Chronic Pain & Repressed Emotions: A Conversation That Demands Sensitivity

There is a link between repressed emotions and pain. What is the appropriate way to talk about that?

By now, the correlation between repressed emotions, childhood trauma, and chronic pain is a well researched and documented phenomena. Doctors like the late Dr. John Sarno, Dr. Bessel van der Kolk, and Dr. Peter A. Levine, have all done revolutionary work in establishing how repressed emotions, and trauma can manifest in the body and create or contribute to chronic pain and other somatic symptoms. The efforts of these doctors and others like them have changed the lives of many patients living with conditions ranging from chronic back pain to psychogenic tics related to PTSD, building bridges between the fields of psychological and biological health.

While the work they have done has expanded our collective understanding of the connection between mental health and physical symptoms, there remains a need for delicate sensitivity when exploring these connections with people living with chronic conditions. We have to be careful when we’re navigating the subject of the confluence between psychology, emotions, and pain for a few very important reasons.  We want to create spaces for healing, and avoid appearing as if we’re blaming people with chronic pain for causing their symptoms. It’s critical that the conditions of the environments into which we are inviting them are psychologically, emotionally, and physically safe. Without intentionally, compassion, and caution, we can inadvertently create or compound problems, when what we’d like to do is help address them.

Contributing to the ‘It’s all in your head’ narrative

In addition to the challenge of living with physical pain, one of the most traumatizing and exhausting experiences for many who have chronic pain is navigating relationships with people in their lives. It’s not unusual for those living with pain to encounter people who doubt their lived experiences, minimize the severity of their pain, or blame them for their pain. Whether from doctors, parents, partners, or friends, people living with chronic pain experience the constant invalidation of having their lived reality of pain doubted and undermined by others. The repeated experience of not being believed about their symptoms, or even worse, blamed for them, can cause them to internalize a narrative that they are at fault for their pain, and can lead to deeply rooted feelings of shame. They may even begin to doubt their own experiences and symptoms, feeling crazy because the people in their lives encourage a narrative that suggests that their pain is all in their minds.

While it’s important to acknowledge that there is a strong correlation between emotions, psychology, personality, and the incidence of chronic pain, it’s equally important to ensure that the message is communicated in a sensitive and empowering way. Whether or not there is a strong psychological component to pain, once the symptoms are manifesting in the body, it simply isn’t appropriate or accurate to suggest that the pain is solely a psychological issue. Without understanding or sensitivity, there is a risk that suggesting to someone that their pain is psychosomatic in origin might be interpreted as a form of blame or another instance of hearing that the pain is all in their head.

Attempting to examine the past when the present is unsafe

While significant attention is being given to the impact that unresolved emotions and trauma have as sources or enhancers of pain, what is insufficiently recognized is that ongoing physical pain can often be a form of trauma itself. Living with chronic pain can be an experience of living in a body that is, itself, experienced as a threat. The uncertainty and unclear trajectory of pain and flare ups, can lead to a feeling that the body is a ticking time bomb that might explode with agonizing pain at any moment. Perhaps one feels a compromised sense of self that comes with living with symptoms that inhibit the ability to live as they had planned or imagined. Often, people with chronic pain face uncertainty about whether or not there will ever be improvement in their symptoms.

All these experiences represent aspects of how living with chronic conditions can cause someone to feel that their body is an unsafe place to reside, and result in a constant state of hypervigilance and bracing. While the brain is experiencing the body as unsafe, any ability to effectively engage in an emotional healing process is limited. Try asking someone to reflect on the emotions of their childhood while they are being chased by a tiger, and you might have an idea of what is being asked of a person who is traumatized by their ongoing physical pain. It’s one thing to acknowledge that the past has an effect on the present, but quite another to realize that the trauma that can result from chronic pain is ongoing. While it is important to find a way to process the unresolved emotions and underlying traumatic experiences of the past that may have triggered the development of chronic pain, before any attempt can be made to do that, a sense of safety needs to be established in the present.

False promises and let downs

Setting expectations is a critical part of managing chronic pain. When a care provider who is in an influential position suggests any sort of miracle treatment that promises to remove the presence of pain, it can be a very exciting prospect for their patient. The problem is that, not uncommonly, the initial feeling of hope is followed by a crash into disappointment and failure. Having fully given themselves to a course of treatment, they find themselves with little to no improvement in their symptoms, which can result in feelings of shame, blame, and hopelessness.

Providing false hope that pain is entirely psychosomatic and will disappear once focus is put on psychology and emotions is insensitive and irresponsible. Most people living with long term chronic pain have tried countless new treatments and solutions, both physical and psychological, that have been presented to them as their long awaited miracle cure. Rather than setting them up for another let down, a more honest, compassionate, and helpful approach is to acknowledge the likelihood that often, some pain symptoms will persist, but that living a full life with pain is still possible.

A sensitive approach to the relationship between trauma, repressed emotions, and pain

Psychosomatic pain is real, and there are legitimate benefits for people living with chronic pain to gain from psychoeducation, therapy, and other approaches that involve processing past trauma and unresolved emotions. However, all of these approaches need to factor in the lived realities of those living with chronic pain to avoid contributing to the creation of unsafe healing environments that cause them to feel blamed or shamed. Acknowledging the ways that the mind influences the body doesn’t mean invalidating someone’s experiences or white washing their agony by explaining it away.

Recognizing that ongoing pain can register in a person’s brain as an existential threat creates an impetus to first prioritize establishing a safe place for healing. There can be no stable foundation from which to examine the past if the present is experienced as unsafe. Once a sense of safety has been established in the present, then it becomes possible to explore any potential trauma or emotional damage of the past that may be relevant.

The work that has been done by doctors and experts to research the influence of repressed emotions and trauma on chronic pain has revolutionized the way that chronic pain is treated. There is a much more holistic view of the bidirectional relationship between mind and body than before, and this is good news for people living with chronic pain. However, if approached without consideration or awareness of the difficult social, psychological, emotional, and physical experiences that people with chronic pain navigate on a regular basis, there is risk of doing more harm than good. To jeopardize the potential benefits of processing repressed emotions and trauma for those with chronic pain with careless treatment is to become a contributor to their struggle, rather than an aid to their healing.

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