Interwoven Paths: Exploring the Complex Relationship Between Trauma and Chronic Pain

May 31, 2024

On a recent lunchtime webinar on ‘An Introduction to Trauma Therapies’ with TICS Associate, Jessica Parker, an interesting question was asked about whether there was a connection between chronic pain, fatigue, and trauma. In response to this question, we have created this blog, which we hope helps to unravel some of the complex connections.

Chronic pain and chronic fatigue are conditions that can significantly impact the quality of life for millions worldwide. Chronic pain is a persistent pain that lasts for weeks, months, or even years. It can arise from an injury, surgery, or a myriad of other causes, often without a clear origin. Chronic fatigue, on the other hand, is characterised by prolonged and severe tiredness that is not alleviated by rest and is not directly caused by other medical conditions. Both conditions can be life-altering, leading to reduced physical activity, social isolation, and psychological distress (De Ventner et al., 2017).

Despite advances in medical science, the exact causes of these conditions often remain elusive. However, a growing body of research suggests a strong link between chronic pain, chronic fatigue, and trauma. Pioneers like Bessel van der Kolk and Wilhelm Reich have provided profound insights into how trauma can manifest physically, influencing our understanding and treatment of these chronic conditions.

A study by Nicol et al., (2016) examined the correlation between a history of lifetime traumatic events and various outcomes in chronic pain patients, including pain severity, physical function, and affective distress. Analysing data from 3,081 individuals, the study finds that those with a history of abuse—15.25% of the sample—experienced significantly greater depression and anxiety, worse physical functioning, and more severe pain. The use of the 2011 Fibromyalgia Survey criteria allowed researchers to measure "fibromyalgianess," which along with affective distress, served as mediators in the relationship between past abuse and pain outcomes. This suggests that both emotional and central nervous system responses to trauma could intensify pain perception and physical dysfunction. The study supports a biopsychosocial paradigm where these factors interact to exacerbate the chronic pain experience, highlighting the importance of recognising and addressing the impacts of trauma in clinical settings to improve patient care and outcomes.

This understanding underscores the necessity for healthcare providers to adopt trauma- informed approaches not only to treat chronic pain more effectively but also to address the underlying trauma contributing to physical symptoms.

Another study, published in "Anaesthesia Critical Care & Pain Medicine," examines the incidence and characteristics of chronic pain in COVID-19 survivors following their ICU stays. A multicenter cohort study conducted by Martinez et al. (2023) involved face-to-face consultations with pain specialists, focusing on patients who had been discharged from the ICU nine months prior. The research revealed that over half of the participants experienced new-onset chronic pain, predominantly classified as secondary pain, which includes musculoskeletal, post-traumatic, neuropathic, and visceral pain types. The study found that
pain severity was linked to a significant impact on daily life and mental health, with conditions such as anxiety, depression, and post-traumatic stress being common among those suffering from chronic pain. The most frequently reported pain sites were the shoulders, chest, and head. Intubation practices during ICU care were notably associated with higher instances of chronic pain. The study advocates for systematic screening of COVID-19 ICU survivors for chronic pain to facilitate timely and effective pain management strategies. This research underscores the complex challenges faced by ICU survivors and the critical need for integrated approaches to address the long-term sequelae of severe COVID- 19 cases.

Bessel van der Kolk, a prominent psychiatrist and trauma expert, has extensively studied the impact of trauma on the body and mind. In his groundbreaking book, ‘The Body Keeps the Score’, van der Kolk explains how traumatic experiences can become imprinted on the brain and body, leading to chronic pain and fatigue. He emphasises that trauma can disrupt the body's stress response system, causing chronic inflammation and altering pain perception. Van der Kolk's work highlights the importance of addressing trauma to alleviate chronic conditions. He advocates for integrative approaches that combine traditional therapies with body-centred practices like yoga, mindfulness, and somatic experiencing. These methods help individuals reconnect with their bodies, release stored trauma, and promote healing.

Wilhelm Reich, an Austrian psychoanalyst, and student of Sigmund Freud, was one of the first to explore the connection between psychological trauma and physical symptoms. Reich introduced the concept of "body armour," referring to the chronic muscle tension and rigidity that develop as a defence mechanism against emotional pain. He believed that this tension could block the flow of life energy (which he called "orgone") and lead to various physical and mental health issues, including chronic pain and fatigue. Reich's therapeutic approach, known as Vegetotherapy, aimed to dissolve this body armour through techniques that included deep breathing, physical manipulation, and the expression of repressed emotions. His work laid the foundation for many modern somatic therapies that address the mind-body connection (Eiden, 2014).

Recognising the link between trauma, chronic pain, and chronic fatigue opens new avenues for treatment. Trauma-informed care involves understanding the pervasive impact of trauma and developing strategies to support healing (Röhricht, 2021). Techniques that focus on the body, such as yoga, Tai Chi, and bodywork, can help release tension and improve body awareness. Mindfulness and meditation can calm the nervous system, reduce stress, and promote emotional regulation. Psychotherapies like Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitisation and Reprocessing (EMDR) can help individuals process and integrate traumatic memories. Integrative medicine, which combines conventional medical treatments with alternative therapies, can address both the physical and emotional aspects of chronic pain and fatigue (Khan et al., 2018 and Pierce et al., 2022).

The insights of Bessel van der Kolk and Wilhelm Reich underscore the profound connection between trauma and chronic health conditions. By understanding how trauma influences the body, we can develop more effective, holistic approaches to treating chronic pain and chronic fatigue. Embracing trauma-informed care not only provides relief from physical symptoms but also fosters overall healing and resilience. The journey towards wellness for those experiencing chronic pain and fatigue is often long and challenging, but recognising the role of trauma can be a crucial step toward finding relief and reclaiming a better quality of life (Themelis, 2023). By integrating mind-body practices and therapeutic interventions individuals can begin to heal from the inside out, addressing the root causes of their suffering.

If you need any help and support or just a general chat about ‘all things Trauma Informed’, please get in touch with Lyndsay, our Working Together Lead at and our team will support you in your journey.

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De Venter, M., Illegems, J., Van Royen, R., Moorkens, G., Sabbe, B. G., & Van Den Eede, F. (2017). Differential effects of childhood trauma subtypes on fatigue and physical functioning in chronic fatigue syndrome. Comprehensive Psychiatry, 78, 76-82.

Eiden, B. (2014). Application of post-Reichian body psychotherapy: A Chiron perspective. In Body psychotherapy (pp. 27-55). Routledge.

Khan, A. M., Dar, S., Ahmed, R., Bachu, R., Adnan, M., & Kotapati, V. P. (2018). Cognitive Behavioral Therapy versus Eye Movement Desensitization and Reprocessing in Patients with Post-traumatic Stress Disorder: Systematic Review and Meta-analysis of Randomized Clinical Trials. Cureus, 10(9), e3250.

Martinez, V., Dziadzko, M., Tamayo, J., Schitter, S., Guichard, L., Richeux, F., Roggerone, S., Branche, P., Schlaefflin, L., Nacto, Y., Antunes, T., Negre, I., Annane, D., Aubrun, F. (2023). Chronic pain characteristics in COVID-19 survivors after an ICU stay. A cross-sectional study, Anaesthesia. Critical Care & Pain Medicine, 42(3).

Nicol, A. L., Sieberg, C. B., Clauw, D. J., Hassett, A. L., Moser, S. E., & Brummett, C. M. (2016). The Association Between a History of Lifetime Traumatic Events and Pain Severity, Physical Function, and Affective Distress in Patients With Chronic Pain. The Journal of Pain, 17(12), 1334–1348.

Pierce, J., Mohan, N., Fatabhoy, M. G., McAfee, J., Zhu, G., & Hassett, A. L. (2023). Posttraumatic stress symptoms and chronic pain: Cross-sectional associations with perception of sensory and social stimuli. Mental Health Science, 1, 23–36.

Röhricht, F. (2021, July). Psychoanalysis and body psychotherapy: An exploration of their relational and embodied common ground. International Forum of Psychoanalysis (Vol. 30, No. 3, pp. 178-190). Routledge.

Themelis, K., & Tang, N. K. Y. (2023). The Management of Chronic Pain: Re-Centring Person- Centred Care. Journal of Clinical Medicine, 12(22), 6957.

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