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Jeannine, who is 37 years old and lives in Burbank, California, has had generalized pain since she was 8 years old. She was examined by dozens of doctors, but none of their X-rays, MRIs or other tests revealed any injuries or damage.
Over the years, desperate for relief, she tried to change diets, wear a belt to correct her posture, and exercise to strengthen her muscles. Taking a lot of ibuprofen helped, she says, but doctors have warned that over taking it could cause gastric bleeding. Nothing else has relieved her. On a pain scale of 0 to 10, her pain ranged from "7 to 9, regularly," she says.
About 50 million Americans suffer from chronic pain. Most of us think that pain occurs after a physical injury, accident or injury resulting from an illness or its treatment. But researchers are learning that in some people there may be another source of chronic pain.
Repeated exposure to psychological trauma, deep anxiety, or depression – especially in childhood – can leave a physical imprint on the brain that can make some people, such as Jeannine, more vulnerable to chronic pain, scientists. (We do not use his last name for confidentiality reasons).
Fibromyalgia was finally diagnosed in Jeannine, a condition characterized among other things by widespread pain throughout the body. The cause is unknown and probably varies from person to person.
Jeannine had a physical pain. She felt "lightning, sort of going between my shoulders, my neck and my head," she says. Other times, she suddenly felt the throbbing pain of sciatica in her legs and often suffered from a "sharp pain" at the hips. "I would feel like I could not walk anymore – it was so painful to walk."
Then, about eight months ago, a friend suggested something else – an emotional awareness and an expression therapy.
Jeannine was skeptical. She had regularly seen a counselor in "intensive therapy" over the years, and yet her terrible pain persisted.
But EAET, she learned from her clinical psychologist, Laura Payne, is a different type of psychotherapy. This is one of many behavioral therapies (among other interventions) included in a report from the US Department of Health and Human Services titled "Best Practices in Pain Management". According to the report released on May 9, "Research indicates that EAET has a positive impact on the intensity of pain, pain interference and depressive symptoms".
EAET was developed in 2011 by psychologist Mark Lumley of Wayne State University and his colleague, Dr. Howard Schubiner. It combines certain techniques derived from traditional conversation therapies (such as the search for insight and context in the life experience of a patient) with those of cognitive-behavioral therapy, which puts more emphasis on 39 focus on skill acquisition and modification of harmful behaviors.
According to Lumley, this is an emotion-based treatment designed to help people with generalized and medically unexplained pain.
In a study conducted in 2017 on fibromyalgia patients, Lumley and his colleagues found that EAET attenuated generalized pain and other badociated symptoms in some patients. "In summary," concluded the researchers, "an intervention targeting emotional awareness and expression related to psychosocial adversity and conflict was welcomed, more effective than an educational intervention and had some advantages over CBT in pain ".
Lumley thinks the treatment could also help patients with other types of pain, although this remains to be proven.
So how does it work?
For starters, as part of the therapy, Jeannine was asked to start writing in a daily journal, looking back at her past to determine when her pain problems had begun.
"I have noticed all the different health problems that I have known during my life," she explains, "in the sense of pain, but also of other things" of all that caused him distress.
For Jeannine, who grew up in a violent household, there was a lot of distress and a lot to write. (We do not use his last name for confidentiality reasons).
"If I were dressed in a way that my father found too provocative, it was not for him that he called me" whore, "she says," and he would also call my mother. "
The aggression was also physical, she says. "A lot of jostling, jostling, beating and certainly a lot of belts in childhood."
Jeannine did not need a lot of therapy to discover something that surprised her. Backaches, stomach ailments, headaches and even skin problems she had as a child tended to occur at about the same time as beating and screaming.
It was "just amazing to make that connection," she says. "I never really stopped thinking about it that way."
Young adult, Jeannine left the house. The abuse has stopped. But his pain did not do it.
Lumley says the researchers are discovering that this is the case for a number of patients with medically unexplained pain. He says studies have followed people prospectively over the years, trying to predict who develops chronic generalized pain.
"They clearly show that difficult life experiences, negative experiences in childhood are future predictors of chronic pain – a generalized pain – years later," Lumley said.
Jeannine says that the idea that there might be a connection between her pain today and the trauma that she suffered during her childhood first seemed "a little crazy".
"It does not make sense to me," she says. "You think of pain as something [that] hit you. Something hurts; it's physical. It's not like something is hitting you emotionally and then it hurts. "But in fact, that's exactly how things can happen, say the researchers.
"It's a real phenomenon," says neuroscientist Amy Arnsten, a professor of neuroscience and psychology at the Yale School of Medicine. In healthy conditions, she says, higher circuits in one part of the brain – the prefrontal cortex – can control whether individuals feel pain and how much pain they feel.
But these higher brain circuits can weaken and even atrophy when we are exposed to chronic stress, says Arnsten, "especially stressors where we feel uncontrolled or frightened."
Fear, depression and anxiety are the stressors that can weaken these brain circuits, she says, making people more vulnerable to pain. And if these pre-frontal circuits do not help regulate sensation, patients may experience prolonged pain long after healing from a physical injury.
In addition, without appropriate regulation, she says, the brain can cause pain in the absence of physical damage. "The brain actually has ways where it can come down and control our body," she explains, "and actually creates a painful response."
And this pain is very real.
The same can happen to adults who are suffering from trauma, says Lumley. But, when it starts in childhood, this type of cycle can trigger chronic pain over the course of life.
"Most people do not necessarily succeed so easily in overcoming some of these difficult early childhood experiences," he says. "Even though life may look good now, people still stay haunted, while memories or thoughts about the family come to the fore."
And that was what happened to Jeannine at a specific hour every day of the week.
"I literally came home by car," she says.
At first, she thought maybe it had to do with her long drive or maybe her sitting position. She got better lumbar support and placed "heating elements" in the car seat.
But in therapy, she realized that it was not the car or the daily commute. It was going home.
"Nothing serious, it's to find myself here on the way back," she said. "But when I was younger, going home was like:" Ahhh, I'm going back there again? "It was just a terrible feeling of" Now, I have to return to this environment. "My house never looked like a safe place."
She realized that fear had taken her away in her adult relationships, even though she was now married and held a good management position in a large company. She had become deeply hesitant to ever express negative feelings that she felt could alienate her family, friends or co-workers.
"Then I decided not to speak honestly – it was my Mr.O.," said Jeannine. And that would often be followed by a physical pain. In his mind, in such cases, it was easier to manage the pain than to risk losing the emotional bond with the people who interested him.
Today, using the EAET tools, Jeannine says she has learned to deal with what happened to her in her childhood and begin the healing process in adulthood. She has learned to be more honest with herself and others about what she really thinks and what she wants.
Lumley says that EAET helps some patients to look under the shame, fear, and guilt that they may now feel about the emotions they have experienced during abuse but long time ago. repressed – anger, sadness or helplessness in the face of the loss of love.
Patients have to face their fears, says Lumley.
"Part of confrontation means talking about it, giving it an expression with your words, your face, and your body."
"The knowledge and insights of therapy can help us feel more in control," says neuroscientist Arnsten, "and can bring the higher brain circuits back online and allow them to regulate our pain pathways, as in a brain in good health. "
Payne, Jeannine's therapist, explains that Jeannine's journey to health has not been easy. "It became very hard and the pain got worse, and it became more persistent."
But Jeannine persevered and worked with Payne to complete all the written exercises and discussions that were part of the treatment.
Only a few months after the start of her therapy, Jeannine began engaging in conversations that she had long avoided – being more honest about her feelings with her colleagues and her family. "It was the hardest thing I ever did in my life," she says.
This is a relatively new treatment and so far, published evidence of its effectiveness is largely based on a study. More research, with more important studies, is needed to really evaluate the value.
But Jeannine says that the therapy worked for her. Today, she does not avoid situations, people or potential confrontations. She is relieved. And happy. And her pain, she says, has greatly diminished. Some days she has no pain.
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