Confronting Trauma Can Reduce Pain In Older Veterans

Chronic pain in older veterans can be reduced through a new form of psychotherapy focused on confronting past trauma.

Research published in JAMA Network Open found that the therapy, known as emotional awareness and expression therapy (EAET) could lead to clinically significant reductions in pain.

“We found that one psychological treatment – EAET – was superior to another psychological treatment – CBT – for older veterans with chronic pain. Specifically, EAET was superior to CBT in reducing the severity of chronic pain and improving mood both at the end of treatment and 6 months later,” Dr. Brandon Yarns, lead author of the study and an assistant professor at UCLA Health’s Department of Psychiatry and Biobehavioral Sciences and psychiatrist at the Veteran’s Affairs Greater Los Angeles.

“The main differences in the treatments are: in EAET, the therapist takes the stance that chronic pain may be reduced or even eliminated, whereas CBT tends to focus more on coping with or managing chronic pain rather than trying to reduce it, and in EAET, chronic pain is reduced by processing painful emotions from trauma and life stress that play a causal role in many cases of chronic pain, whereas CBT teaches coping strategies (such as deep breathing, guided imagery, and progressive muscle relaxation) and doesn’t focus on trauma.”

The study found that among veterans who underwent EAET, 63% experienced at least a 30% reduction in pain. By comparison, only 17% of veterans who did cognitive behavioral therapy experienced a reduction.

Among those who participated in EAET, 41% of them sustained their pain reduction six months on from their treatment. Comparatively, just 14% of patients who underwent CBT sustained pain reduction.

Those in the EAET group also reported that the therapy was beneficial in addressing depression, anxiety, PTSD and life satisfaction.

Cognitive behavioral therapy has been considered the gold standard for psychotherapeutic treatments of chronic pain in veterans. 

But research suggests that the benefits of CBT in relieving pain are modest. 

Yarns says there is a strong relationship between trauma and pain. 

“A history of trauma is very common among people with chronic pain, including at least 50% overlap of PTSD and chronic pain diagnoses in veterans. Neuroimaging studies show that similar brain regions are involved in PTSD and chronic pain, especially networks in the brain dealing with emotion and emotion processing. We also know now – based on our study and others – that processing people’s trauma, as well as relationship conflicts and other life stress, can help reduce chronic pain,” he said. 

Whilst the research found EAET to be effective in reducing chronic pain, Yarns also notes that it can at times be a difficult process for those undertaking the therapy.

“EAET is challenging because it asks patients to face the most painful, difficult emotions and traumas that they have ever experienced. We have found this to be very useful for helping people improve chronic pain and their mood, but many patients are hesitant at first. However, we always emphasize that EAET does not just rehash trauma but tries to change the associated memories and emotions to help people resolve it within themselves or let it go. It is key to obtain thorough informed consent from patients about exactly what the therapy entails. If that is accomplished, the dropout rate is very low,” he told Theravive. 

“Many people with chronic pain acknowledge that there is a relationship between stress, emotions, and their pain. So, the model is generally accessible. But EAET tries to drill down and make these relationships explicit, for instance asking patients to recall exactly what was going on in their lives when chronic pain started (or times it got worse or got better). When we do this, patients are often surprised at just how much their pain level tracks with their life experiences and emotional states. Once patient and therapist identify those areas of stress and trauma that seem to match times when pain was at its worse, then EAET undertakes the processing of those traumas.”

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