. My experience was consistent with this. During a protracted psychological trauma “event”, I experienced minimal physical pain in spite of a chronic pain condition. As I began to heal psychologically, the level of physical pain I experienced increased. It made no sense that I could be so debilitated psychologically yet experience so little pain. Now it seems there’s a possible explanation for this. And it seems there might be new ways to treat physical pain.
I am currently in treatment for complex ptsd.
My therapist used the MAP program.
It’s proving to be very helpful….extremely life changing actually.
For the first time in many many years I feel hopeful about the future.
As a therapist who treats youth and adults with PTSD it is interesting to see how these traumatic events actually “shape” how the brain functions. While people with PTSD symptoms can show a higher pain tolerance they can conversely be triggered by seemingly innocuous events/things in their environment – things such as a clear, dark, quiet night, a paramedic in uniform, a specific automobile, etc. How do we help those with trauma? I believe through providing support and education about the effects of trauma on the brain, body, soul… and helping them heal through a gentle and comprehensive approach that demystifies the effects of trauma. We combine equine assisted psychotherapy, exposure therapy and psychoeducation to help our clients on their healing journey. This is a solution-focused, experiential (learning while doing), and gestalt-like approach that involves a client/s, therapist, equine specialist and horses. One of my recent clients recounted a horrible sexual trauma while standing next to a retired racehorse in a session. As she explored the depths of the trauma verbally and emotionally, this tall horse nodded his head at what looked like just the right times. This was very affirming for her on an emotional level – allowing her to share what she has been suppressing for years. You see, as prey animals, horses are acutely aware and tuned in to their environment – internal and external – and their survival depends upon this awareness. As a therapist, I build on these powerful shared experiences, which can be explored in future sessions, in office or otherwise. These types of moments can be enlightening, affirming and powerful for clients and facilitators alike.
I have done EAP as well. It is mind blowing how these horses respond at times, isn’t it? I actually commented in the appeasement article about horses. They have so much to teach us.
Hi:
I have dealt with my own trauma with a feeling therapy for many years. I think l was hard wired as an infant with trauma. I never got over the war terror. I also think my mothers probably high stress hormones got into me.
I avoid napping. What happens is, l suddenly get shocked into waking, my heart is racing. I am resigned to being put to sleep. I do not like medications and only take two. Seroquel and a Transdermal patch Emsam for depression. l am seventy-two.
Lynette
Hi Lynette,
I am a 67 year old therapist working in Vancouver. Is there a therapist in your community who practices EMDR? It stands for Eye Movement Desensitization and Reprocessing. I use it with clients who have experienced trauma of many kinds, and the vast majority of them find it very effective in reducing, sometimes completely clearing symptoms of PTSD. You can find more information about it online… Barb
It’s been known for a while from animal studies that stress decreases pain by engaging the endorphin and noradrenaline systems in the spinal cord. Therefore, it makes sense that people with PTSD, who feel stress more acutely, have less pain. However, there is an important caveat: in animals with chronic pain, stress switches over to increasing pain instead. The same thing seems to happen in humans, because in chronic pain diseases like Irritable Bowel Syndrome stress triggers pain episodes. The pain-increasing effects of stress in chronic pain disorders seem more powerful than the pain-decreasing effects of stress in normal people. This can explain why people with PTSD and chronic pain have stronger symptoms.
Rivat C, Laboureyras E, Laulin JP, Le Roy C, Richebe P, Simonnet G. Non-nociceptive environmental stress induces hyperalgesia, not analgesia, in pain and opioid-experienced rats. Neuropsychopharmacology. 2007;32(10):2217-28.
This notion certainly resonates. Supposing that all baby boys who undergo circumcision carry PTSD into their lives and this coupled with birth trauma whether forceps ,c/section and drugs etc could we see an explanation for the insensitive male culture that prevails. This is a generational situation in America with even today 60% of infant boys being genitally mutilated?
This information dovetails with my experience of parasympathetic shock. Dissociation blanks out emotional pain like crazy. It puts people in *lala land*, and they don’t know it. But underneath it, when that deep shock is released…..there lies the sympathetic layer– acute pain, flashbacks, and a somatic *picture* of what happened when you were blanked-out.
I see this information as the biggest break-through in trauma understanding, of the century, right along side and equal to the importance of attachment repair of early insults.
the comments are as fascinating and helpful as this study. Thanks to all and especially to mariella nicolosi, marjorie, and redpelican. Thanks Ruth for sharing.
Can the free seminars be sent recorded ,I am never on time to listen
Hi Maria,
Thanks for reaching out!
While our free seminars are not currently live, you can purchase the programs on our website to get access to the prerecorded programs that you can watch at your own pace at any time!
I’m always fascinated with new research since it challenges us all to expand our opinions & practises. Spectrum is the key word with autism that I use with PTSD. Each person may have a cluster of common symptoms while each experience them in a unique fashion. Hence the more diverse a counsellors education and experience the more equipped they are to respect & respond to the clients they serve.
What I find interesting is the responses the PSTD people I serve have to the information I share with them about your seminar series. I call it “the dear in the head light” response. Knowing they are not failing to heal because of their unwillingness but because of physical changes they are not aware of brings them so much relief they are more willing to be compassionate with themselves. The sighs of relief I hear once they let themselves breath are music to my ears!
Thank you for this beautiful music!
Thank You Faye . your comment is so insightful and so beautifically put.I am an experienced Australian physiotherapist who has had EMDR myself with great effect. I am excited to “hear” your ideas re Spectrum PTSD because, well, I agree 100 % . I have seen the parallels b/w Chronic pain and PTSD for many years , especially in MVA people. I treat transitioning to civilian military members and I used to see serving Airforce members (overflow) . In the past in Public sector I treated many Chilean and Cambodian, Bosnian, torture survivors.
Too many people recover physically but cannot move on after major orthopaedic trauma. I recommend to you STARTTS in Australia , so it is .com.au , for a useful Torture and Trauma resource. It exists on at least 2 campuses in Sydney. If you telephone them pls respect they rely on volunteer , multicultural, reception staff. Julie
I wonder about the possibility that people can do this for years until their body becomes fatigued and breaks down eventually such as occurs for soldiers who retirre and have many physical problems
This is a fascinating study about PTSD clients having more resilience to different kinds of pain. I have helped some clients deal with emotional pain from trauma and to ultimately break free of it. I had a client who was molested in childhood and then raped in adulthood. She spent five years in therapy in another state, dealing with the molestation, then moved to where I practice and was raped here. The rape reawakened a good deal of her pain from her childhood molestation, but we worked through it all until she felt free of the pain and truly ready to move on with her life.
I went to the dentist today and when I said no to Novocain they looked traumatized. I believe I have PTSD and this article makes a lot of sense to me.
Yes. People who go through trauma can be numb and experience shutting down as a form of protection.
An interpretation that is in the realm of the way it’s being expressed here –as if a physical stimulus could possibly carry the same weight as an emotional one –is to be questioned in the first place. Maybe I’m not understanding the merits of finding that physical stimulus are not as troubling to people with emotional pain partly because this kind of research might be termed, “client systems non-responsive to stimulus who are traumatized”. Showing a lack of responsive need not be interpreted as a healthy situation, but the body’s attempt to mitigate pain by shutting down.
Or a better worded title is “Clients who are traumatized are less responsive to physical stimuli due to the body’s attempt to mitigate pain through shutting down.” Okay, that’s a little long.
How fascinating, this may explain why at times when I was in the full blown period of PTSD; flash backs, anxiety, nightmares, disassociation, and while the pain was excruciating, I experienced a sense of being “high” or almost an elation, as the mystics would call it, my brain was releasing endorphins or dopamine to assuage the pain of the trauma.
It also explains how I could manage to keep on moving forward all those years with my ADL’s and get myself out of bed every day to go to work.
Thank-you Ruth and all of you at NICABM, some of us folks who have suffered with PTSD want to understand this dis-ease of the brain and psyche as much as clinicians do.
It will not only help me to develop better tools of self care, but also help me with the clients I work with, some that are terminally ill and faced with their own form of end of life terror.
I second Karen”s comment.
That is a very interesting study. I work with patients who have PTSD and pain (from both injury and illness) on a regular basis in my rehabilitation practice. I often find that patients with developmental trauma do tend to minimize their pain levels and it can make it difficult to bring them on board with pain management. I find that in this group pain can also be seen as evidence that they are weak or defective, and they are disturbed by their pain. I feel like there is a second group, however, who are triggered by their pain into their trauma experience and they tend to find their pain excruciating and avoid working through their pain.
Yes, your second group resonates with me. I wonder if someone with historical PTSD who has mitigated pain, then a second trauma could “remove the safety net” and certain pains are then amplified? The other conundrum–if the pain is PTSD related, its “all in their head” so they just need counseling. Yet if changes are happening at the neurochemical level, neuroplasticity level, should we be looking at bioneuromodulation as well?
Amazing, not what you would expect, but if you think about it, it makes sense. Does this have a link to teenagers cutting themselves to experience some form od “feeling”?
Actually, this might make perfect sense. If a person was exposed to trauma for a long time and had produced a lot of endorphins to deal with it. It would make sense that later it would not sense danger or unpleasantness in the same way to its own detriment. The present research says that these endorphins run out eventually and such people often develop pain conditions in their middle years.
thanks for the research – I assume that by “pain” is meant the emotional and physiological reactions that are biologically linked to traumatic events. So it appears that that, under some conditions, the ways in which we have been COPING with past traumas can be triggered more readily than our initial response to trauma. Could this finding explain why traumitised children seem to grow and “choose” traumatizing partners and are able to remain in traumatising situations for a long period of time. If I am reasoning correctly, the study results can lift the self-esteem of many battered women who have remained in abusive relationships for too long, or keep choosing abusive partners. Training to help them breaking the cycle could be developed.
Yes, that’s exactly what happened to me. My body would dis-associate and shut down. I became so numb I couldn’t function physically and mentally on and off for years. I got help in healing my birth and developmental trauma through psycodynamic talk therapy with a psychologist, a lot of education by reading up on my symptoms and trauma and ECT at Camh. I got myself back and I am forever grateful for all the guidance, self determination and help. If you don’t give up and keep looking you will find what will work. Help is out there so seek it out, without shame. It’s not who you are, It’s what happened to you!
I am 48 and have had the same. I think i have CPTSD and have had therapy 20yrs ago but have kept going into abusive relationships. I am now in therapy again and realising that i am enjoying the pain of my trauma and struggle to know the difference between pain and pleasure. I think this is because i am now ‘feeling something’ as apposed to nothing. But this still doesn’t really make sense to me.