“When people experience trauma, it doesn’t just impact them in terms of their mental health,” says Abigail Lott, licensed clinical psychologist and assistant professor at Emory University. “It can impact their body as well.”

“In statistical models that we run, you can use different variables to predict the likelihood that someone will report pain,” she says. “We’ve seen that the more trauma you experience, the more likely you are to have a pain condition.”

One notable example of this is the adverse childhood experiences (ACE) study. Published in 1998, the study surveyed 9,500 people about past trauma as kids, such as sexual abuse, domestic violence, and exposure to substance abuse. People who were exposed to more than one adverse childhood experience had a two- to fourfold increased likelihood of poor physical health, including suffering chronic physical pain. Other studies have found a correlation between emotional trauma and the onset of conditions like fibromyalgia, premenstrual syndrome, unspecified lower back pain, and pain-related disability.

“Fear and pain kind of work together and help keep each other around.”

Researchers are exploring why emotional trauma and chronic physical pain so often coexist. One theory is that trauma-based disorders like post-traumatic stress disorder (PTSD) prime the body for pain.

“When you experience [PTSD], you have a symptom called hyperarousal where your autonomic nervous system is on high alert all the time,” Lott says. “Part of that means being extremely tense and attuned to threats all the time, including physical pain.”

This hypervigilance not only makes a person more attuned to pain cues within the body, but it can also lower a person’s threshold for what causes a pain sensation, and how quickly someone can recover from it. When this happens, “patients start isolating, they’re not engaging in anything, not trying to exercise, and that can make a pain condition worse,” Lott says. “Fear and pain kind of work together and help keep each other around.”

Researchers have also found that emotional trauma and chronic physical pain activate similar neuro-pathways in the brain. In one 2011 study, people were asked to view photographs of their former romantic partners during an fMRI scan. Researchers noted that the areas in the brain that process physical pain lit up. In other words, to the brain, physical pain and painful emotional experiences are indistinguishable, the researchers said.

What researchers are just now beginning to understand is that exposure to multiple emotional traumas may strengthen neural associations with pain so much so that unresolved emotional hurts can actually produce chronic physical pain within the body.

Dr. Howard Schubiner, a clinical professor of internal medicine at Michigan State University, has studied the connection between trauma and pain for decades — something he refers to as a neural circuit disorder or mind-body Syndrome, a term he has popularized. Schubiner leads workshops around the country teaching other physicians, clinicians, and laypeople about the relationship between trauma and physical pain, and how those associations can be “unlearned.” Schubiner also treats people in his private practice.

“The first step is ruling out a physical condition, and then ruling in a neural circuit disorder,” Schubiner says. “As a physician, if I find that you have a large herniated disc that’s pressing on a nerve, that makes me happy — it says I’m a good doctor, I found out the patient has a structural problem, and that they don’t need mind-body treatment.” But often, says Schubiner, the people he sees have chronic pain due to a learned association between pain and trauma, even after the injury has healed. For example, a Vietnam veteran whose wounds throb at the sound of a helicopter, or a young woman who feels pelvic pain when she relives a childhood sexual assault (both people he has treated).

“When these triggers occur, the neural circuits learn, just like Pavlov’s dogs, to create pain,” Schubiner says. Triggers can be anything, he says, from events linked to the trauma (like the helicopter) to seemingly random associations like stormy weather or sitting in a certain seat. “The pain is real, but not because of changes in the weather or the chair you’re sitting in — it’s because the brain recognizes those triggers and says that it’s time to generate pain.”

Pain that is highly localized in a person without a history of trauma is likely to be a tissue problem, says Schubiner — for instance, a slipped disc pressing on a nerve in someone’s back. But when the tissue is healed and the pain persists, it could be due to hyperarousal, something that Schubiner says can be calmed in time. Pain that shifts to different places in the body, or pain that fluctuates based on an emotional experience, may be a neural circuit disorder.