You have really sore hips, but that’s not a new thing. You can remember having pain in your lower back and hips in your teens, and that was longer ago than you care to admit.
Over time you have gotten very good at putting up with the pain. You have a way of pushing it into the background, so that you are able to function.
One day you are looking through some old holiday photos. You realise that without you noticing your hips have gotten a lot worse over the previous 10 years. When you stop to think about it further, you realise the last two years have been particularly bad.
Feeling concerned about premature aging, you decide to get your hips checked out. A friend has been nagging you to see their chiropractor about your hips for a long time, so you decide to give him a shot.
The chiropractor does all the usual history taking, x rays, gait analysis and physical examinations. During the history he asks you a lot of questions about your pain, going back as far as you can remember. He seems a little surprised by some of the answers you give. During that history taking, you realise that you have a lot more pain than you thought you did. It also strokes you that it probably isn’t normal to have hip pain every day since you were 13, it’s just become normal for you.
The chiropractor confirms for you that it’s not normal to have so much pain. And he explains that it isn’t caused by old age. Part of you is surprised by this because you have felt your hips get tight over time, and you know some older people who have had hip issues.
He also tells you that you have chronic pain, but that you have ‘normalised’ it – telling yourself it’s just aging, when really there is a deeper problem.
He asks you if there was an increase in emotional stress around the time your hips got worse. You realise that they had in fact got worse from around the time that your mum got sick two years ago.
He explains that pain diagnosis is not an exact science, so he could be mistaken – but your pain patterns are consistent with someone who was been exposed to abuse. You are absolutely shocked. Partly because you thought you were going to be talking about back cracking or arthritis. And partly because you were abused as a child.
The term psychosomatic refers to real physical symptoms that are heavily influenced by the mind and emotions. Pain that is caused by stress based activity in the nervous system. Our thoughts and emotions have the ability to re-calibrate the amount of pain we experience – deep in the brain.
Research has shown that pain patients who report a history of abuse experience greater psychological distress, have more severe pain, and greater loss of function from their pain.
Most psychosomatic pain is not the really full on kind that can come from abuse however.
You don’t have to be abused as a child to end up with a bit of stressy psychosomatic type pain in your life. Work stress, anxiety, difficult relationships, divorce, finances, bereavement, depression, mental illness & post traumatic stress are all probable causes if you have pain and ‘stuff going on’.
Most psychosomatic pain is part psychosomatic and part biomechanical.
A common perception of psychosomatic pain is that it exists in the absence of physical issues. People have written whole books on this concept. We love to play either/or with complex health issues – when in fact shades of grey tend dominate reality.
Having been hands on with a few thousand cases, my observation is that psychosomatic type pains nearly always have a physical component. My suspicion is that the ‘its all in your head’ concept has been incubated by professionals who have a limited understanding of biomechanics & psychosomatics.
Maybe psychosomatic pain exists on a spectrum, lots of health issues do. Some people might have pain that is 10% psychosomatic and 90% simple biomechanical. Others might have pain that is a 80% psychosomatic and 20% complex biomechanical.
Sections of the deep brain and brain stem regulate physical processes, like immunity, hormonal function and inflammation. Modern imaging studies have shown altered brain activity in a wide variety of physical disorders; including irritable bowel syndrome, asthma, fibromyalgia and pain disorders.
There is a very long and important nerve in your body called the vagus nerve. The Vagus nerve is a vital connection between your brain and your physical processes. It runs from the brainstem right down to your gut, making many stops along the way.
The vagus nerve plays a critical role in maintaining heart rate, breathing, digestive tract movement and many other basic body functions.The vagus can also regulate inflammation – this may be a key point in undertanding psychosomatic pain.
Researchers have had some success in reducing physical pain associated with post traumatic stress through stimulation of the vagus nerve. Tracey K. J. (2007). Physiology and immunology of the cholinergic antiinflammatory pathway. J. Clin. Invest.
The prevalence of psychosomatic pain is up for debate. Very severe cases of psychosomatic pain may only account for 1 0r 2% of foot traffic in regular clinics. Moderate and mild forms that are more intertwined with biomechanical issues are extremely common. They have certainly always made up a significant portion of my patient base anyway.