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Introduction/About:

The International Association for the Study of Pain (IASP) has evolved its definition of pain, acknowledging its multifaceted nature. 30 years ago, pain was primarily defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. However, the IASP now recognizes that pain can exist in the absence of identifiable tissue injury, often with significant psychological contributors. The IASP recognized this in their revised definition of pain as “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. They clarified further, adding “Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons”.

The concept of the "threat response" is crucial in understanding pain. When faced with perceived threats, whether physical or emotional, the body activates physiological and psychological responses, including heightened pain sensitivity, anxiety, depression, and in some cases, post-traumatic stress disorder (PTSD). These responses can contribute to the development and maintenance of chronic pain conditions.

For instance, early life experiences, such as inconsistent or unresponsive caregiving, can profoundly impact the developing nervous system. This can lead to chronic activation of the threat response, even in the absence of immediate danger, resulting in heightened pain sensitivity and contributing to various physical and psychological health problems. Importantly, the chronic threat response and it's consequences can be modified through appropriate therapeutic interventions

When our bodies perceive a threat (physical or emotional), they activate a response which if it becomes persistent, can lead to heightened pain sensitivity, increased anxiety and depression, the constellation of symptoms labelled PTSD, and ultimately contribute to the development of chronic pain conditions as well as physical ailments, such as coronary artery disease, autoimmune disorders, and more.

For example, if a primary caregiver was consistently unavailable or unresponsive to a child's needs, the child's nervous system may have learned to constantly be in a state of alert, even in the absence of immediate danger. This "threat response" can continue to operate long after the initial experience, contributing to chronic pain and other health problems, and yet it is reversible with the right treatment

Adverse Experiences and Pain:

Adverse experiences, such as childhood trauma, chronic stress, neglect, abuse, poverty, war, and other adverse experiences throughout life, including significant life stressors, can profoundly change nervous system function, altering its function and structure. These experiences can also disrupt the immune system and the neurohumoral system, the body's stress response system. These changes can have lasting effects on the developing nervous system and contribute to the development of chronic pain by altering sensory processing and pain perception.

These experiences can lead to:

• Central Sensitization: Neuroplastic changes in the nervous system structure, and function lead to increased excitability within the central nervous system, resulting in amplified pain signals and reduced pain thresholds.

• Dysregulation of the HPA Axis: Chronic stress disrupts the hypothalamic-pituitary-adrenal (HPA) axis, leading to elevated cortisol levels and the physiological changes that occur as a result.

• Dysregulation of the immune system: Altered immune function which can contribute to chronic pain.  For example, immune system changes documented in PTSD include but not limited to altered glucocorticoid sensitivity among immune cells, shifts in immune cell distribution, early immunosenescence, elevated pro-inflammatory, cytokines, and a decrease in regulatory T cells. Subsequent CNS inflammation, may lead to chronic pain as well as psychological consequences.

Clinical Implications:

Emerging evidence highlights the strong link between adverse life experiences and chronic pain. To provide the most effective pain management, a comprehensive assessment should include a thorough psychosocial history, including...

• Childhood adversity: ACEs, trauma history.

• Chronic stress: Work, relationship, financial stressors.

• Social isolation: Loneliness, lack of social support.

Treatment Considerations:

• Integrated Pain Management: A multidisciplinary approach that addresses the biological, psychological, and social aspects of pain.

• Mind-body Therapies: Mindfulness-based stress reduction (MBSR), cognitive-behavioral therapy (CBT), yoga, and tai chi can help regulate the nervous system, reduce stress, and improve pain coping strategies. Trauma recovery therapies have been shown to be effective in treating many chronic pain conditions and specific therapies have been developed that adapt trauma recovery work to the chronic pain condition.

• Pharmacological Interventions: Medications may be used to address pain, anxiety, and depression, but should be considered within a comprehensive treatment plan.

The Healing Role of Play, Joy, and Novelty

While adverse experiences and physiological dysregulation contribute to chronic pain, the nervous system is also inherently wired for repair, resilience, and pleasure. Play, joy, and novelty are not frivolous — they are biologically impactful experiences that support neuroplasticity, co-regulation, and downregulation of threat physiology.

Engaging with moments of curiosity, delight, creative expression, and social play can activate circuits that counterbalance chronic pain pathways. These experiences have been shown to increase vagal tone, reduce inflammation, and shift attentional and emotional networks in the brain. Even small moments of genuine joy can help rewire systems conditioned toward vigilance and suffering.

As practitioners, expanding the treatment lens to include play and pleasure-based neurobiological support can offer clients meaningful tools to reconnect with life, agency, and hope — even when pain is present.

Conclusion:
Understanding the impact of adverse experiences on pain mechanisms is essential for providing effective and compassionate care to patients with chronic pain. By incorporating a biopsychosocial perspective and addressing the underlying psychological and social factors, clinicians can improve pain management outcomes and enhance the overall well-being of their patients.

Importantly, interventions that support regulation and resilience are not limited to traditional therapies. Play, joy, and novelty can serve as powerful modulators of pain, activating neural pathways that support safety, curiosity, and connection. These elements—often overlooked in clinical settings—can be vital in restoring a sense of agency, vitality, and pleasure in the body, even in the presence of persistent pain.

Join us for a 3-part interactive Zoom series to:
• Explore the neuroscience of pain beyond tissue damage
• Identify how adverse experiences and chronic threat responses shape pain perception
• Discover the healing potential of play, joy, and novelty—even when pain is present
• Integrate this knowledge into your clinical or therapeutic practice with greater clarity and compassion

We’ll also explore different types of pain, including:
• Nociceptive pain: Pain arising from actual or potential tissue damage
• Neuropathic pain: Pain caused by damage to the nervous system
• Stress-related pain: Pain shaped by chronic stress and altered nervous system processing.

Are your patients or clients navigating persistent pain that doesn’t seem to respond to typical treatments—pain that lingers, shifts, or defies a clear diagnosis? These experiences may be rooted in long-standing patterns shaped by early adversity, chronic stress, unresolved trauma, or grief.