Resource Elements

Unique Aspects:

  • His experience of injuries with and without pain, and pain without injury.
  • His insight into the origin of pain as the 5th vital sign, as the origin of the opioid epidemic in the early 2000’s.
  • Relating PTSD to Chronic Non-Cancer Pain associated with disease.
  • His insight to:
    • the ACES data, which shows strong correlation between Adverse Childhood Experiences and the likelihood of later disease and shortened lifespan.
    • the development brain decision centers as a causal factor for disease later in life, for shortened lifespan, and for chronic pain that is sometimes associated with disease.
    • how trauma influences brain changes and brain functioning.
  • An insightful definition of trauma and that trauma is more common than we had guessed.
  • That there is expectation and hope for improvement after trauma.

(His presentation to the 2022 Oregon Pain Summit includes more development of potential remedies for PTSD and chronic pain than are included in his story here.)

Dr. Jonathan Betlinski is a professor at Oregon Health Science University and Director of Public Psychiatry. He shares three personal experiences that sparked his interest in the relationship between trauma and pain: mountain biking accidents, a water skiing incident, and his medical training with the Veterans Health Administration.

Key ideas:

  1. The opioid crisis and his experience in the ER treating overdoses led to his interest in the relationship between trauma and pain.
  2. Statistical data shows the similarity and overlap between symptoms of PTSD and Chronic Non-Cancer Pain.
  3. Traumatization occurs when both internal and external resources are inadequate to cope with external threats.
  4. The Adverse Childhood Experiences (ACEs) study shows a relationship between trauma and pain.
  5. Early trauma affects brain development and functionality.

He continues with the following:

    • Differentiation of roles in the decision centers in the brain: amygdala, hippocampus, and prefrontal cortex.
    • Growing up in a traumatic environment leads to relying on the amygdala for survival.
    • Trauma overwhelms our ability to self-regulate, which leads to difficulties in recognizing our own emotions.

And ends on the following note:

    • Change starts with listening to understand what’s happened to someone who has been affected by trauma, rather than focusing on what’s wrong with them.
    • Trauma and pain are common and require our brains and bodies, but recovery can be expected.

Dr. Jonathan Betlinski is a professor at Oregon Health Science University and Director of Public Psychiatry.  His story (Linking Trauma and Pain) opens with three personal experiences that piqued his interest relating to trauma and painconcluding with: ‘Why is it some things hurt, and others don’t?’

  • At 16, he encountered loose gravel while mountain biking.  He lost control, was thrown from his bicycle, and experienced multiple abrasions.   He felt little pain and continued with his ride.
  • At 20, while mountain biking on a dirt track, he flipped end-over-end. Before his hitting the ground, he experienced pain.
  • That same year, a water-skiing incident caused his ski to hit him in the mouth, breaking two teeth and damaging the rest.  This only caused pain on impact, but no pain afterward.

During his medical training, the Veterans Health Administration added ‘pain’ as the 5th vital sign which added a dramatic shift in healthcare practice to minimize chronic pain.  This practice helped to create the opioid crisis with the use of addictive opioid medication.  His internship in the ER treating overdose and withdrawals led to a psychiatry residency and furthered his interest in how trauma relates to pain.

His talk identifies the similarity and overlap between symptoms of PTSD and Chronic Non-Cancer Pain using statistical data, then discusses how ‘traumatization occurs when both internal and external resources are inadequate to cope with the external threat’ and how similar threats may not produce similar responses in everyone, or on every instance.

Dr. Betlinski then addresses the Adverse Childhood Experiences (ACEs) study.  This revolutionary research asked yes/no questions regarding 10 possible life experiences (including abuse, neglect, domestic violence, substance abuse, divorce).  More than 2/3 of the 17,000 subjects had at least one adverse childhood experience, and often more than one.  Those 10 questions account for more than half of one’s risk of developing chronic diseases or having a shorter lifespan.  The study clearly displays the trauma/pain relationship and how trauma changes us.

His discussion further looks at how early trauma impacts the life of an individual through brain development and functionality, and that the kind of environment your brain is in when you’re growing has a profound effect.  The number of cells in the brain and their interconnections change through life, sometimes rapidly; the number of cells depends on a person’s experiences; and changes in the number of cells continue to occur throughout life, not only from the impact of trauma, but also of healing.

He goes on to cover the differentiating roles of the decision centers in the brain:

  1. The Amygdala, which develops first in children for spontaneous and quick responses to protect one in a fight or flight situation (e.g. a newborn or young baby crying for help)
  2. The Hippocampus, which starts to develop around 4 months of age, helps with short- and long-term memory.  By 2 years of age, a child can take stock of immediate surrounding to either agree or disagree with the Amygdala’s threat assessment.
  3. And last, the Prefrontal Cortex, the last to develop (around puberty), where thought-based decisions are made, which take much longer times for decisions that are dependent on the person’s attention to various situations.

Growing up in a traumatic environment leads people to rely on their amygdala’s assessment in order to survive.  These people may be able to use other pathways for thinking and reasoning when they feel really safe, but their default becomes relying on the amygdala.  And, in fact, functional MRI testing in these cases shows a thinner, less robust cortex, and sometimes even a poorly developed hippocampus.  The brain is wired to the body and all organs through the vagus nerve thus affecting function and development.

Trauma overwhelms us.  It overwhelms our ability to self-regulate.  And when we can’t do that, we stop being able to recognize our own emotions.

Dr. Betlinski credits Dr. Bruce Perry’s suggestion to change the basic question when addressing someone who has been affected by trauma from “What’s wrong with you?” to “What’s happened to you?”  This allows us to reinterpret what’s happened through the lens of trauma exposure.  By listening to understand what’s going on for other people instead of listening for our turn to talk, communication is open and healing can begin to happen.

In summary, trauma and pain are common.  They require our brains and bodies.  Recovery can be our expectation.  Change starts with us.

Please click on the link to open PDF in a new widow: 1021-linking-trauma-to-pain

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