- Early Trauma and Adult Pain Perception -

The Torments of the Chronic Pain Patient

by John A. Speyrer

"The earlier the trauma during womb life the more disastrous the effects.
That is our important secret life."

--Arthur Janov, Ph.D.

It was Russian physiologist and psychologist, Ivan Pavlov (1849-1936) who proved that a newborn being's stress tolerance was based on its previous painful stressing. Earlier stress and pain reduced its tolerance to future stress and pain. Not having a previous injury is thus a future advantage. Therefore, if the trauma of birth had been overwhelming future shocks can be felt as devastating. The child as adult becomes hypersensitive to painful stress.

Psychiatrist Frank Lake, in 1966, wrote, "...(J)ust as neurotic adults regress until they experience unfortunate contemporary happenings as if they were major disasters, on the basis of infantile imprinting, so the three-months-old baby who is going through a difficult, anxious (i.e., narrowed-down) passage in his relationships with the mother will tend to regress and experience this as if it were the crushing terror by which he entered the world."
Clinical Theology, p. 936.

A study published in November of 2008 zeroed in on how the traumas of infancy influenced pain perception in infancy and in later life.

Iileana Arias, director of the CDC National Center for Injury Prevention and Control believes that "a trajectory of a number of negative outcomes, including health outcomes" can begin at that time. One conclusion was that maltreatment of infants can result in problems with brain development. Importantly, the infant may develop a permanent connection between the abuse and intense physical pain. To establish this hypothesis, a group of 20 women who had irritable bowel syndrome were subjected to mild painful stimuli resulting in a more intense pain for those who had a history of both IBS and early abuse.

Remarkably, the subjective pain's existence could be readily established by modern imaging techniques (fMRI). It was also found that the built-in brain's areas which normally dampen negative sensations and emotions did not work as well. Here was a "mechanistic explanation" for the perceived effect.

It has long been known that earlier physical and emotional pain sets up one's brain to experience such untoward effects. Thomas Miller, a professor of psychology at the Univ. of Connecticut, is quoted as having said that "(i)ndividuals who complain of pain-related symptoms have experienced other forms of pain."

Both recent and much earlier trauma victims often complain that pain sedatives they are prescribed do not suffice. "During a traumatic experience, the prefrontal cortex, the rational part of the brain, shuts down. Anything the body experiences after that time -- including fear, confusion, feeling out of control and physical pain -- is relayed directly to the emotion processing centers in the brain, creating areas of hypersensitivity. Later, pain can parallel those feelings." The old imprint even though physically healed for perhaps decades can continue its nefarious effects by causing physical suffering in the present.

Other recent studies have discussed how old memory traces of injuries and trauma can trigger chronic pain. These studies are germane to trauma theory and the regressive therapies. It was also found by a Northwestern University researcher that such unwanted pain residuals remain in the prefrontal cortex. Such residuals act as old repressed memories, (which they seem to be!). Much hope is held for the drug D-Cycloserine. In experiments, the drug significantly reduced both the patient's physical and emotional sensitivity to the suffering, due to the earlier trauma, for a period of one month.

The authors of the CDC study wrote that pain effects are cumulative. Remarkably, the functional MRI contains a record of past pain endured and can even be used to predict the number of years the patient had been suffering from chronic pain! Apkarian is quoted: "I can predict with 90 per cent accuracy how many years they have been living in that pain without even asking them the question." (www.bio-medicine.org/biology-news).Thus measurements can finally be made which give an objective evaluation of the amount of pain from which a person suffers.

The National Institute of Health funded the study which was published in the journal, Pain in the Fall of 2007. Dr. Vania Apkarian, who has studied the cortical dynamics of pain for two years, was in charge of the experiments. He felt that chronic pain can actually cause a physical shrinkage of the brain and recommends that such pain not be simply tolerated but treated aggressively in order to prevent any permanent brain changes. Clinical trials will be the next step in studying D-Cycloserine's effect on chronic pain.

Is it reasonable to conclude that someone who complains of greater amounts of physical pain than expected may have a sufficient reason for complaining even though objective evidence is sometimes lacking? Actually, the study means that the evidence of the existence of such suffering is no longer lacking even though the early state of the evidence means that few physicians know what clinical psychologist's Apkarian's pain research has revealed.

In the near future, it is hoped that clinical testing with the fMRI will be used to firmly establish that the pain patient's strongly held certainties -- that they are not hysterics enjoying their secondary gains from their sufferings. There will be much reassurance when it will become scientifically established that those, like fibromyalgia victims, are not suffering from imaginary diseases, but are rather suffering from trauma residuals.

Retired neurologist Robert Scaer, who himself was a trauma victim, writes poetically in his most excellent book, The Trauma Spectrum: Hidden Wounds and Human Resiliency (2005):

One can't begin to address the topic of healing trauma without dealing with the fact that trauma is an aberration of memory. It freezes us in a past event that thereafter dictates our entire perception of reality. The past event is everpresent, awaiting its chance to intrude on our daily life based on the subtlest of cues. Locked in the crucible of terror created by the traumatic experience, we dance like a puppet on strings controlled by a manic and repetitive puppeteer. Our thoughts, our choices, our values, our behavior, even the control of our bodies seem to be governed not by conscious intent but by some inner tyrant that operates with an unknown and sinister agenda.

The messages provided by our very thoughts are alien, nonsensical, and divorced from the events around us and from our moment-to-moment perceptions. Our storehouse of old memories on which we base the perception of our identity is fragmented, distorted, at times terrifying, at times confusing. We respond to events in our daily life with emotions that seem to arise spontaneously with a degree of intensity that alone is terrifying. Deep in our hearts we recognize that our inner life makes no sense, and overlying it all is a deep sense of shame. Seeking safety, we find ourselves shrinking into a smaller and smaller space until there is no space at all around us that we can call ours. And still the world seems able to assault us with messages that somehow instill fear. (p. 252)

And if that is not unfortunate enough, usually the pain patient does not realize that the pain in their lives has its origin in very early, deeply repressed traumas. Without deep regressive psychotherapy these secrets may never become known.

As does Apkarian, Scaer writes that his chronic pain patients have higher levels of anxiety and fear of pain than one should expect from their history because their unknown history cannot be verbalized. Their patient's pain origins were decades in the past - before there were words to conceptualize their pain.

For those who were most severely traumatized, ingesting high doses of painkillers in the here and now will not adequately sedate their suffering. Dr. Scaer feels that narcotics treated his pain patient's terror as much as it treated their physical pain. (pps. 182-3) "If one explores the emotional state of such chronic pain patients, one finds high levels of anxiety, vigilance and fear of the pain," Scaer writes.

Doses which would cause coma in others sometimes do not even alleviate the pain of such patients. In spite of high doses, they are terrified of withdrawal from their pain medication. (p. 182). Such reactions are typical of those who have suffered severely from very early trauma. Some clients in primal therapy tolerate opiates and other pain killers well - at levels which would cause death in others who have not had these early intrauterine and birth traumas. This tolerance exists because of the "...massive amount of pain activation of their brain that galvanized the system." (A. Janov, Primal Healing , p. 218)

Susceptibility to the untoward side effects of anti-depressants are very common in trauma patients, especially to the newer SSRI medications - more so than in non-trauma, general population patients. Often the older classes of anti-depressants work better and the newer SSRIs are discontinued. Beginning with microdoses and increasing consumption in very small increments, can sometimes allow for some success in toleration, Dr. Scaer writes. Such painful medication experiences by trauma patients are the result of "...an actual change in brain and body physiology." (Scaer, op.cit, p. 276)

"(F)etal life is "not drifting on a cloud, [but is] eventful as the nine months that come after birth. The foetus is not unaware of itself, or of the emotional response of the mother to its presence,
but acutely conscious of both and their interaction."

-Frank Lake, M.D., Mutual Caring, pps. 57-58, quoted in Maret, op.cit.

Like most regressive therapy theoreticians, Frank Lake, at first, believed that infancy/early childhood, were the most significant times of one's life insofar as trauma was concerned. Then later, he was convinced of the overriding importance of birth trauma and womb life. During the last part of his life's work, however, he became adamant and insisted that the first three months of embryonal development was the most significant part of one's life. Towards the end of his life, he wrote: "The focus for psychopathology is now, for us, the first trimester of intra-uterine life. These first three months after conception hold more ups and downs, more ecstasies and devastations that we had ever imagined." Lake, Frank. (1966). Clinical Theology: A Theological and Psychiatric Basis to Clinical Pastoral Care.

This piece began with a review of an article about how the assault of trauma on the infant can result in prolonged episodes of pain in later life. However, its effects on the brain of the early developing fetus can be even more pernicious than its effects on the infant even before development is further advanced or completed. ( See my article, Fibromyalgia and the Traumas of Birth )

Also see recent blog writings of clinical psychologist, Arthur Janov, Ph.D.:
The referenced articles in the paragraph above, discuss the evidence that the mother's diet, her anxiety, drug taking, smoking and depression, and the womb environment of the fetus, can lay down even more severe trauma than that which originates during infancy. Inutero trauma will also exacerbate the later trauma of infancy as well as add to the train of mental illness in later life. When the fetal environment caused by high stress levels of the mother occurs, that fetus can be left with a malfunctioning immune system for the rest of its life. Even the very earliest events in the life of the fetus has a direct bearing on its future life.

Dr. Janov writes that someone can be born with all kinds of allergies. A history of emergency clinic visits for all kinds of infections, asthma, breathing problems, and in general, having a very deficient immune system is not uncommon. To understand the origins of much ill health in youth, middle age and old age, we need to go back in time and direct our attention to those early months in the womb. When we do, we often find out that the mother-to-be was quite anxious and/or depressed. Often, her marriage was falling apart.

Indeed, the pregnancy itself can cause the breakup of the marriage. For unconscious reasons, the husband may feel it imperative that he leave. (See Bonds of Fire by Alice Rose, Ph.D.) A well known example is the case of Elvis Presley. He asked his wife, Priscilla, late in her pregnancy, for a trial separation. He needed time to think he said. His daughter, Lisa Marie, was born two months later. ( http://en.wikipedia.org/wiki/Elvis_and_Me )

Psychiatrist, Frank Lake, believed:

Before birth, the foetus may be seriously damaged if the mother is dependent upon alcohol, nicotine or other drugs. It is also damaged by less readily identifiable changes that transmit to the baby a mother's rejection of a particular pregnancy and of the life growing within her. Any severe maternal distress, whatever its cause, imprints itself on the foetus. [Quoted by Maret, ibid. p. 66, Tight Corners in Pastoral Counselling, Frank Lake, M.D., p.16. (from Maret)]

It may be due to her marriage, to her husband's withdrawal rather than more intimate supporting when he is asked urgently for more than his personality can easily give. It may be due to the family's economic or social distress in a distressed neighborhood . . . If she is grieving the loss of, or nursing a still dying parent, the sorrow overwhelms her and overwhelms her fetus. [Lake, ibid., "Theology and Personality", p. 66. (from Maret, p. 69.)]

She may have been full of anger internally, while fear, compliance or compassion prevented its ever being shown externally. she may have loved the man by whom she became pregnant, while hating the resultant fetus, or loved the prospect of having a baby, while hating, fearing or feeling deeply disappointed and neglected by its father. The fetus receives all such messages but has difficulty in distinguishing what relates specifically to it and what belongs to the mother's feelings about her own life in general. [ibid., p. 21. (from Maret, p. 67)]

Abortion attempts can be understood and assimilated by the unborn for what they are - "failures of murder" (See Intimations of Failed Abortion Attempts in the Regressive Psychotherapies ) with the outside world intruding the fetus' space of being with resulting feeling of being 'marinated' in its mother's sadness and miseries. Rejective despair can have its original origin in these abortion attempts. Thus, the foundation of continued expectation of painful rejection may already have been laid even before a breath is drawn.

Recent writings of clinical psychologist, Arthur Janov, have placed an increased emphasis on the perniciousness of distorted set points of early brain physiology rather than the psychological aspects of the fetus' trauma. See the earlier referenced articles in Dr. Janov's blog.

He believes that even though our DNA is established at our very beginnings, the womb environment can influence how epigenetics establishes our neurotransmitter outputs (Links to three articles follow). [epigenetics I - epigenetics II - epigenetics III] A less than satisfactory womb environment can inhibit beneficial outputs and thereby have a detrimental effect. Dr. Janov, who has authored articles II and III, writes that reliving our most earliest traumas can perhaps undo the changes to these earlier evolutionarily-intended setpoints.

It has already been established how future sexual orientation of the fetus can become established by its womb environment. (See The Origins of Homosexuality: Insights From The Deep Feeling Psychotherapies )

Dr. Scaer in, The Trauma Spectrum, laments that medical science still does not seem to understand that even during the inutero period, the developing fetal brain can be physically changed by trauma. The adequate functioning of the adult brain can be severely compromised as is shown in the many cases of brain dysfunctioning as a result of traumatic situations in wars. This is not to imply that the servicemen had not endured even earlier traumas which are causing present symptoms. Even neonatal intensive care can be an emotional and physical assault on fetal vulnerability. ( See The Terribleness of Being Alone After Birth )

"Whatever the stress and whenever it strikes, the "womb-distressed" person, Lake
writes, "complains as if it remembered the bad times it had been through.
It reacts to the world around it as if it were still in the bad place,
still having to 'feel its keenest woe.' It reacts defensively
as if the attack were till going on."

- Frank Lake, Supplement to Newsletter No. 39, 4.

Just as the regressive therapies changed their theories and emphasis when the reality of the birth trauma was acknowledged, so too will the understanding of the importance of the role of very early fetal neuro-biological development be accepted and emphasized by more and more theoreticians. But can the early physiological set-points be changed early enough and significantly enough, to allow a vital change in those who were deeply traumatized in the womb and at birth? Perhaps, resolution can only occur if therapy is begun soon enough. In the severest cases, perhaps, even during one's babyhood or toddlerhood.

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