Nurse who suffers chronic tailbone pain

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I am a Registered Nurse who has suffered with tailbone pain for over 8 years. Like all chronic pain, it is essential that sufferers get the correct support, diagnosis and treatment appropriate for them as an individual. This blog follows my journey with chronic pain, it expresses my personal opinions and thoughts. It is not intended as a replacement for advice or treatment from your normal Healthcare Provider.

Tuesday, 5 April 2016

The Body Keeps the Score', and revisiting the ACE Study

Obviously having chronic pain means that I have an interest in the subject, and I am continually looking at causes of chronic pain. My exploration of this diverse subject often leads me onto new avenues. One of these avenues has been the ACE study (Adverse Childhood Experiences) which I have mentioned previously. This led me onto to a book called 'The Body keeps the Score' (Van Der Kolk, B. 2015.), as recommended by the physio that I am currently seeing. There are many more research papers and books supporting the view that traumatic experiences can cause chronic pain, and mental health problems in adulthood. I mention Van Der Kolks as it is my most recent read, and one I found fascinating. It's not often that I find a factual book hard to put down and stop reading!

In this book Van Der Kolk discusses Veterans in America and Post Traumatic Stress Disorder (PTSD). He also explores other adversities experienced by both adults and children. By using recent advances in science he explains how the brain and body can literally be reshaped by adversities. 

Trauma victims will sometimes be unable to respond to stress correctly, they have learnt to ignore the body's cries for help. Ignoring stress will not stop the body responding correctly to it. As with the ACE study, the book explains in detail how traumatised people will continue to secrete large amounts of stress hormones long after the danger has passed. Cortisol (one of the stress hormones) should end the stress response by sending out a signal and stopping it's release, but in some trauma sufferers this does not happen. Instead it is continually released, and expressed as "agitation and panic", and will go on to cause "havoc" with ones health. Van Der Kolk states that if the adversity remains unresolved "fragments of it will intrude into the present", the stress hormones keep circulating and the "defensive movements and emotional responses will keep getting replayed". This affects individuals in different ways: some people may shut down and dissociate themselves for example, while others may get physical symptoms such as headaches. Whichever survival mode your body chooses will ultimately result in fatigue and chronic illness unless it is dealt with. 

After the traumatic event the "world is experienced with a different nervous system". Relevant to chronic pain Van Der Kolk says "attempts to maintain control over unbearable physiological reactions can result in a whole range of physical symptoms, including fibromyalgia, chronic fatigue, and other autoimmune diseases".

Our nervous system consists of the autonomic nervous system (ANS): the sympathetic and parasympathetic. The sympathetic is responsible for arousal, including our fight, flight, or fright response. The parasympathetic branch is as Van der kolk describes more for "self preservation"; it relaxes muscles and breathing and aids digestion and wound healing. One can see then, that an exhausted sympathetic  nervous system will effect the associated body systems. (Obviously there is much more to our nervous system than just this!)

Traumatic memory and it's effects on the body, is not a new phenomenon. Pierre Janet (1859-1947) a French psychologist, philosopher and psychotherapist discussed traumatic memory as far back as 1889. I therefore find it surprising that medical practitioners do not explore this more as to a possible cause of an individuals ongoing pain.

Van der kolk says "they may visit multiple specialists, undergo extensive diagnostic tests, and be prescribed multiple medications, some of which may provide temporary relief but all of which fail to address the underlying issues".

In support of this, in an article by Jaime A Heidel 'Adverse Childhood Experiences Linked to Adult Chronic Disease', Jaime describes trauma in Childhood as possibly "the missing link". He agrees that an individual may have had varying treatments, with varying degrees of success, but never completely got control over their 'condition'. Heidel cites the ACE study and says that those with an ACE Score of 1 or more are 86% more likely to develop a chronic disease in adulthood, something I find quite staggering. Heidel states that we need to deal with the past experiences because otherwise they are in control. The pain and fatigue that we feel may be their outlet. Other researchers have claimed that it may just be one traumatic event- just one- that is all it takes to initiate this response. Even if one feels they have dealt with this trauma, the body does not, the body remembers it : 'The Body keeps the Score', as Van Der Kolk says in the title of his book. The nervous system has remained in this 'survival mode'. 

Don't misunderstand me, stress hormones are good and necessary when utilised for their correct purpose. It is when a traumatic event is overwhelming and/or continuous and the body continually releases the stress hormones to no avail, that the body is flooded by them, and we become immobilised and helpless to respond to them correctly- this is when we may cause longer standing damage to our body.

It is also true that if one is always sad, scared, or angry, then the body will be tense. This continued tension may also lead to to headaches, back ache and general aches and pains as well as chronic fatigue. We already know that anxiety can cause stomach ache and headaches, but we are less aware that it can cause chronic health problems.

A part of the brain known as the insula, interprets input from our organs, including joints and muscles. Van der Kolk reports that trauma patients brain studies reveal 'abnormal activation of the insula', again, relevant to chronic pain. Scientists further found that a developing brain with chronic exposure to stress, will actually alter its shape. The part of the brain responsible for managing stress, emotions and emotional memory, in fact shrinks. So therefore children exposed to stress, especially chronic stress are less able to handle it in adult life.

As discussed previously, stress in childhood has been found to particularly affect cortisol levels. This is because the physiological mechanisms that  regulate cortisol production are still developing. The research from the ACE study, suggests that when we are exposed  to unpredictable and chronic physiological stress in childhood our stress response goes into overdrive. Scientists claim that we are then less able to respond correctly to stresses in the future. A child's brain that is put into stressful situations over and over again, will be on  a permanent state of alert. The body cannot and does not switch off. It stays in 'survival mode'. Chemicals and hormones that are released in stressful situations, will be flooding the child's body. 

Additionally, in children who experience chronic stresses, small chemical markers adhere to the genes involved in controlling their response to stress. The function of these genes then becomes altered and they are on 'high alert' all the time, which promotes inflammation and disease.

Furthermore, the part of the DNA that protects the genome wears away, and exposes the person to disease because the cells age faster. For any child who has experienced adversity, the link between this adversity, and their mental and physical health is very strong. 

Now, I am not saying that all people who experience chronic, unexplained pain should look at their childhood and think of adversities they may have faced, and I am not saying anyone who has faced adversity should look at blaming anyone for their chronic pain. I am simply suggesting that it may be a causative factor for some individuals who cannot seem to find any other reason for their ongoing pain. 

If perhaps this may be relevant to you, there is hope. Van Der kolk, and others like him, have found many therapies and treatments that help. He admits that the past cannot be undone, but the imprint of the trauma can however be helped. He suggests that at some point you will need to revisit the trauma. Some 'treatments' he has found helpful are, mindfulness, yoga, professional therapy, cognitive behavioural therapy , or writing a journal or notes to yourself.

If you have a good healthcare provider, someone you feel safe with and can trust perhaps approach them and voice your thoughts. It may help bring an end to your suffering both emotionally and physically.

As I have said before,our body is a complex thing, and every action has a consequence. 

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