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The Chronic Pain, Mental Health Overlap

Updated: Jul 20, 2023



Over the past year, my journey of research and continued learning on the overlap between chronic pain/illness and mental health struggles has been transformative. Recognizing this overlap in my own life has been instrumental in finding deeper healing. Today, I wanted to offer a deeper look at the interconnected nature of pain and mental health. While my primary focus is not on trauma, it would be remiss not to invite trauma into this discussion, as it often leads to experiencing both emotional/mental and physical symptoms. So, let's begin by defining trauma.



Trauma is a profound psychological response to distressing events that surpasses an individual's capacity to cope effectively. Often referred to as "Big T" trauma, it induces transformative changes in neural pathways, emotional regulation, and physical responses. Such experiences extend beyond ordinary life challenges, leaving an enduring impact on an individual's sense of self and their perception of the world around them.

In the wake of trauma, both the human brain and body undergo significant changes as they grapple with the overwhelming impact of distressing events. Our intricate command center, the brain, is heavily influenced by traumatic experiences, while our finely tuned instrument, the body, reacts and adapts to the emotional and physical toll.


Understanding how trauma affects both the brain and body is vital in comprehending the intricate relationship between chronic pain/illness and mental health struggles, shedding light on the complex interplay between these aspects of well-being. So, let's take a closer look at how trauma can affect the nervous system.



The Polyvagal Theory, proposed by Dr. Stephen Porges, offers valuable insights into understanding how trauma can impact the nervous system and subsequently influence our responses to stress, anxiety, and depression. According to this theory, the autonomic nervous system (ANS) plays a crucial role in regulating our physiological responses, especially in the face of perceived threats or trauma. The ANS operates through three distinct branches: the sympathetic nervous system (fight/flight), the parasympathetic nervous system (rest/digest), and the newer Polyvagal branch (social engagement).


In the aftermath of trauma, individuals may find themselves trapped in the fight/flight state, where the sympathetic nervous system becomes overactive. This heightened state of arousal can manifest as persistent anxiety and stress, as the body remains on high alert, anticipating danger at every turn. Even in situations that may not pose a real threat, the nervous system continues to respond as if in a state of emergency, leaving individuals feeling constantly on edge.


Conversely, trauma can also push individuals into the freeze state, where the nervous system activity is suppressed. This response is an evolutionary survival mechanism akin to "playing dead" when escape or confrontation seems futile. In this state, individuals may experience feelings of numbness, detachment, and an inability to engage fully with the world around them. The freeze response is often associated with depression, as the lack of activation in the nervous system may lead to feelings of numbness, hopelessness, or emotional shutdown.


Trauma can keep the nervous system stuck in a dysregulated state, perpetuating chronic stress, anxiety, and depression. Interventions aimed at restoring nervous system balance, such as mindfulness practices, therapeutic techniques, and self-regulation exercises, can help individuals move towards a more resilient state, fostering healing and improved well-being.


Chronic stress (occurring with or without trauma) is another significant factor that can profoundly impact nervous system functioning, therefore having an impact on mental and physical health. Prolonged exposure to stress hormones, such as cortisol and adrenaline, can dysregulate the autonomic nervous system, leading to a state of chronic sympathetic dominance. This prolonged activation of the fight/flight response can impair the body's ability to return to a balanced state, causing a cascade of physiological and psychological effects.


In this heightened state of arousal, the body remains on constant alert, leading to increased muscle tension, elevated heart rate, and shallow breathing. Over time, these physical responses contribute to a range of health issues, including cardiovascular problems, digestive disorders, and weakened immune function. Moreover, the constant bombardment of stress hormones can negatively impact the brain's structure and function, affecting memory, emotional regulation, and cognitive abilities.


The impact of chronic stress on the nervous system can intensify the experience of chronic pain, as heightened sensitivity to pain stimuli becomes more pronounced. This is a phenomenon called central sensitization and, in addition to chronic stress, can occur due to trauma, prolonged pain exposure, repeated injuries, etc. What we can take from this is that there are shared neurobiological pathways which create a complex and interconnected relationship between body and mind; and learning to train the nervous system can be an effective part of healing.


One of the main reasons I wanted to be trained and certified as a Yin Yoga Therapy instructor was specifically for the impacts it can have on the multidirectional relationship of thoughts, emotions, and physical states, through the way of the nervous system. By incorporating this gentle practice into a comprehensive treatment plan, individuals may experience profound healing on multiple levels, fostering resilience, and enhancing their overall quality of life.


The focus on fascial release in Yin Yoga is particularly beneficial for individuals experiencing chronic pain. As connective tissues surround muscles and organs, they can become tight and restricted due to trauma or repetitive strain. Holding Yin poses allows the fascia to slowly stretch and release, promoting increased blood flow and nutrient exchange to the affected areas. This can alleviate tension, improve joint mobility, and offer relief to those living with chronic pain conditions.


In addition to just the physical benefits of releasing fascia, it's important to note that 80% of nerve pathways end in the fascia. This means that when one experiences trauma, heightened stress, unprocessed emotions, etc., the neural pathways are not able to be completed, leading to the storing of that energy in the fascia, creating blockages.


Additionally, Yin Yoga's emphasis on deep breathing and mindful awareness contributes to nervous system regulation. The practice activates the parasympathetic nervous system, which counteracts the sympathetic "fight-or-flight" response often triggered by chronic stress and trauma. As a result, individuals may experience reduced anxiety, improved sleep patterns, and an overall sense of relaxation and well-being.


Beyond the physical benefits, Yin Yoga can also facilitate emotional release and healing. Holding passive postures for an extended time allows individuals to confront and process stored emotional energy in the fascia and the body. The practice creates a safe and nurturing space for individuals to explore their emotions without judgment, fostering emotional catharsis and a sense of emotional freedom.



Furthermore, the meditative and mindfulness aspects of Yin Yoga enhance the body-mind connection. Practitioners are encouraged to cultivate present-moment awareness and tune into their bodily sensations and emotions. This heightened awareness helps individuals gain insights into their emotional experiences, recognize patterns of tension and stress, and develop self-compassion and acceptance. Through learning to sit with and observe one's thoughts and emotions without judgment or reaction, space is created for neuroplasticity to occur. Neuroplasticity is the ability to form new or reorganize old neural pathways. This means changing our neural networks in a way that allows us to learn new ways of processing, organizing, and responding to stimuli/information, such as learning new ways to process/respond to triggers.


Incorporating Yin Yoga into a holistic approach to healing offers individuals a valuable tool for addressing the physical, emotional, and psychological effects of trauma and mental health struggles and chronic pain (or illness). This gentle practice not only promotes physical well-being but also supports mental and emotional resilience, enabling individuals to navigate the complex challenges they may encounter on their journey towards healing and self-discovery.



Polyvagal Theory

Buczynski, R. [NICABM]. (n.d.). The Polyvagal Theory for Treating Trauma: A Teleseminar Session with Stephen W. Porges, PhD [Transcript]. Retrieved from http://www.complextrauma.uk/uploads/2/3/9/4/23949705/stephen_porges_interview.pdf


Theodore P. Beauchaine, Lisa Gatzke-Kopp, Hilary K. Mead, Polyvagal Theory and developmental psychopathology: Emotion dysregulation and conduct problems from preschool to adolescence, Biological Psychology, Volume 74, Issue 2, 2007, Pages 174-184, ISSN 0301-0511, https://doi.org/10.1016/j.biopsycho.2005.08.008. (https://www.sciencedirect.com/science/article/pii/S0301051106001839)



Trauma

Levine, P. A., Levine, P. A., & Frederick, A. (2023). Waking the tiger: Healing trauma: The innate capacity to transform overwhelming experiences. North Atlantic Books.


Pain & Mental Health

Fleming, K. C., & Volcheck, M. M. (2015). Central sensitization syndrome and the initial evaluation of a patient with fibromyalgia: a review. Rambam Maimonides medical journal, 6(2), e0020. https://doi.org/10.5041/RMMJ.10204

W. Michael Hooten,Chronic Pain and Mental Health Disorders: Shared Neural Mechanisms, Epidemiology, and Treatment, Mayo Clinic Proceedings, Volume 91, Issue 7, 2016, Pages 955-970,ISSN 0025-6196,https://doi.org/10.1016/j.mayocp.2016.04.029. (https://www.sciencedirect.com/science/article/pii/S0025619616301823)


Yin Yoga

Marian E. Papp, Malin Nygren-Bonnier, Janni Gillerius, Per Wändell, Petra Lindfors. (2020) Effects of hatha yoga on self-reported health outcomes in a randomized controlled trial of patients with obstructive pulmonary disorders. Nordic Psychology 72:1, pages 65-79.

Meyers, T. (2022). Yin Yoga therapy and mental health: An integrated approach. Singing Dragon.




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