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 procedure^1,2.

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 response^3,4.

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.

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 include^5,6:

• 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.

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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/symptoms^2,3.

When our brain or nervous system feels in emotional danger or dysregulated, chronic pain or symptoms can be triggered and perpetuated^2,3. 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.

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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

How Pain Becomes a Conditioned Response

By Alex Klassen MSW, RSW

Our brain is a learning machine that quickly develops associations, meaning we connect conditions and responses as we move through the world. To understand how this works, we can think back to Pavlov’s research on the brain and learning, where he experimented with dogs. Right before feeding his dogs, Pavlov started turning on a clicking metronome. After a few trials, he noticed the dogs started salivating from the sound of the metronome alone. The dogs developed a conditioned response¹.

The condition: the sound of a metronome

The response: salivation

When we’re experiencing chronic pain, it’s easy for the brain to make an association between an activity or stimuli (the “condition”) and pain (the “response”). For example, imagine a woman notices her back pain increasing when sitting in her computer chair. Naturally, her brain asks the question, “Why does my back hurt?”. And the most obvious answer might be, “It’s this stupid chair!”. If there was a problem with the chair and it was hurting her back, this association is helpful. She might fix the problem by adjusting the chair, buying a better one, stretching more, changing her posture, getting a massage, or avoiding sitting for long periods of time.

Making associations is essential for learning and survival, but the brain can make mistakes. Let’s imagine instead this woman’s pain is neuroplastic, meaning it is caused by her brain mistaking safe nerve signals from the body as dangerous². In this scenario, the trigger of her back pain is actually a stressor like her job, or some other cognitive or emotional problem occurring^2,3. In this case, the conditioned response connecting her pain to the chair is unhelpful. Rather than helping the woman address her stress and emotions, the pain sensations may send her down the wrong road, fixating instead on problems with her chair and back.

The condition: sitting in the computer chair

The response: back pain

If the woman believes the chair was the cause of her pain, her brain is more likely to generate more pain the next time she sits in it. This is because pain is a danger signal, it’s job it to protect you from things it believes to be dangerous². This can lead to the conditioned response growing stronger and stronger.

Conditioned responses can happen all over the place, including foods, weather, time of day, stress, emotions, smells, environments, and certain movements and activities. This often leads to more and more avoidance behaviours, increased fear in our bodies, and life getting smaller and smaller. It’s a nasty feedback loop, but it’s possible to reverse it.

When working with our clients, we gather evidence for physical safety, while providing education on how neuroplastic pain works. Through this process, our clients often realize their brain is being over-protective, producing pain in many conditioned responses where it doesn’t need to. Recognizing how neuroplastic pain is occurring as part of a conditioned response allows our clients to feel safer and make changes. Step by step, we can teach our brain that our body is a lot safer than it used to think, changing our beliefs and gradually re-engaging in activities and environmental stimuli. Over time, this leads to less pain and a fuller life, which are the goals we work toward with every client.

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

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1. Rehman I, Mahabadi N, Sanvictores T, et al. (2023). Classical Conditioning. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.

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

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