Medical Trauma: Causes, Signs, and Treatment

 

By Tanner Murtagh

Medical trauma is a common category of trauma that, unfortunately, often goes unrecognized by physicians or therapists and adequate treatment for it is rarely provided1. It can be defined as a somatic, psychological, or cognitive stress response following a medical procedure1,2.

As Levine3 discusses, trauma is not the event that occurred but the response of our nervous system to the event. Trauma is actually prolonged dysregulation in the nervous system, which could look like a fight, flight, freeze, and/or shutdown response3,4.

In my experience working with clients with chronic pain or illness, a large portion of them have medical trauma. Following a surgery, scary procedure, unhelpful treatment, or generally unsupportive or stigmatizing care from medical professionals, many people, for months or years after, have chronic nervous system dysregulation and greatly fear interacting with the medical system.


Medical Trauma: Causes, Signs, and How to Treat It

Causes of medical trauma can include:

  • Confusing, scary, or conflicting opinions and information from medical professionals
  • Proper education about a procedure not being provided prior to it occurring
  • Compassionate support not being provided prior, during, or after a procedure
  • Stigma from medical professionals, family, or friends, such as being mistreated or being made to feel “crazy”
  • Onset of symptoms due to another health crisis or injury that caused a great sense of danger prior to a procedure
  • Experiencing great fear prior to a procedure or surgery occurring
  • A sense of inescapable attack was felt before and during a procedure5
  • A procedure was unsuccessful or had a bad outcome, resulting in symptoms worsening
  • Hope is repeatedly gathered and broken by failed treatments or interventions

Signs of medical trauma can include5,6:

  • Prior, during, and/or after a medical procedure a person experiences the following physical symptoms:
    • Flight response: anxious, panic, on edge, racing heart, difficulties breathing, tingling, dizziness, racing thoughts, or excessive worry
    • Fight response: irritated, angry, racing heart, shortness of breath, high anger towards medical professionals, or rigid movements
    • Freeze/shutdown response: shutdown, numb, drowsy, dissociation, floaty sensations, exhaustion, low muscle tone, numbness, poor immune function, or disconnection
  • Following the procedure a person has a heightened dysregulated response to routine medical appointments or interactions
  • Avoidance of future medical appointments, assessments, or procedures
  • Injuries from the procedures, such as scars from a surgery, take longer than normal to heal
  • Somatic symptoms, as medical trauma can trigger and perpetuate chronic somatic symptoms such as chronic pain, fatigue, dizziness, and other symptoms



Preventative therapy for medical trauma

Getting psychological treatment prior to an upcoming medical procedure is one of the best ways to prevent medical trauma from occurring5. A well-trained therapist can support somatically processing unpleasant sensations related to upcoming procedures and cognitively processing negative thinking and beliefs regarding it. A therapist can also help in setting up the conditions for a more somatic sense of safety to occur during and after the procedure. This could include5:

  • Supporting the individual in educating themselves about the procedure
  • Helping the individual in advocating for themselves with the medical team to receive what they need to feel safe
  • Aiding an individual in identifying resources of safety they can use during the procedure (e.g. music, supportive person, blanket, or item)
  • Supporting an individual in writing a script of instructions for the surgeon or medical team
  • Helping an individual gain exposure to being in the hospital while processing sensations

Therapy for Medical Trauma

Once medical trauma has occurred and you have identified it, it can be vital to seek the support of a trained therapist in the area. Our therapists specialize in treating clients with chronic pain or illness and, because of this, are experienced in helping clients in overcoming medical trauma. Collectively, our therapists utilize the following approaches to treat medical trauma:

  • Somatic Experiencing
  • EMDR
  • Somatic Attachment Therapy
  • Emotional Awareness & Expression Therapy
  • Accelerated Resolution Therapy (ART)
  • Radical Exposure Tapping
  • Prolonged Exposure Therapy

If you are ready to begin healing from medical trauma or need support to prevent future occurrences, book a free 20-minute consultation with one of our therapists.

 

  1. McBain, S., & Cordova, M. J. (2024). Medical traumatic stress: Integrating evidence-based clinical applications from health and trauma psychology. Journal of traumatic stress, 37(5), 761–767. https://doi.org/10.1002/jts.23075

  2. Birk, J., Kronish, I., Chang, B., Cornelius, T., Abdalla, M., Schwartz, J., Duer-Hefele, J., Sullivan, A., & Edmondson, D. (2019). The Impact of Cardiac-induced Post-traumatic Stress Disorder Symptoms on Cardiovascular Outcomes: Design and Rationale of the Prospective Observational Reactions to Acute Care and Hospitalizations (ReACH) Study. Health psychology bulletin, 3, 10–20. https://doi.org/10.5334/hpb.16

  3. Levine, Peter A. (1997). Waking the tiger : healing trauma : the innate capacity to transform overwhelming experiences. Berkeley, Calif. :North Atlantic Books,

  4. Dana, D. (2018). The polyvagal theory in therapy: Engaging the rhythm of regulation. W W Norton & Co.

  5. Somatic Experiencing International (2021a). Somatic Experiencing Intermediate year Module 2.

  6. Somatic Experiencing International (2021b). Somatic Experiencing Beginner year Module 1.

 
 

What is Pain Reprocessing Therapy?

 

Can PRT Help in Retraining my Brain out of Chronic Pain and Symptoms?


By Tanner Murtagh, MSW, RSW

For 3 and a half years I experienced widespread chronic pain that continued to worsen over time. To try and reduce or eliminate my chronic pain I did what most people do which included: being examined by several physicians, MRI and x-rays, physiotherapy, chiropractic work, pain medication, and several other physical treatments. However, all the medical tests and treatments did not resolve my pain and in fact, caused my pain to increase.

This is a common story I hear when providing therapy to clients with chronic pain or symptoms. “The medical system has failed me. No treatment is helping.”

The reality is that medical procedures have poor results when it comes to reducing or eliminating chronic pain and symptoms. Surgery, injections, and narcotic pain medications are no more effective than placebo or conservative treatments.1.

So, what is the solution to healing chronic pain and symptoms? The answer lies in the brain. Chronic pain, fatigue, dizziness, or other physical symptoms are often neuroplastic. Neuroplastic pain/symptoms are when the brain changes in such a way that it reinforces chronic pain/symptoms2,3.

When our brain or nervous system feels in emotional danger or dysregulated, chronic pain or symptoms can be triggered and perpetuated2,3. Over time, as pain or symptoms are repeatedly produced, the brain learns to generate these sensations better and better. It is vital to understand that a significant portion of chronic pain and symptoms are neuroplastic, meaning the brain is responsible for triggering and perpetuating them4.

For myself, after 3 and a half years of being in pain I came to understand that my symptoms were neuroplastic in nature. This realization allowed me to shift my focus to rewiring my brain instead of fixing my body. I began to utilize brain retraining exercises, in combination with emotional processing and nervous system regulation, and in doing so over several months I was able to become pain-free.

Research on Pain Reprocessing Therapy (PRT), which is a psychological approach focused on rewiring the brain out of chronic pain, has shown that reversing neuroplastic pain is possible5. In a clinical trial on PRT 66% of participants who received the treatment were able to become pain-free or nearly pain free after 9 sessions5. Over 98% of participants in the study had pain reductions. This research and my personal experience showcase how it is possible to retrain your brain out of chronic pain!

At our clinic we support clients in utilizing brain retraining practices from PRT to heal their chronic pain and symptoms. PRT brain retraining practices for chronic pain and symptoms can include:


Creating New Beliefs about Your Body, Pain, or Symptoms

Understanding that our symptoms are neuroplastic and our body is not permanently damaged is essential. At our clinic, we support people in looking for evidence that their pain or symptoms are in fact neuroplastic. We want to foster the belief that healing is possible. Retraining our brain to develop new beliefs about our body and symptoms, with less fear and more safety, can result in the sensations of pain or symptoms reducing over time 2.

Developing Cognitive Safety Messages

Fearful, frustrated, or despairing thoughts about our pain or symptoms can worsen the sensations2. Brain retraining can involve changing our thoughts about our symptoms by utilizing cognitive safety messages. These could include:

  • “I know I’m okay; my brain is just misinterpreting normal sensations in my body.”
    • “I see how my symptoms are inconsistent, moving around, and triggered by emotions. This shows me it’s neuroplastic and my body is healthy and capable.”
  • “I don’t need to control or change these sensations. There is nothing to fix or figure out!”
  • “My muscles and tendons are healthy. My nerves and ligaments are perfectly intact. My brain is just sensitized and overprotective.”
  • “It’s physically safe to move this way.”
  • “I don’t need to like the sensations; I just need to remember they’re safe!”

Using messages of safety consistently when you notice yourself having negative thoughts about your symptoms and body can support you in rewiring your brain2. In our clinic, we support people in creating unique messages of safety about their body.


Visualizing Yourself Healing and Moving Your Body

Visualization can be a supportive tool in rewiring the brain. Consistently visualizing yourself becoming pain or symptoms free, being able to approach life again, and being able to exercise and use your body the way you want to can support teaching your brain that your body is healthy and capable.


Somatic Tracking

Often, we have an emotional response of fear, frustration, despair, or annoyance to our pain or symptoms. This negative emotional response to our chronic symptoms can actually worsen our symptoms over time as it increases the level of danger and dysregulation our brain is experiencing2. Somatic tracking is a skill that can support us in changing our emotional response to our chronic pain or symptoms2. Utilizing somatic tracking can teach us to respond to our symptoms with lightness, ease, calmness, and compassion. By changing our emotional response to the symptoms, it can result in our symptoms reducing or becoming eliminated2. Our therapists are experienced in teaching somatic tracking and making it individualized for each client.

Here is a free somatic tracking practice to try:


Graded Exposure to What You Fear

Our natural response to chronic pain or symptoms is to start avoiding anything and everything that could be triggering our symptoms, which can include: certain movements, positions, activities, environments, foods, sounds, or time of day. This causes us to enter into a symptom-avoidance cycle where our symptoms cause us to avoid, the avoidance causes our brain to feel more in danger which triggers more symptoms, more symptoms cause more avoidance, and more avoidance causes more symptoms. We have seen clients stuck in this cycle for decades.

It often isn’t the condition that is triggering our pain or symptoms, but the fact that the brain has learnt to view the condition as dangerous2. Essentially the brain has made a mistaken association between the condition and the symptom. Healing chronic pain and symptoms involves slowly, gently, and compassionately approaching conditions we fear while using somatic tracking to create safety. Approaching these conditions can be REALLY SCARY, however, it supports our brain in breaking these mistaken associations2. This can allow us to live more fully with less pain or symptoms!


Leaning into Pleasant Sensations

When we experience chronic pain or symptoms we get really good at hyper-focusing on unpleasant sensations in our body. Part of retraining our brain is teaching it to focus on pleasant sensations. Consistent practice of leaning into pleasant sensations cultivates nervous system regulation and supports the brain in more easily gravitating towards these sensations in the future2. Leaning into pleasant sensations could look like:

  • Feeling the warmth of the sun on your skin
  • Feeling the pleasant sensations of breathing slowly
  • Noticing loose or relaxed sensations in your body
  • Attending to sights or sounds that are calming
  • Enjoying a warm coffee or tea
  • Using soothing touch (making circles on your chest or giving yourself a hug)


Conclusion

As you can see there are many ways we can utilize PRT to retrain our brain out of chronic pain or symptoms. If physical treatments have provided limited results in healing your symptoms, it may be time to start focusing on treating the brain.


If you need support with your healing book in for a free 20-minute consultation with one of our therapists.

  1. Deyo, R. A., Mirza, S. K., Turner, J. A., & Martin, B. I. (2009). Overtreating chronic back pain: time to back off?. Journal of the American Board of Family Medicine : JABFM, 22(1), 62–68. https://doi.org/10.3122/jabfm.2009.01.080102

  2. Pain Reprocessing Therapy Center (2021). Pain reprocessing therapy training. 

  3. Gordon, A., & Ziv, A. (2021). The way out: A revolutionary, scientifically proven approach to healing chronic pain. Sony/ATV Music Publishing LLC.

  4. Woolf C. J. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2–S15. https://doi.org/10.1016/j.pain.2010.09.030

  5. Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carlisle, J., Polisky, L., Geuter, S., Flood, T. F., Kragel, P. A., Dimidjian, S., Lumley, M. A., & Wager, T. D. (2022). Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA psychiatry, 79(1), 13–23. https://doi.org/10.1001/jamapsychiatry.2021.2669

 

What Symptoms or Conditions Can Be Neuroplastic?

 

By Tanner Murtagh, MSW, RSW

Neuroplastic pain and symptoms are caused and amplified by the brain and nervous system processes and are not due to disease or structural damage in the body. Put simply, pain or symptoms are felt even though the body is structurally healthy or has healed from an injury. The brain continues to generate pain or symptoms due to negative thoughts or beliefs, emotions, and a dysregulated nervous system1,2.

The brain is responsible for generating pain and symptom sensations. When the brain receives signals from the body, it combines that information with a large amount of data already present in the brain. This means our emotions, nervous system state, memories, and beliefs about the health of our body greatly influence if, or how much, pain or symptoms are generated3.



One of the most common questions we are asked is, “What types of symptoms can be neuroplastic?” It is vital to understand a significant portion of chronic pain and symptoms are neuroplastic in nature4.

Here is a list of conditions that can be fully neuroplastic or have a neuroplastic component1:

  • Fibromyalgia
  • Chronic neck and back pain
  • Abdominal and pelvic pain
  • Irritable bowel syndrome
  • Non-ulcer dyspepsia
  • Headaches & migraines
  • Complex regional pain syndrome (CRPS)
  • Vestibular concerns and dizziness
  • Tinnitus
  • Chronic fatigue syndrome (CFS)
  • Postural orthostatic tachycardia syndrome (POTS)
  • Myofascial pain syndrome
  • Chemical sensitivities
  • Irritable bladder syndrome (interstitial cystitis)


Our therapists specialize in treating neuroplastic pain and symptoms. If you are ready to begin your healing journey, book in for a free 20-minute consultation with one of our therapists.

  1. Clarke, D. D., & Schubiner, H. (2019). Introduction. In D. Clarke, H. Schubiner, M. Clarke-Smith, & A. Abbass (Eds.), Psychophysiologic disorders: Trauma informed, interprofessioal diagnosis and treatment (pp. 5-25). Psychophysiologic Disorders Association.

  2. Gordon, A., & Ziv, A. (2021). The way out: A revolutionary, scientifically proven approach to healing chronic pain. Sony/ATV Music Publishing LLC.

  3. Pain Reprocessing Therapy Center (2021). Pain reprocessing therapy training.

  4. Woolf C. J. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2–S15. https://doi.org/10.1016/j.pain.2010.09.030

 

What is Dysregulating Your Nervous System?

 

Information you need to know to Heal Your Chronic Pain and Symptoms


By Tanner Murtagh, MSW, RSW

Chronic dysregulation of the nervous system is when you get stuck in the states fight, flight, freeze, or shutdown for prolonged periods of time1. When prolonged dysregulation occurs, your nervous system can then become sensitized, meaning it begins to generate chronic pain and/or symptoms.

A healthy nervous system is a flexible system that shifts with ease between different states1. This doesn’t mean you will always feel calm or relaxed, but instead, you are able to flexibly shift with ease out of states of fight, flight, freeze, or shutdown. Our therapeutic approach with clients supports them in becoming more regulated and flexible, and in our experience, this can support the reduction or complete dissipation of chronic pain and symptoms.

An essential step in regulating the nervous system is first understanding the factors that are causing you to become dysregulated. These factors could include but are not limited to:

  • Trauma1, 2
  • Childhood adversity3
  • Chronic stress3
  • Burnout4
  • Social isolation5
  • Perfectionism6
  • Suppressing difficult emotions7
  • Poor sleep8
  • Lack of exercise9
  • Poor diet10
  • Premature birth11, 12
  • Dangerous and oppressive social factors13, 14, 15

It is important to reflect on if you relate to any of these factors as understanding what factors are dysregulating you can support you in knowing where you need to focus your healing work. Remember this can support you in eliminating your chronic pain or symptoms.

Our therapists are trained in assessing a client in what factors are dysregulating them early on in treatment and a unique treatment plan is then developed based on this.


If you are ready to begin regulating your nervous system and reduce your chronic pain and symptoms, book in for a free 20-minute consultation with one of our therapists.

1.     Dana, D. (2018). The polyvagal theory in therapy: Engaging the rhythm of regulation. W W Norton & Co.

2.     Schneider, M., & Schwerdtfeger, A. (2020). Autonomic dysfunction in posttraumatic stress disorder indexed by heart rate variability: a meta-analysis. Psychological medicine, 50(12), 1937–1948. https://doi.org/10.1017/S003329172000207X

3.     Elbers, J., Jaradeh, S., Yeh, A. M., & Golianu, B. (2018). Wired for Threat: Clinical Features of Nervous System Dysregulation in 80 Children. Pediatric neurology, 89, 39–48. https://doi.org/10.1016/j.pediatrneurol.2018.07.007

4.     Kanthak, M. K., Stalder, T., Hill, L. K., Thayer, J. F., Penz, M., & Kirschbaum, C. (2017). Autonomic dysregulation in burnout and depression: evidence for the central role of exhaustion. Scandinavian journal of work, environment & health, 43(5), 475–484. https://doi.org/10.5271/sjweh.3647

5.     Grippo, A. J., Lamb, D. G., Carter, C. S., & Porges, S. W. (2007). Social isolation disrupts autonomic regulation of the heart and influences negative affective behaviors. Biological psychiatry, 62(10), 1162–1170. https://doi.org/10.1016/j.biopsych.2007.04.011

6.     Afshar, H., Roohafza, H., Sadeghi, M., Saadaty, A., Salehi, M., Motamedi, M., Matinpour, M., Isfahani, H. N., & Asadollahi, G. (2011). Positive and negative perfectionism and their relationship with anxiety and depression in Iranian school students. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 16(1), 79–86.

7.     Patel, Jainish & Patel, Prittesh. (2019). Consequences of Repression of Emotion: Physical Health, Mental Health and General Well Being. International Journal of Psychotherapy Practice and Research. 1. 16-21. 10.14302/issn.2574-612X.ijpr-18-2564.

8.     Hirotsu, C., Tufik, S., & Andersen, M. L. (2015). Interactions between sleep, stress, and metabolism: From physiological to pathological conditions. Sleep science (Sao Paulo, Brazil), 8(3), 143–152. https://doi.org/10.1016/j.slsci.2015.09.002

9.     Schuch, F. B., & Vancampfort, D. (2021). Physical activity, exercise, and mental disorders: it is time to move on. Trends in psychiatry and psychotherapy, 43(3), 177–184. https://doi.org/10.47626/2237-6089-2021-0237

10.  Kris-Etherton, P. M., Petersen, K. S., Hibbeln, J. R., Hurley, D., Kolick, V., Peoples, S., Rodriguez, N., & Woodward-Lopez, G. (2021). Nutrition and behavioral health disorders: depression and anxiety. Nutrition reviews, 79(3), 247–260. https://doi.org/10.1093/nutrit/nuaa025

11.  Mulkey, S. B., & du Plessis, A. J. (2019). Autonomic nervous system development and its impact on neuropsychiatric outcome. Pediatric research, 85(2), 120–126. https://doi.org/10.1038/s41390-018-0155-0

12.  Pyhälä, R., Wolford, E., Kautiainen, H., Andersson, S., Bartmann, P., Baumann, N., Brubakk, A. M., Evensen, K. A. I., Hovi, P., Kajantie, E., Lahti, M., Van Lieshout, R. J., Saigal, S., Schmidt, L. A., Indredavik, M. S., Wolke, D., & Räikkönen, K. (2017). Self-Reported Mental Health Problems Among Adults Born Preterm: A Meta-analysis. Pediatrics, 139(4), e20162690. https://doi.org/10.1542/peds.2016-2690

13.  Goosby, B. J., Cheadle, J. E., & Mitchell, C. (2018). Stress-Related Biosocial Mechanisms of Discrimination and African American Health Inequities. Annual review of sociology, 44(1), 319–340. https://doi.org/10.1146/annurev-soc-060116-053403

14.  Brandt, L., Liu, S., Heim, C., & Heinz, A. (2022). The effects of social isolation stress and discrimination on mental health. Translational psychiatry, 12(1), 398. https://doi.org/10.1038/s41398-022-02178-4

15.  Caldwell, J. A., Borsa, A., Rogers, B. A., Roemerman, R., & Wright, E. R. (2023). Outness, Discrimination, and Psychological Distress Among LGBTQ+ People Living in the Southern United States. LGBT health, 10(3), 237–244. https://doi.org/10.1089/lgbt.2021.0295

 

Are you Traumatized from your Chronic Pain and Symptoms?

 

In this blog post we discuss what trauma actually is, the link between trauma and chronic pain/symptoms, and how we can experience chronic pain/symptoms as traumatic.


Defining Trauma

Trauma is not the event that occurred, but our autonomic nervous system response1. The same event could be traumatizing for one person, and not for another. It’s not black and white; trauma can be more and less severe in its impact. Trauma can be defined as nervous system dysregulation, including an overactive sympathetic and/or dorsal vagal state, that remains stuck in the body1.

Symptoms of trauma can look like:

Overactivation of the sympathetic system:

  • Physical symptoms: difficulty breathing, increased heart rate, difficulties or inability to sleep, tingling, cold sweats, dizziness, chronic pain, tension, tinnitus and other physical symptoms1,2
  • Mental symptoms: racing thoughts, worry and obsessive thinking, anxiety, irritation, panic, or rage1,2

Overactivation of the dorsal vagal system:

  • Physical symptoms: exhaustion, low energy, low muscle tone, numbness, poor immune function, issues with digestion, chronic pain/symptoms, and chronic fatigue1,2
  • Mental symptoms: lacking motivation or interest, dissociation, depression, numb, disconnection in relationships, lack of responsiveness1,2

So why does this matter when it comes to chronic pain and symptoms? It matters because when we experience trauma, our nervous system can become sensitized meaning chronic pain, fatigue, dizziness, and/or other chronic symptoms are triggered.


Trauma and Chronic Pain/Symptoms

There are major links between trauma and chronic symptoms:

  • Adults are 2.7 times more likely to have chronic widespread pain if they have significant trauma in their past3
  • A meta-analysis study on trauma showed a significantly increased likelihood of developing Fibromyalgia and a 4-time higher likelihood of developing chronic fatigue syndrome4
  • Chronic nervous system dysregulation is associated with inflammatory bowel diseases, functional digestive disorders, and IBS5,6
  • PTSD is associated with higher rates of dizziness/vestibular concerns7

These studies teach us that trauma can be a factor in triggering and perpetuating chronic pain and symptoms. Our nervous system lets us know, through chronic pain and symptoms, that it is feeling dysregulated and in a state of survival. As Deb Dana states, “Trauma replaces patterns of connection with patterns of protection”8, and because of this shift, we become much more likely to develop chronic symptoms. This is why trauma is a major factor that we focus on when treating chronic pain and symptoms.

Now let’s discuss one specialized type of trauma that commonly occurs when we are experiencing chronic pain and symptoms, which we call sensitization trauma.


Sensitization Trauma

When we experience chronic pain or symptoms, we can experience what we refer to as sensitization trauma. Sensitization trauma is trauma that occurs during the onset, progression, or relapse of chronic pain/symptoms, resulting in our nervous system having an overactive sympathetic (fight/flight) and/or dorsal vagal (freeze/shutdown) response. Unfortunately, sensitization trauma being untreated can result in chronic pain and symptoms worsening over time.

Sensitization trauma occurs because:

  • We feel dysregulated by the onset, progression, or relapse of symptoms
  • Fear, confusion, frustration, or hopelessness while trying to diagnose the problem and dealing with the medical system
  • Stigma from medical practitioners or individuals in our lives (being mistreated or being made to feel “crazy”)
  • The onset of symptoms occurring due to another health crisis or injury that caused a sense of high danger
  • Scary physical procedures or surgeries
  • Made worse if treatments weren’t helpful
  • Significant reduction in ability and change in lifestyle
  • Hope is gathered and broken by failed treatments or interventions

Releasing Sensitization Trauma

For many people with chronic pain and symptoms, sensitization trauma needs to be processed for symptoms to reduce or dissipate. At our clinic, we provide a somatic approach to clients to support them in healing their sensitization trauma. This can result in our chronic pain or symptoms reducing or dissipating.


If you are ready to begin your healing journey from trauma and chronic symptoms, reach out to one of our therapists to book a free 20-minute consultation.

  1. Somatic Experiencing International (2021). Somatic Experiencing Beginner year Module 1.

  2. Anda, R. F., Felitti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., Dube, S. R., & Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience 256, 174-186.

  3. Afari, N., Ahumada, S. M., Wright, L. J., Mostoufi, S., Golnari, G., Reis, V., & Cuneo, J. G. (2014). Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Psychosomatic medicine, 76(1), 2–11. https://doi.org/10.1097/PSY.0000000000000010

  4. Bonaz, B., Sinniger, V., & Pellissier, S. (2016). Vagal tone: effects on sensitivity, motility, and inflammation. Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society, 28(4), 455–462. https://doi.org/10.1111/nmo.12817

  5. Pellissier, S., Dantzer, C., Mondillon, L., Trocme, C., Gauchez, A. S., Ducros, V., Mathieu, N., Toussaint, B., Fournier, A., Canini, F., & Bonaz, B. (2014). Relationship between vagal tone, cortisol, TNF-alpha, epinephrine and negative affects in Crohn's disease and irritable bowel syndrome. PloS one, 9(9), e105328. https://doi.org/10.1371/journal.pone.0105328

  6. Haber, Y. O., Chandler, H. K., & Serrador, J. M. (2016). Symptoms Associated with Vestibular Impairment in Veterans with Posttraumatic Stress Disorder. PloS one, 11(12), e0168803. https://doi.org/10.1371/journal.pone.0168803

  7. Dana, D. (2019). 2-Day Workshop: Polyvagal Theory Informed Trauma Assessment and Interventions

 

Polyvagal Theory and Chronic Pain and Symptoms

 

By Tanner Murtagh, MSW, RSW

At our clinic, we utilize Polyvagal Theory to support clients in reducing their chronic pain or symptoms. In this post we’ll explore Polyvagal Theory, providing education on the nervous system, and how this relates to your neuroplastic pain and symptoms.

Our human bodies contain a built-in hierarchy of responses, meaning we shift between three systems depending on safety or danger. Our nervous system detects and interprets signals of either safety or danger and guides what system we shift into1.

The Parasympathetic Branch

Your parasympathetic branch consists of your vagus nerve, the 10th cranial nerve and the longest of the cranial nerves1, 2.

The vagus nerve facilitates bidirectional communication between the body and brain:

  • 80% of safety or danger signals are sensory, meaning they come from the body and go to the brain.
  • Only 20% of safety or danger signals are motor, meaning the messages come directly from the brain1, 2.

This is why safety starts in the body! While thinking and beliefs are important, we are greatly influenced by our nervous system state. To fully heal trauma, mental health problems, and chronic pain/symptoms, we need to regulate the nervous system. At our clinic we focus our treatment on this.

The vagus nerve travels from the brainstem at the base of the skull in 2 directions1, 2:

  • Downward through the lungs, heart, diaphragm, and stomach.
  • Upward to connect with nerves in the neck, throat, eyes, and ears.

The vagus nerve is split into two parts: the ventral vagal system and the dorsal vagal system.


The Dorsal Vagal System

Evolutionarily, this system is 500 million years old! The dorsal vagal system is unmyelinated, comes down the back of the body, and is located below the diaphragm1, 2.

The dorsal vagal system responds to signals of extreme danger, causing us to freeze, disconnect, dissociate, feel numb or depressed, and protect ourselves by going into a state of shutdown and collapse1, 2.


The Ventral Vagal System

Evolutionarily, this system is 200 million years old! The ventral vagal system is myelinated, comes down the front of the body, and is located above the diaphragm1, 2.

The ventral vagal system responds to signals of safety, allowing us to feel socially connected, engaged, and safe. Part of the ventral vagal system is the social engagement system which controls facial expression, social gaze, middle ear muscles, ingestion, vocalizing, swallowing, breathing, orienting, and social gesturing1, 2.


The Sympathetic Branch

Evolutionarily, the sympathetic system is 400 million years old! It is found in the midsection of the spinal cord1, 2.

The sympathetic system mobilizes us for action, responding to signals of danger by triggering our fight or flight response. But, it’s more than just fight or flight! It provides energy to live – excitement, play or passion1, 2.

Shifting Within the Autonomic Nervous System

The autonomic nervous system shifts between ventral vagal, sympathetic, and dorsal vagal based on neuroception1, 2.

  • Signals of safety → ventral vagal activation (connected, safe, social, calm) 1, 2
  • Signals of danger → sympathetic system activation (mobilize to fight or flee) 1, 2
    • Often, taking action helps us restore safety and shift back to the ventral vagal system
  • High, inescapable, and persistent danger → dorsal vagal activation (freeze, shut down, and collapse to survive) 1, 2
    • This may also be a helpful survival option!

This chart shows how we typically experience the three different systems and how they can impact pain and symptoms:

An important note: Briefly shifting into the sympathetic or dorsal vagal systems is healthy as long as we’re able to shift back to safety with ease. It’s when we’re dysregulated for prolonged periods of time that our nervous system becomes sensitized, triggering and perpetuating chronic pain and symptoms 1, 2.

A key focus for our therapists when collaborating with clients is to assist their nervous system in accurately recognizing signals of safety and danger, both internally and externally. This allows the nervous system the ability to shift more easily to a ventral vagal state after they experience stressors. We support clients in learning how to connect with their body and understand what state they are in. This is a vital step in having a client’s chronic pain and symptoms reduced.

To begin your healing, book a free 20-minute consultation with one of our therapists:

 

  1.  Dana, D. (2018). The polyvagal theory in therapy: Engaging the rhythm of regulation. W W Norton & Co.

  2. Porges, S. W. (2019) Clinical Applications of the Polyvagal Theory.

  3. Dana, D. (2019). 2-Day Workshop: Polyvagal Theory Informed Trauma Assessment and Interventions

What Somatic Tracking Is and Isn’t

 

By Alex Klassen, MSW, RSW

Somatic tracking is an exercise developed in Pain Reprocessing Therapy, which helps clients reduce neuroplastic pain by developing safer responses to sensations occurring in the body1,2. It provides our clients with an active skill they can practice in recovery.

The goals and practice of somatic tracking can be a bit tricky to wrap your head around. To clarify, here’s a breakdown of what it is, and what it isn’t.


Somatic Tracking is Mindfulness

Mindfulness can be defined “moment-to-moment, non-judgmental awareness, cultivated by paying attention in a specific way, that is, in the present moment, and as non-reactively, as non-judgmentally, and as openheartedly as possible”3. When somatic tracking, we direct mindful awareness to pain sensations. It can be helpful to begin this practice with the guidance of a therapist and/or recorded meditations. Mindful awareness is different than our habitual responses to pain, where we often try to fix it, escape it, diagnose it, or fight it. While meant to help, habitual responses often increase emotional dysregulation, negative thinking, and fixation, leading to more pain1. By mindfully observing physical sensations with curiosity, non-judgment, and non-fixing, we create safety in our nervous systems and reduce pain4. When practiced over time, somatic tracking helps us reduce the amount of chronic neuroplastic pain the brain generates2.


Somatic Tracking is About Safety

While practicing somatic tracking, we want to coach our brains with simple messages of safety1. This can sound like this pain is not dangerous, it’s safe for me to feel this, my body is safe, or my brain is misinterpreting safe signals right now. Simple, meaningful safety messages that resonate are helpful to include in the practice1,2.


Somatic Tracking is Exposure

Just like a fear or phobia, to reduce neuroplastic pain, we need to teach the brain it is safe. Pain is a protector that wants us to fear, fix, or avoid dangers1,5. By intentionally moving toward pain and difficult emotions, while fostering a curious, non-judgmental, non-striving posture, we show the brain we’re safe in the presence of all of our physical sensations. This provides the opportunity for “corrective experiences”, where our brain realizes we are safe1. More safety leads to less pain.


Somatic Tracking is Acceptance (But only for now!)

While practicing somatic tracking, we hold a posture of acceptance for all the sensations we can feel right now. This means allowing things to feel how they feel in this moment, rather than suffering by fighting or fixating on how we wish things would be6. An accepting posture doesn’t mean we resign, believing the neuroplastic pain will be here permanently (in fact, we’re doing this very exercise to reduce it over time!). It means, because pain is already here, the wisest response is to create safety in the nervous system and facilitate a corrective experience in the brain by accepting the sensations with a curious, non-judgmental, and non-fixing awareness.


Somatic Tracking isn’t A Quick Fix

Sometimes when practicing somatic tracking, our clients will notice their pain moves around, reduces, or even disappears. Bringing calmness and safety to our bodies/minds can have this effect, and it’s really cool when it happens! Other times, the pain will stay the same, or move somewhere else. Remember, the goal of somatic isn’t to reduce your pain right now. The goal is to facilitate corrective experiences for the brain, where your brain learns to feel safe with physical sensations1. These corrective experiences stack up over time, retraining the brain. It may take a while, so play the long game!


Somatic Tracking isn’t Only Focused on Pain

In addition to pain sensations, it can also be very helpful to somatic track emotions, neutral sensations and pleasant feelings in the body. When in chronic pain, we often pay attention to our bodies when focusing on the pain, or not at all. Rebuilding safe connection to all physical sensations, including our emotions and nervous system states, is a crucial part of self-regulation and recovery1,7.


Somatic Tracking isn’t a Thought Exercise

“Somatic” can be defined as “relating to the body as opposed to the mind”7. While changing your thoughts and beliefs about your body is an important part of healing mind-body pain and symptoms, it’s not the central focus when somatic tracking. The goal of somatic tracking is to facilitate corrective experiences for our brain by observing physical sensations in a state of safety and curiosity2. While we can use a bit of language to describe what we’re feeling or provide simple messages of safety to ourselves during the practice, we don’t want to drift back into thinking, debating, analyzing, problem-solving, judging, and mind-wandering. That said, don’t be surprised when your mind continually drifts away from physical sensations! This is normal and expected; there’s no need to judge your judging. Simply catch when your brain starts thinking, congratulate yourself for noticing what it’s up to, and gently return to the light, curious observation of physical sensations.


Book a free 20-minute consultation with one of our therapists and begin your journey out of chronic pain today.

 

  1. Gordon, A., Ziv, A. (2021). The way out: A revolutionary, scientifically proven approach to healing chronic pain. Sony/ATV Music Publishing LLC.

  2. Pain Reprocessing Therapy Center (2021). Pain reprocessing therapy training.

  3. Kabat-Zinn, J. (2015). Mindfulness. Mindfulness, 6(6), 1481–1483. https://doi.org/10.1007/s12671-015-0456-x

  4. Zeidan, F., & Vago, D. R. (2016). Mindfulness meditation-based pain relief: a mechanistic account. Annals of the New York Academy of Sciences, 1373(1), 114–127. https://doi.org/10.1111/nyas.13153

  5. Moseley, L. & Moen, D. (2022). Tame the beast: Understanding your pain. University of Southern Australia. https://www.tamethebeast.org/understanding

  6. Kabat-Zinn, J. (2013). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness

  7. Dana, D. (2019). 2-Day Workshop: Polyvagal Theory Informed Trauma Assessment and Interventions

  8. Cambridge Dictionary. (2023). Definition of somatic. Retrieved from https://dictionary.cambridge.org/dictionary/english/somatic

 

Is My Pain Neuroplastic or a Mind-Body Concern?

 

By Alex Klassen MSW, RSW

Unfortunately, it’s not always easy to tell! After all, pain signals tell us (very convincingly) the body is in danger. It doesn’t feel like an easy thing to disagree with.

Let’s start with a quick definition of neuroplastic pain. Put concisely, neuroplastic pain occurs when your brain mistakes safe nerve signals from the body as dangerous, generating pain1. It’s a habitual mistake the brain can develop over time, which is why it’s called “neuroplastic”. You can think of it like an over-protective guard dog. A knock at the door may be a friendly visitor, but the reactive dog becomes too alarmed and starts barking. Research shows us that when the brain receives nerve signals from the body, “cognitive and emotional factors have a critically important influence on pain perception”2, meaning an over-protective brain can generate too much pain.

We’ll use the term “structural pain” in contrast to neuroplastic pain. Structural pain occurs when there’s an injury/physical problem in the body, and the brain accurately perceives these danger signals. The brain generates pain to tell us something is wrong, which needs our care and attention. This helps us stop, diagnose, and treat the structural problem.

If you’ve been experiencing chronic pain, we’re not suggesting you start viewing all the pain in your body as neuroplastic. We don’t want to jump too quickly to mind-body conclusions about the nature of the pain you’re feeling. The purpose of this post is to help you understand the signs of neuroplastic pain, so you can reflect on your experiences, engage in self-assessment, and get an idea if the pain you’re experiencing is treatable with a mind-body therapeutic approach3.

An important note: You don’t need to check off every point below for your pain to be neuroplastic. Some of my clients find nearly every one of these factors applies to their pain, while others only align with a few items, yet their pain is neuroplastic and reduced by therapy.


Sign 1: The Pain Isn’t Behaving Like Structural Pain

  1. Inconsistency

    Injuries and structural problems in the body typically hurt quite consistently. In contrast, when experiencing neuroplastic pain, my clients will often notice their pain changes day-to-day. Sometimes it’s quite confusing, as there’s no clear sense of why it feels better or worse. Because structural pain is caused by physical conditions that change slowly over time, quicker or more spontaneous shifts in sensation and intensity can suggest our pain is caused by the brain1.

  2. Spread and Movement

    The spread of pain symptoms often causes fear, confusion, and frustration, but on the bright side, it can suggest your pain is neuroplastic and curable. Structural pain is typically consistent and localized to injury sites or structural problems in the body. If your pain symptoms migrate around the body, move up and down, or become symmetrical, this suggests they may be neuroplastic rather than structural1.

  3. Multiple Symptoms

    If there are multiple pain spots occurring in your body that are difficult to explain, the brain may be the common denominator. While multiple chronic pain symptoms could be coming from multiple injuries or systemic disorders, it’s quite possible an over-protective brain is the central cause1.

  4. Pain is Triggered by Things that Shouldn’t Physically Hurt

    Stimuli and activities like weather, smells, foods, workplaces, crowded places or the time of day can become associated with pain. If the brain believes a certain stimuli/activity causes pain, we’ll feel in danger the next time we’re doing it. To protect us from the danger, our brain then triggers neuroplastic pain, reinforcing the connection between that stimuli/activity and pain. This is called a conditioned response. If you’re noticing triggers you wouldn’t expect to hurt are causing physical pain, be aware this pain could be neuroplastic1.

  5. Delayed Onset

    Sometimes we engage in a certain physical activity or task, and it feels ok in the moment, only for pain to emerge later. Structural pain doesn’t typically behave this way. Injuries should hurt when they happen, and structural problems should generate pain when they are aggravated by movement. Pain emerging following a physical activity may be neuroplastic, not structural1.

  6. Lacking Physical Diagnosis

    If you’ve had various scans, tests and assessments, and physicians and specialists are unable to find a structural problem to accurately explain your pain, it can suggest your pain is neuroplastic. Furthermore, many of our clients have been given a structural diagnosis, but their pain is neuroplastic. If you’ve received a diagnosis and tried many different physical treatments and medications, with little success, it can suggest that you’re trying to fix or heal problems in the wrong place. We always recommend extensive physical assessment from specialized medical providers. However, if no accurate structural problems can be found and treated, it may be time to shift your treatment focus from the body to the brain and nervous system1.


Sign 2: The Pain Is Connected to Emotion

  1. Pain Emerged During a Stressful Time or Life Transition

    During periods of stress and change, our brain may be functioning on high alert much of the time. This can make our environment, emotions, and body feel more dangerous. It’s in this unsafe, reactive brain-state that neuroplastic pain is more likely to develop1.

  2. Symptoms are Influenced by our Emotional State

    Problems in relationships, difficulties at work, and systemic stressors like loneliness, poverty, racism, gender-based oppression or sexual oppression can cause flare-ups and increases of pain. It is common for human beings to experience physical pain or symptoms during stressful or emotionally difficult times. If your pain is worse during stress and emotionally difficulty, and reduced when you feel safe and calm, it suggests the pain is neuroplastic1.

  3. High-Intensity Living

    Living our lives on-edge due to perfectionism, people-pleasing, worrying, controlling, and self-criticizing makes us more likely to develop chronic pain. While we all experience stress, maladaptive thinking habits and ways of navigating the world can make us feel chronically unsafe, resulting in neuroplastic pain symptoms1.


Sign 3: Predisposing Factors and Life Events

  1. Childhood Adversity

    Experiences of neglect, trauma, bullying, and accidents in childhood can lead to feeling unsafe in the world. Research shows strong connections between childhood adversity and chronic pain4,5. A brain that feels chronically unsafe is more at risk of developing neuroplastic pain and symptoms.

  2. Trauma

    Survivors of physical, sexual, and psychological trauma are much more likely to develop chronic pain. In fact, research shows between 10% and 50% of individuals diagnosed PTSD report chronic pain7. If the impacts of trauma are not processed and healed, a persistent sense of chronic danger and dysregulation in the nervous system can lead to the generation and amplification of neuroplastic pain symptoms8.

  3. Chronic Nervous System States of Fight/Flight/Freeze/Shutdown

    Pain is designed to protect us. So is entering a nervous system state of fight, flight, freeze, or shutdown. While our bodies are meant to move in and out of these danger responses, becoming stuck in states of dysregulation can trigger and perpetuate neuroplastic pain9. If you are experiencing chronic symptoms of fatigue, depression, dissociation, insomnia, anxiety, and/or anger, these are signs of nervous system dysregulation that can generate pain symptoms9, 10.

  4. Pathological Views of the Body

    In attempts to understand and fix the problem, chronic pain sufferers often collect a set of pathological beliefs about their bodies. Through interactions with various health professionals, forums, and online research, many unhelpful labels may be gathered. While structural diagnosis is meant to help with treatment, if the pain is neuroplastic, pathological labels can create confusion and increase fear, despair, and frustration. Viewing the body as broken, abnormal, or unable to heal increases emotional danger and avoidance behaviours, amplifying neuroplastic pain3.


Book a free 20-minute consultation with one of our therapists and begin your journey out of chronic pain today.

 

  1. Gordon, A., Ziv, A. (2021). The way out: A revolutionary, scientifically proven approach to healing chronic pain. Sony/ATV Music Publishing LLC.

  2. Crofford LJ. Chronic Pain: Where the Body Meets the Brain. Trans Am Clin Climatol Assoc. 2015;126:167-83. PMID: 26330672; PMCID: PMC4530716.

  3. Pain Reprocessing Therapy Center (2021). Pain reprocessing therapy training.

  4. Schubiner, H. & Kleckner, I. (2019). The neurophysiology and psychology of pain in psychophysiologic disorders. In D. Clarke, H. Schubiner, M. Clarke-Smith, & A. Abbass (Eds.), Psychophysiologic disorders: Trauma informed, interprofessioal diagnosis and treatment (pp. 45-68). Psychophysiologic Disorders Association.

  5. Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of chronic pain and high-impact chronic pain among adults - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(36):1001-1006.

  6. Stickley A, Koyanagi A, Kawakami N. Childhood adversities and adult-onset chronic pain: results from the World Mental Health Survey, Japan. Eur J Pain. 2015;19(10):1418-1427.

  7. Gasperi, M., Afari, N., Goldberg, J., Suri, P., & Panizzon, M. S. (2021). Pain and Trauma: The Role of Criterion A Trauma and Stressful Life Events in the Pain and PTSD Relationship. The journal of pain, 22(11)

  8. Sharp TJ, Harvey AG: Chronic pain and posttraumatic stress disorder: Mutual maintenance? Clin Psychol Rev. 21:857–877, 2001

  9. Dana, D. (2018). The polyvagal theory in therapy: Engaging the rhythm of regulation. WW Norton & Co.

  10. Kolacz, J., & Porges, S. W. (2018). Chronic Diffuse Pain and Functional Gastrointestinal Disorders After Traumatic Stress: Pathophysiology Through a Polyvagal Perspective. Frontiers in medicine, 5, 145. https://doi.org/10.3389/fmed.2018.00145