Pain is never fun, but if it’s brief enough, your brain and body tend to move on without any lasting negative effects from the pain itself. “It’s unpleasant, but it goes away,” says Eva M. Szigethy, MD, PhD, a professor of psychiatry and medicine and the founder of the Visceral Inflammation and Pain (VIP) Center at the University of Pittsburgh School of Medicine. But chronic pain — especially when it originates in your abdomen — can have more complex and lasting effects on your brain, changing how it responds to pain signals. This is what Dr. Szigethy calls the “traumatizing aspects” of chronic abdominal pain, which she and her coauthor explored in an April 30, 2019, article in GI & Hepatology News. Here’s an overview of how chronic abdominal pain can affect your brain, leading to greater pain perception and suffering — and what you may be able to do to reverse these effects.
From Pain to Trauma
Szigethy defines trauma as the brain and body’s reaction to anything that threatens someone’s safety. Often, perceived threats that lead to trauma come from the outside — such as the threat of violence from another person or group. But they can also come from within the body. There’s a strong neurobiological connection between the brain and the gut, which may help explain why chronic abdominal pain — lasting longer than about three months — can be so traumatizing. This ongoing pain can actually rewire your brain, with different brain systems mounting a greater response to what’s seen as danger. “You not only have the continued signal coming from the gut, but now you have secondary responses from the brain that perpetuate the negativity,” says Szigethy. “So now you have worry, catastrophic thinking, you emotionally become very anxious and depressed. You become hypervigilant to this signal because it’s persistent and perceived as dangerous.” As this process continues, we suffer not just from the pain itself, but from our cognitive and behavioral reactions to it, says Szigethy. This can include anticipatory worrying about pain, inability to think about the future, and mood changes like irritability. These problems all stem from a pain signal that, when long term, confuses the brain, Szigethy explains. “We’re supposed to have pain intermittently — find the cause, do something about it. And then it goes away, and we go back to being our centered selves,” she says. When pain doesn’t go away, “it dysregulates communication pathways, both the chemical and electric ones. And the negative cycles of pain and worry start winning.”
Reversing the Cycle of Pain and Fear
For a doctor, Szigethy says, the first step in treating chronic abdominal pain is to get an understanding of the patient’s experience. This includes not just the location, type, and severity of the pain, but also asking questions like: “How has this changed your life? What emotional state are you finding yourself in?” Getting a good pain narrative only has to take about 10 minutes, Szigethy says, and it helps doctors take the next important step in treating the pain — explaining its traumatizing effects in the context of the person’s symptoms. “People get worried when they don’t have an answer for why they start feeling or behaving in certain ways that they know are not what their norm is,” she explains. “Having an explanatory model is very helpful.” Once someone has an understanding of how their pain is affecting them — a crucial part of the healing process — there are two main treatment options: drugs and behavioral therapy. “Unfortunately, when pain becomes chronic, we don’t have really good long-term medication solutions,” says Szigethy. While these drugs — such as antidepressants or gabapentin — can “take the pain down a few notches, they rarely, in my clinical experience, take the pain away completely. And they certainly don’t teach you how to cope,” says Szigethy. Behavioral therapy aims to teach people strategies for coping with pain, and has been shown to be very effective in numerous research studies, Szigethy says. There are many different forms of behavioral therapy. But in each one, “you’re basically teaching them ways to gain back control of the centers of their brain that have been hijacked by this pain,” says Szigethy. These approaches may include: Cognitive behavioral therapy This technique teaches people how to change negative thoughts, feelings, and behaviors related to their pain and trauma. Hypnotic techniques This broad array of techniques involves entering a trancelike state, in which you’re more open to your therapist’s suggestions about your emotions, thoughts, behaviors, and perceptions. Narrative exposure therapy Usually done in a group setting, this technique involves people sharing their experiences of pain and trauma, with the goal of feeling empowered and recognized. Different forms of behavioral therapy will work better for different people, Szigethy says. The most important first step for someone seeking treatment is to find a therapist “who appreciates that there has been traumatization and who is willing to discuss that aspect with you, whatever behavioral modality they’re using.” There are also steps you can take on your own to retrain your brain. A variety of smartphone apps offer guided meditation or relaxation, which can help you focus on something other than your pain or negative emotions. Szigethy also recommends simply engaging in activities than you enjoy — such as reading a good book or watching a movie — to distract yourself from pain. And adding in exercise, with your doctor’s approval, “is actually a wonderful way to help build your resistance to pain, even if it’s not directly treating the source,” she says. But it’s usually not enough to take steps on your own, even if it takes some persistence to find a therapist who can help you work through the issues surrounding your pain. “I think that once your pain has become chronic, and your brain has been traumatized from the pain, you really do need at least some sort of human coaching — if not formal therapy — to help you and your brain back to that safety zone,” says Szigethy.
