The Expert: 

Shea O’Neill, M.D. is an Obstetrics & Gynecology Specialist based in San Diego, CA.

How does trauma play a role in pain?

It’s a long time of a lot of research where we started looking at pain, but for the most part, where we’re landing is that a human will have a genetic predisposition to a certain response. For instance, you would have a history of migraines in your family. You would have a history of jaw pain in your family. You would have a history of endometriosis in your family. So somebody has a genetic predisposition to respond a certain way. Not everybody gets migraines. So you have a genetic predisposition that starts somebody out, and then you have a traumatic event. And I really explain to patients that there’s two ways to deal with trauma, and only two. One is to deal with it, and the other is to not deal with it. And there’s two ways of dealing. There’s intellectual dealing, meaning gosh, I put my hand in that fire, that hurt, I’m not going to do that again. And then there’s emotional dealing with it. Every human deals with it intellectually, like I’m not going back there, I’m not going to do that ever again. But they don’t emotionally process it because there’s no human on the planet that likes being sad. It’s kind of that simple. We don’t like being sad. It doesn’t feel good being sad. Nobody teaches us how to be sad. Nobody sits with our sadness. And so, if you don’t like being sad and you are capable, you’re going to box that sadness, whatever made you sad – whether it’s a house fire, it’s a mother dying, it’s losing a toe – I’ve heard every conceivable human trauma at various ages. And once that trauma is not processed, it gets put down, and if the trauma is, I don’t want to say if it’s bad enough, if they’re traumatized and they put it away, um, the first physiologic response every human does, whether they’re 2 years old or 72, is they stop sleeping. So they have a lot of pretty good data that, um, widespread pain, and you can include all kinds of pain conditions, is predated by about six months by a sleep disorder. And somebody who’s hypervigilant because they haven’t processed their trauma, again, whether they’re 2 or 72, and they’re putting it down … They stop sleeping. And stop sleeping means either difficulty falling asleep or difficulty staying asleep. Now, if you have a child who’s been traumatized at an early age, then you ask them their sleep history, it’s difficult to get one because bad sleep is all they know. So when you stop sleeping, I always tell patients, well then you start breaking. It’s not hard for people to imagine if you stop sleeping for three or four days for whatever reason and somebody asks you to go do a 5K run, you’re gonna sprain your ankle. But it surprises people that if they’ve not been sleeping for 20 years and now they’re 22, and their body has been breaking with headaches, jaw pain, reflux, and it goes on. So it’s, and a majority of patients know the trauma. It’s not darkness. It’s not repressed memories. A majority of patients, it just doesn’t occur to them that they were traumatized, because doesn’t everybody’s mother die? And don’t other people have house fires? And doesn’t everybody move 16 times in their life? So people don’t really associate that. So how I get them to understand things, I say, well look, your headache started at age five. Headaches in a 5 year old are not normal. Your stomach pain started at age 12. You had a painful period starting at 14. You start having pain with intercourse at 19, and you were assaulted at 22. So lots of people would assume that that assault was the problem, and so trauma-informed care is to say yes, that’s a problem, but that’s not the problem. The problem is what happened to you at five. And so then I can direct counseling, because once they know really what the problem is, then the pain, it’s just energy. So they’re either having physical pain or emotional pain. And no human on the planet wants to be in emotional pain, so it’s a hard thing to tell somebody: you’d prefer to be in physical pain than emotional pain. But that’s a, that’s a normal human response, as I far prefer to have my shoulder hurt than my heart.