The Buck O’Neil Bridge just north of downtown is one of more hectic traffic spots in Kansas City, Missouri, and for Shari H, a car accident here in 2012 turned out to be life-changing.
She didn’t have any major injuries, but after days and weeks passed, she realized that her post-accident soreness wasn’t going away.
“It grew and grew in intensity for me,” Shari says. “I thought, ‘This is not just a whiplash feeling. This is something else.’”
About one in five adults in the U.S. suffer from chronic pain, and in a lot of cases, there’s no clear reason why or treatment that works.
As the dangers of opioids are becoming clearer, many doctors are looking at other ways to address pain, including addressing childhood trauma.
Shari, who asked that we not disclose her last name because of her childhood trauma, had a consultation with University of Kansas Health System pain specialists and started by talking with doctors about her recent accident and pain.
But the conversations ended up going much further into her past – into a ten-year stretch of her life she’d been trying to put behind her.
“Growing up as a child, I experienced some things with an inappropriate family member, and it did cause me to have tightening muscles, insecurities, trust issues,” Shari says.
A growing body of research shows how trauma – especially in early childhood – may be one of the most important factors in how people handle pain.
At a lab at the University of Kansas Medical Center, liquids stir in flasks, centrifuges whirl, and associate professor of anatomy and cell biology Julie Christianson leads researchers working to understand the links between stress and pain in mice.
Christianson explains that pain generally works in two stages. First we have an injury and feel pain, then – just as importantly - our brains dial the pain back down.
“Under normal conditions, if you’ve had this injury, you pull your hand away, you pull your foot away, you’ll have healing of the site, you don’t have ongoing pain,” Christianson says.
But when children are exposed to lots of stress and stress hormones like cortisol, researchers think it disrupts brain development and creates lifelong changes in the way they process pain.
Even in adulthood, it can be much harder for these patients’ brains to regulate pain signals. They can become hypersensitive to pain or, like Shari, a relatively minor injury can turn into something permanent.
“If you’re in a car accident or have really bad whiplash, you can develop chronic pain from that,” Christianson says. “Even after this region has healed, you still have pain from that region.”
Even though it starts with stress, Christianson explains that these pain problems are not just in someone’s head.
For these patients, brain regions that are supposed to work together actually function differently.
“You can use functional MRI scans and see that there are inappropriate or loss of connection between these different brain regions,” Christianson says.
Stress reduction and therapy have been shown to help these patients reduce pain, and pain treatment groups, such as the American Academy of Pain Medicine, are pushing for wider use of psychology in pain management – even for people who haven’t had serious trauma.
That can be a tough sell, according to Maisi Ziadni, a clinical instructor and postdoctoral fellow at Stanford University School of Medicine in Palo Alto, California.
“I think patients are generally looking for a quick fix, as evidenced by the opioid crisis,” Ziadni says. “They have a desire for an interventional approach, whether it’s surgery, whether it’s a pill, whether it’s an injection to take this pain away. And there is somewhat of a trend that shows that providers are quick to prescribe opioid medication.”
The science of trauma and pain is still being investigated, and even though pain psychology is growing in special clinics, it’s still not available to lot of people who could use it.
However, even Ziadni acknowledges it’s not going to be practical for all of these patients to spend years on a shrink’s couch.
Instead, she says, pain psychologists will have to develop shorter workshops or online treatments to accomplish the same goals.
“To try and overcome some of these barriers related to the costs, whether insurance covers these sessions, the ability for patients to attend,” Ziadni says. “So we’re trying to think very creatively about solutions.”
After years of pain treatment being dominated by pills and surgery, many patients may have to upend their expectations that these are the only real ways to treat pain.
Research has shown that expectations can make a big difference in how well pain treatment works, and Ziadni says doctors have a lot of work to do to show patients how strong the connections between trauma and pain really are.
“That way they can develop more positive expectations from treatment,” Ziadni says. “There’s better buy in. And they also are more empowered and have more self-efficacy in their ability to manage their pain condition.”
For Shari H, what started as a simple doctor’s visit to fix her pain has turned into something much more.
She started group therapy and stress reduction, and even though she still experiences some pain, coming to grips with her past has changed her life in ways she never imagined.
“I’m happy,” Shari says. “I feel like at 52 years old I have found the peace I was looking for. Because I have found out through the physical pain what I am made of on the emotional end.”
Alex Smith is a health reporter for KCUR. You can reach him through email: firstname.lastname@example.org.