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Understanding and Implementing Trauma-Informed Care for Clients in Pain: Summary
important link between our neocortex and the brain stem Slide your hands toward the middle of your head, near your ears. This layer of the brain is called the limbic system. The limbic system has been referred to as the “smoke detector” of the brain • Brain stem : Trace your hands to the base of your skull. The brain stem connects your brain to your spinal cord to regulate balance, breathing, blood pressure, heart rate, and more autonomic functions. The brain stem is also where our vagus nerve travels through, a critical structure involved in the stress response THE IMPORTANCE OF THE “CONNECTION NERVE” Also known as Cranial Nerve X, the vagus nerve is the longest nerve in the body. The vagus nerve contains both motor and sensory conditions and is recognized for its “wandering” nature to innervate with organs throughout the trunk. It connects to brain regions associated with pain processing and contains anti-inflammatory properties that may provide pain-inhibitory effects . The vagus nerve is part of the parasympathetic branch of the nervous system, emerging directly from our brain stem rather than through our spinal cord. Roughly 80% are afferent (sensory) fibers, which allow the body to communicate to the brain, and 20% are efferent (motor) fibers, which allow the brain to communicate with the body. The vagus nerve plays a role in our appetite, digestion, hormone production, pulse rate, immunity, circulation, stress responses, and inflammation. It innervates with all of the internal organs in the abdominal cavity except for the adrenal glands. Since the vagus nerve is a cranial nerve, it is involved with eye contact, speech, hearing, nursing, kissing, smiling, and other attributes of social connection. The vagus nerve has been referred to as the “connection” or “love” nerve. • How to locate: ○ Place your fingers in the soft space right below and behind your ear lobes ○ Trace your hands down the sides of your neck and down to your collarbones where it travels underneath ○ Trace your hands down your chest toward your heart, your lungs, and down your trunk to your spleen, intestines, liver, and kidneys Vagus nerve stimulation (VNS) is being studied for its benefits in pain, inflammation, and stress. There are two different protocols: • Invasive protocol: Placing an electrode around the cervical vagus nerve, which connects to an implanted generator • Noninvasive protocol: Stimulating the cervical vagus nerve through the skin
Vagus nerve stimulation is known to: • Decrease RA disease activity • Limit fatigue in Sjoren’s syndrome • Limit fatigue in systemic lupus • Decrease fibromyalgia pain • Decrease pain in osteoarthritis • Alleviate refractory epilepsy • Relieve depression symptoms Exercises: • Vagus Nerve Tapping • Vagus Nerve Activation: ○ Humming or singing
○ Deep breathing ○ Somatic practices ○ Safe connection
POLYVAGAL THEORY Polyvagal theory uses a scientific theory to inform how to effectively work with clients suffering with trauma and pain. Polyvagal theory has been referred to as “a science of safety.” Connection is a neuromodulator . Polyvagal theory was founded by Stephen Porges in 1994 after decades of research on the vagus nerve and the evolution of the autonomic nervous system. Porges discovered that instead of the autonomic nervous system being a two- part system, there was another parasympathetic branch. Polyvagal Mapping: You will need to separate your sheet into three sections by drawing two horizontal lines: • Ventral (Ventral Vagal Complex): ○ Social engagement system ○ Part of the parasympathetic pathway ○ “Healing state” ○ Considered a physiological state of safety ○ Patient will present with a lower heart rate, slower respiratory rate, less muscular tension (jaw/ shoulders/neck), soft eyes • Sympathetic: ○ Fight or flight ○ Sympathetic pathway ○ “Sympathetic - dominance" ○ Defensive state ○ Charged, rage, extreme fear, anxious, jittery, stressed, overwhelmed, out of control • Dorsal (Dorsal Vagal Complex): ○ Freeze state (part of the parasympathetic pathway) ○ Self-preservation ○ “Emergency break” ○ Spacey, “out of body” or dissociated, “frozen” or immobile, depressed, disconnected ○ Slow or heavy movements, flat tone, minimal expressions, dissociation, hypoarousal
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