Chronic Pain

Can Childhood Trauma also be a Precursor to Adult Chronic Pain?



Several research studies indicate the relationship between childhood suffering and adult chronic pain. In fact, one study revealed that 73% of women with chronic pain also have experienced some childhood trauma (www.instituteforchronicpain.org/…/complications/trauma).  Woah!! – for those suffering from chronic pain, this likely draws your back hairs to stand straight up, shuddering at the notion that the pain “is not real.  Most of us have recognized that depression and anxiety are oftentimes results of chronic pain, or that pain is worsened when experiencing depression or anxiety based on a person’s thoughts about the pain.  However, to consider childhood trauma as an instigator for adult chronic pain is far-fetched for many that are suffering.

Truly, most of us know that much of chronic pain is due to a diagnosable anatomical cause, such as degenerative disc disease or spinal stenosis, or the result of physical trauma or accident, or genetic anomalies, or hereditary factors, and the list goes on.  However, diagnosticians note that more and more often, chronic pain has no clear anatomical cause or identified pain generator, as in tailed back surgery syndrome or chronic back pain. In such cases, specialists identify the pain is in itself to be the disease. However, this is not to say that there aren’t biological impacts of childhood adversity.

When we are threatened, our bodies have what is called a stress response, which prepares our bodies to fight or flee. However, when this response remains highly activated in a child for an extended period of time without the calming influence of a supportive parent or adult figure, toxic stress occurs and can damage crucial neural connections in the developing brain. Scientists also report that DNA is stored in every cell of the body and transferred from generation to generation. As mental and emotional levels are also stored by the cells, emotional imprints are left on the cellular memory by the traumatic incidents from the past.  Although every experience is not remembered by the conscious mind, the cells encode the memory of every experience.

Past negative experiences, personal beliefs and unresolved emotions create emotional blockages, suppressing and bottling up inside the person experiencing them. These emotional blockages perform as a defense mechanism in deep emotional pain produced during these traumatic or dysfunctional situations, resulting in physical manifestations like chronic pain, anxiety and depression.

www.health.harvard.edu/blog/chronicpainand-childhood

Specifically, it appears that children who have experienced one or more of the following 10 ACE (Adverse Childhood Experiences) descriptors, are much more likely to develop chronic pain as an adult.  These descriptors include: physical abuse, sexual abuse, emotional abuse, mental illness of a household member, problematic drinking or alcoholism of a household member, illegal street or prescription drug use by a household member, divorce or separation of a parent, domestic violence towards a parent, incarceration of a household member, and death of an immediate family member.  The higher the score, the more chances these children will eventually have to deal with adult chronic pain.

The good news is that psychological care for those with a history of childhood trauma may help tame their overactive stress response, and in turn provide some complementary health benefits for those also dealing with physiological diseases.   As there is more and more concern about those addictive tendencies with pain medications, it is interesting to consider that possibly pain medications may be a band-aid for many. Maybe, a primary consideration for treatment is dealing with the root of the problem, working through the suffering of emotional pain as a child as well as an adult already dealing with chronic pain.

Claudia A. Liljegren, MSW, LICSW

St. Williams Mental Health



Conflict

Why Be in Combat When There is No War?

How often do you Draw your Weapon and are Ready to Fire, when there is no Battle?

In a non-war zone, such as in our home or community, we may find ourselves in battle against others, using the weapon of defense mechanisms against those we find unreasonably critical.  We may fear that our integrity is at stake when we feel unjustly judged by others and/or want to protect ourselves from someone else’s control. To make matters worse, when one responds with conflict by being defensive, the other oftentimes joins in and the battle ensues.  As the walls go up, the underlying reason for the argument becomes irrelevant as the focus turns to a matter of winning or losing.

Being protective of ourselves is a God-given trait, and we are hard-wired to defend ourselves when legitimately threatened (e.g., being chased by a bear, a break-in, etc.).  However, oftentimes we react to illegitimate threats and become defensive when, in fact, what is called for is being more open and forthcoming.

Conflict is normal.  It helps us communicate and work through issues so that reconnection can occur.  During a struggle, all of us at some time or other become unnecessarily defensive.   It becomes problematic when our defensive posturing remains stuck and we have a hard time letting it go, even when we realize what we are doing.  It can also become habitual, especially if there is that strong need to protect ourselves.

Our responses to criticism depend on several factors.  Some people struggle with disapproval by others due to brain chemistry or how their brain is wired.  They may have a nervous system that is over-sensitive and a temperament that reacts to perceived danger more readily. Some people refer to this as being “thin-skinned”.

Our childhood history also has a lot to do with how we respond to criticism.  If parents or caregivers oftentimes shamed their children and punished them harshly, it’s likely that, as an adult, their impulse is to quickly self-protect whenever they see someone upset and angry about something.

Regardless of the reason, self-esteem issues are a common thread that impacts our level of defensiveness in relationships.  With self-doubt comes either reactive defensiveness and belligerence or, the opposite, someone who takes on the role of a “people pleaser” to avoid any possible criticism.  Reactive defensiveness keeps people away and “People pleasures” don’t allow conflicts to occur, so honest communication is replaced by underlying resentment.

Relationships give us the opportunity to be more loving and accepting of one another.  Learning to hear the others’ complaints with curiosity and openness deepens our connection and puts away unnecessary defensiveness and any potential illegitimate war.

Claudia Liljegren, MSW, LICSW

Psychotherapist at St. Williams Mental Health program

Obstacles

Success is not to be Measured by the Position Someone has Reached in Life But the Obstacles he has Overcome

How do we get through some of the tough experiences in life’s journey?  We all go through challenging times, be it dealing with the death of someone close, having a serious illness, being separated from loved ones or feeling rejected, or losing a job and having financial restraints.  The list goes on…


Some tragedies allow for some preparedness while others are abrupt and unexpected, leaving us feeling punched in the gut or knocked down at the knees.  Some people have to endure a life full of misfortunes while others squeak by with only a few calamities along the way. The discrepancy for this is unknown, and answers to those “Why?” questions will likely not be known to us until we meet our Maker.  

Of course, most of us try to adapt to these life-changing events.  However, sometimes the burden is too much to bear. Oftentimes, “giving up” or not being able to “get up from off the floor” is influenced by the load by which we carry.  However, despite the level and degree of burden, it is also based on the character of the person. Here is another “Why?” question: Why are some able to “bounce back” while others remain overcome by the tragedy and are stuck in their own grief?  You may ask yourself what special personality traits are needed to get through these life’s battles., or how much can we actually recover on our own volition? It is interesting that those with a spiritual faith are much more likely to be resilient than those that don’t; another “Why?” question.

Resilience.  That’s the word.  Resilience is when you can change and adapt how you respond to a crisis or while in the face of tragedy.    It is about changing how you interpret and respond to the problem or circumstance. It is about challenging your thoughts and behaviors so that you create a more positive outlook.  It provides you with a pat on your back and encouraging words so that you will continue walking through the muck, believing that somehow, someday, you will get through all this and be better for it.  

Resilient people oftentimes have these suggestions, noted through the American Psychological Association in “The Road to Resilience”:

  • Make connections with others: Having close relationships with family and friends are very important and may be key to building resilience. Accepting help from other local groups are also very helpful during this difficult time
  • Avoid seeing crises as insurmountable problems:  You can’t change the crisis, but you can change how you manage it.  Look beyond the present to how future circumstances may be a bit better  
  • Accept that change as part of living.  Alter your goals to what you can attain and accept circumstances that you can’t.  
  • Move towards your goals:  Praise the subtle or small accomplishments you have made
  • Make decisions to problems and move in the direction you want to go rather than wishing they would go away
  • Look for opportunities for Self-Discovery:  Recognize your increased internal strengths and growth due to your ability to get through the hardships you have experienced
  • Nurture a positive view of self:  Develop increased confidence in your ability to solve problems and trust your instincts
  • Keep Things in Perspective:  Look at a broader framework and keep a long-term perspective of problems.  Avoid taking the situation out of proportion
  • Maintain a hopeful outlook:  Visualize what you want, rather than worrying about your fear
  • Take care of yourself:  Pay attention to your own needs and feelings.  Engage in activities you enjoy and find relaxing, Exercise regularly
  • Journaling:  Writing down your deepest thoughts and feels related to the trauma.  Meditation and spiritual practices oftentimes help people build connections and restore hope.

Actively participating in your life’s journey through resilience is so much better than responding with lingering vulnerability to the obstacles that come your way.  It may be a difficult task, but overcoming obstacles allows you to get up from off the floor.

Claudia A. Liljegren, MSW, LICSW

St. William’s Mental Health

Chronic Pain

How To Seek Treatment

Although there are lots of children, adolescents and adults who experience some type of mental health problem in their lives, they can oftentimes work through it with time and good support from others. However, if the symptoms linger and don’t improve or become more severe and it is impacting their ability to get through the day, getting professional help may be the next best course of action.

Warning signs for children and adolescents include slipping grades, difficulty getting along with other students or friends, getting into fights, having difficulty with authority figures, school absences, difficulty concentrating, isolating, fighting with family, difficulty controlling mood swings, thoughts of running away or wanting to die, substance abuse and much more. Children are more apt to show that they are struggling by acting out as they don’t necessarily have the ability to communicate what is wrong.

For adults, symptoms are similar but cater to those in the adult world. They can show their struggles through poor work performance, irregular attendance, problems with the boss, a bad attitude, moodiness or are easily offended on the job. Then there are those who have difficulty with increased/decreased sleeping and eating, racing thoughts or difficulty concentrating, motivational problems with uncompleted household tasks, increased relationship problems with family or friends, inability to leave the house or suffer with panic attacks, come up with blanks on positive thinking, feeling hopeless, helpless or worthless, getting in trouble with authorities or having anger problems, struggle with nightmares or flashbacks from previous trauma, and/or are abusing alcohol or other substances by trying to escape from emotional pain. There is a whole host of mental health issues that are not listed here but cause significant difficulty and impact the ability to function in our day-to-day routines. When there are problems getting through the day or a large part of our world is falling apart, it may be time to ask for professional help.

Oftentimes, those suffering from mental health problems visit their physician and discuss their concerns. Psychotropic medications may be considered if it appears that the patient would benefit from such. Oftentimes, physicians also refer patients to a mental health provider as medications may reduce symptoms but does not help the patient deal with the underlying problems that need resolve or teach coping skills. There are some insurance companies that require a physician referral for mental health services, but most don’t. Most insurances help pay for mental health treatment but it is a good idea to check with them about coverage. Individuals also seek mental health treatment on their own or self-refer, in addition to social workers, ministers, employers, family members or friends.

Usually, the initial stage of treatment is meeting with a mental health professional who can be found at nearly all mental health clinics. Usually, the mental health professional meets with the client and learns about the client’s symptoms as well as gains a well-rounded picture of the client’s situation and history. All information shared is confidential with very few exceptions of which the client will be made aware in privacy documents reviewed at intake.

Once the mental health professional has met with the client 1-2 times, they complete a Diagnostic Assessment, a summary of findings that includes treatment options most recommended for that individual. Mental health treatment encompasses a wide range of services based on need. For example, an individual may be recommended to receive psychotherapy in the office or outreach services in their home, if eligible. More intensive services are also offered if an individual is experiencing more serious symptoms, such as psychiatric consultation, case management, psychological testing, psychiatric hospitalization, crisis services, or other placements. The client is free to determine their level of involvement in the services recommended, unless they are at imminent risk of hurting themselves or others. A treatment plan is oftentimes devised in coordination with the client to reduce symptoms and improve their ability to function better in their life. Although it may be nerve-racking to disclose personal parts of yourself, it also helps to know that it is the beginning process of dealing with the problems that keep on interrupting your life. You don’t have to be an island. There is evidenced-based professional treatment that can help!

For more information please visit our mental health services page.

Claudia Liljegren, MSW, LICSW
Mental Health Professional
St. Williams Mental Health

WHEN IT DOESN’T COME EASY

When you are feeling bad and are struggling with life, you are not alone. Everyone experiences emotional anguish sometimes. It’s one of those human experiences we are likely not able to avoid in our lifetime. 
However, when the pain becomes really tough or too long-lasting, it is time to do something about it. When life gets hard, you have to figure out what you can do to make it better. Sometimes you can change your circumstances so that your situation is better. Most times, you have to accept your situation and learn how to change your train of thought or challenge your thinking so that you can modify your mood and actions. 
What is the connection between our thoughts, feelings and actions? Oftentimes, how we interpret our thoughts has a significant effect on our emotions, including emotions that are painful as well as pleasant. For example, if you think that your husband doesn’t love you because he didn’t get you anything for your birthday, you are setting yourself up for a downward spiral of depression and resentment. However, if you think that your husband shows his love in many different or spontaneous ways, not including times you expect acknowledgement, you are likely to be less disappointed if he doesn’t come through. Changing how you think can significantly alter how you feel. 
Most of us can’t change our feelings unless we change what we think. I can ask you to feel “happy” right now, but it is unlikely to happen unless you think of something that makes you happy. On the other hand, sometimes our feelings come from nowhere, like a panic attack, and we can’t think of any thought that may have brought on the emotion. When this occurs, you can choose to change how you think to help better manage your anxiety and realize that the panic is simply an autonomic response telling you to better manage your stress level; or you can let your emotions run the show to a point in which you are convinced that you will die, have a heart attack or go crazy because of the panic attack. Again, how you think about the panic attack makes a difference in how you cope with it. 
The same goes with excessive worriers who ruminate about something they have no control over. Once they realize that they need to challenge those thoughts to stop their unnecessary worrying, they may be able to “let go” of what they can’t control and have room to take a breath and enjoy the moment. 
Sometimes, thoughts and emotions spiral down to a point that is difficult to break the fall. However, changing your actions may then be a positive step to regain some control. For example, even if you don’t feel like it, go for a walk, take a hot bath, watch a good movie, smile even if you don’t want to, or do something fun; all of which help you get a better perspective. 
Helping yourself by using your thoughts to change your moods or using your actions to help both your moods and thoughts are good starters when life gets tough. Of course, getting out of a bad mood takes lots of will power and motivation, but it just may be worth it when things don’t come so easy. 

Claudia A. Liljegren, MSW
Licensed Independent Clinical Social Worker
St. Williams Mental Health Services

claudia@stwilliamslivingcenter.com

Phone: 218-338-5945