Dealing With The Past – Part I: Psychological Factors

When I initially injured my left Achilles tendon in 2004, it felt like something hit my heel even though nothing was there.  For a while after that, every time something brushed against my heel, I would be startled and jerk my leg away from the object.  During the initial stages of my rehab, that quick movement was quite painful.  It was during that time that I realized how the memory of an event can directly affect the body as well as the sensation of pain.

Our past experiences forge our memories and habits.  In essence, they define who we are to ourselves and others.  For better or worse, they also shape how we respond to future events.  Here is an example that we commonly encounter:  A patient recounts that she severely fractured her leg when she was a student in her 20's but her doctors fixed the bone so she was able to make a speedy and complete recovery.  Now, as a working parent in her 40’s, she gets into a minor car accident and injures her neck.  A simple sprain of the neck is nowhere near as bad as a leg fracture, so she should recover in no time, right?

But the pain doesn’t go away.

Furthermore, her doctors tell her that they do not have a fix for her condition and her insurance company cuts her off because there is "nothing wrong" with her.  To this patient, it does not matter that a neck sprain is not as simple as it sounds and that she is at a different place in her life with different responsibilities.  What matters is that, given her previous experience of an injury, she expects to get better quickly.  And now that the expectation is not met, she feels invalidated, frustrated, hopeless, betrayed, angry…which perpetuates the pain (for more information, refer to the blog “Regulating Thoughts And Emotions To Control Pain”).

This process can be quite overwhelming.  In order to properly recover from chronic pain, it is vital to: 1) Be aware of the link between memories/experiences/expectations and pain; 2) Accept the current situation; 3) Develop strategies to deal with the present condition (both physically and psychologically); and 4) Understand how to navigate the healthcare and insurance systems.  A team that includes a psychological professional is invaluable to assist in this process.

But sometimes, our experiences don’t just shape our futures – they can trap us in the past.  People who have experienced traumatic experiences, such as war, abuse (emotional, physical and sexual) or horrific accidents cannot escape the memory of those events.  Moreover, they do not simply remember the event.  They will re-experience all of the emotions and sensations in their bodies as if it was happening for the first time.  This creates a continual state of heightened emotions which amplifies the pain sensation.

Science is beginning to show that psychological trauma is linked to physical changes in various regions of the brain.  These changes in turn hinder the person's ability to recover from the trauma.  This is similar to how muscles shrink and become weaker after injury, leading to an impairment of normal function and making it harder to be active in order to recover.  Pain is related to psychological trauma since some of the changes in the brain also coincide with regions of the brain responsible for processing pain (for more information, please refer to the blog “Why Does Pain Persist?”).  The good news is that, just as the muscles and bones in the body can become stronger and adapt to injury, so can the brain.  Psychological professionals can help a person deal with past trauma through three general processes.

Reducing emotional chaos

Someone who has experienced trauma will be "on edge" since their memories of the event cause them to constantly be assessing for danger and preparing them to fight or escape.  Therefore, a key element of psychological therapy is to calm this heightened emotional state.  The first step is to find a peaceful, safe place within the mind.  This safe place can then be used as a home base from which the person can gradually and safely explore their traumatic memories.  The purpose is not to wipe out the memories but to enable the resumption of a normal life...even with the memories.

Telling your story

Traumatic memories are often fragmented so that a person can only recall bits and pieces of what happened rather than the entire story.  Imagine trying to read a book that only has fragments of words and sentences.  It would be quite hard to follow the book, let alone understand what the meaning of the book is.  A second key component of therapy has to do with assisting the person to fill in the gaps of missing information in their memories.  There are different therapeutic approaches that a psychological professional can use to help a person achieve this.  Once the complete story is known, the person then has more control over how the story is told, giving them more power over their past.

Giving meaning to trauma

When something bad happens for no apparent reason, it can seriously damage our sense of hope and negatively affect our outlook on life.  The third key component of therapy helps to put traumatic events into the larger context of life and give meaning to it.  Once a person can give a reason for why an event happened, they can then accept it as part of their life story and move forward.

Today, January 31, 2018, is "Bell Let's Talk Day” to raise awareness for mental health.  I'd like to take this opportunity to express the importance of sharing our thoughts with one another.  Not only does it open up healthy lines of communication, but it can also affect all other aspects of our lives in a positive way - emotionally as well as physically.  Let's get the conversation started.

Dr. Trung Ngo founded Novah Healthcare in 2017, an interdisciplinary clinic that specializes in the conservative management of acute and chronic pain. His Novah clinic will continue the work he did from 2011 to 2016 at Mount Sinai Hospital, where he led an interdisciplinary team in assessing and treating complex, chronic, non-cancer pain. His Mount Sinai team helped patients decrease their pain, improve their daily and vocational functioning and reduce or eliminate their intake of pain medications (including opioids). Dr. Ngo graduated from the Canadian Memorial Chiropractic College and subsequently pursued a residency program at Hamilton General Hospital in which he furthered his training in orthopaedics and pain management.

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