The Complete Guide to Healing from Medical Trauma & Chronic Pain
- Dr Tovah Goldfine
- Aug 27
- 8 min read
Updated: Sep 2
Insights from John Gasienica & Charlie Scott Merrill
🎥 Watch the full conversation here before diving into the guide.
Medical trauma is a silent epidemic. While the term might sound rare, the experience is common — and its effects run deep. It’s what happens when your interactions with the healthcare system leave you feeling unsafe, unseen, or powerless. And for people living with chronic pain, this kind of trauma can be the invisible anchor keeping them stuck, even when tests show “nothing is wrong.”
In this TMS Roundtable Recovery conversation, Dr. Tovah Goldfine speaks with two leading voices in neuroplastic pain recovery:
John Gasienica, LCSW — Director of Clinical Research at the Pain Psychology Center and co-host of the Pain Reprocessing Therapy Podcast
Charlie Scott Merrill, PT — Mind-body physical therapist, performance coach, and founder of Merrill Performance
Over the course of an hour, they unpack what medical trauma is, how it rewires the nervous system, and what practical steps you can take to move from fear and doubt into recovery and trust.
“If you’ve been through medical trauma, I’m sorry that happened to you,” Charlie says. “But there’s hope. There are real, practical tools you can use to take your life back.”
This guide expands on their discussion — blending their insights with research and actionable advice so you can understand medical trauma, calm your nervous system, and begin rebuilding trust in your body.
Understanding Medical Trauma
Medical trauma isn’t a diagnosis you’ll often find on a chart, but its impact can be profound. It can stem from:
Invasive procedures (even those that technically went well)
Receiving a frightening diagnosis without adequate emotional support
Feeling dismissed or disbelieved by medical professionals
Repeated negative medical experiences over months or years
Charlie defines it this way:
“It could be anything from a surgery that left you feeling unsafe, to being told something scary about your health, to having your symptoms minimized. Neuroplastic pain is ripe with opportunities to leave people feeling minimized and invalidated.”
John adds another layer: the trauma of living with a chronic condition that no one can fix.
“There’s the medical trauma, and then there’s the trauma of the condition itself. Historically, our field didn’t have strong research to point to. Now we do, and that changes everything.”
How Medical Trauma Shows Up in the Body
Medical trauma can trigger a state of ongoing hypervigilance in the nervous system. This means your body stays in “protect mode,” ready to defend against perceived threats. The symptoms can include:
Heightened pain sensitivity
Anxiety around medical environments
Avoidance of medical care
Increased flare-ups when discussing or thinking about symptoms
In neuroplastic pain, this protective mechanism can cause real, physical pain even without structural injury — not because it’s “in your head,” but because your brain has learned to associate certain activities, sensations, or situations with danger.
How Trauma Shapes Chronic Pain
When you’ve been through medical trauma, it’s not just your memories that hold the imprint — your nervous system does too. John explains:
“Doubt that you can get better is a function of trauma. It’s not your personality. Trauma teaches you the world isn’t safe — and your brain acts accordingly.”
The Brain’s Danger Alarm
Your brain’s job is to protect you from harm. After trauma, the “danger alarm” can become overly sensitive, sounding off at the slightest sign of perceived threat — whether that’s bending over to pick something up or scheduling a doctor’s appointment.
In practice, this might look like:
Pain starting before you even move (“anticipatory pain”)
Flare-ups after hearing a diagnosis or prognosis
Avoiding safe activities due to fear of making symptoms worse
Charlie describes it as the smoke alarm problem:
“The alarm is so sensitive that it won’t even let you get close to injuring yourself. That’s protective — but it’s also limiting your life.”
The Cycle of Fear and Pain
You experience pain or symptoms.
You interpret them as signs of damage.
This triggers fear, anxiety, or hopelessness.
Your brain reinforces the “danger” association.
The nervous system stays on high alert, perpetuating the pain.
Breaking this cycle requires both physical and psychological safety signals — teaching your brain and body that it’s safe to move, feel, and live again.
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Building Bridges with Doctors
One of the most surprising takeaways from the conversation with John and Charlie is this: many doctors are more open to mind-body approaches than we think — but they often don’t say it out loud.
John explains:
“If a patient comes in and says, ‘I’m open to this idea that my pain could be neurological,’ doctors are much more comfortable talking about it. It gives them permission to explore the topic without feeling like they’re gaslighting the patient.”
Why the Disconnect Happens
Doctors fear their patients will feel dismissed if they mention a psychological or neuroplastic component to pain.
Patients, after years of invalidation, may enter appointments defensive and skeptical.
Both sides want the same thing — relief — but the communication gap keeps them on opposite ends.
The ATNS Letter: A Simple Bridge
The Association for the Treatment of Neuroplastic Symptoms (ATNS) created a printable letter that patients can hand to their doctors. It explains the science behind neuroplastic pain and invites collaboration.
Purpose: Removes pressure from the patient to explain everything in one appointment.
Benefit: Signals to the doctor that the patient is informed, open, and proactive.
Charlie notes that when conversations shift from adversarial to collaborative, the healing process starts sooner — because the patient feels seen and the doctor feels trusted.
The Role of Hope, Belief, and Education
Hope isn’t fluffy optimism — it’s neurochemistry. Dr. Tovah says it plainly:
“Belief is chemical. Laughing is chemical. Hope creates chemical changes in the brain.”
When you believe recovery is possible, your brain releases chemicals that:
Reduce the threat response in the nervous system
Encourage neuroplastic rewiring
Lower stress hormone levels that amplify pain signals
How Education Fuels Hope
John emphasizes that understanding pain science is often the turning point for patients.
Knowing that pain can be real without structural damage reframes it from a permanent injury to a reversible state.
Understanding neuroplasticity helps patients see their symptoms as changeable.
Social media has amplified this educational reach. People are finding recovery stories and learning about concepts like TMS (Tension Myoneural Syndrome), PRT (Pain Reprocessing Therapy), and nervous system regulation from anywhere in the world.
“Replacing fear narratives with possibility isn’t just inspiring — it’s therapeutic,” John explains.
Busting Myths About Pain
Charlie calls himself a “professional myth buster” — because so much of chronic pain recovery starts with unlearning.
Common myths they address in the conversation:
Myth 1: Pain always means damage.
Truth: Pain is an output of the brain, not a direct measure of tissue injury.
Myth 2: Perfect posture prevents pain.
Truth: People with “bad posture” can be pain-free, and people with “perfect posture” can have severe pain.
Myth 3: You should avoid any movement that hurts.
Truth: Some discomfort is safe and part of retraining the nervous system.
John adds that it’s not about swinging to extremes:
“The goal isn’t to ignore your pain or identify as your pain. It’s finding that middle path where you can acknowledge it without reinforcing it.”
The Therapeutic Alliance: Why Trust Matters
In any mind-body recovery journey, the relationship between patient and clinician is a treatment in itself.
Charlie explains:
“If the person doesn’t trust me, it’s not going to go anywhere. They have to feel safe with me before I can challenge them to move or think differently.”
Trust creates a physiological sense of safety, which helps turn down the volume of the nervous system’s danger signals. Without it, even the most evidence-based strategies may fail — because the brain still perceives threat.
How to build trust with your clinician:
Share openly about your fears and doubts.
Ask them how they view pain and healing — see if their perspective aligns with yours.
Remember it’s okay to seek a provider who supports a mind-body approach.
Restoring Agency and Trust in Your Body
One of the most powerful turning points in recovery from medical trauma and chronic pain is regaining agency — the belief that you have some control over your healing.
Charlie explains how he helps patients take back that control:
“We start by ruling out any serious structural issues. Once we’re confident the body is safe, we reintroduce movement gradually, in ways that feel good and build confidence. Your danger alarm is so sensitive, it won’t even let you get close to injuring yourself.”
This “danger alarm” analogy helps patients understand that the nervous system isn’t trying to hurt them — it’s trying to protect them, but it’s gone overboard.
Why Agency Matters
Without agency, recovery can feel like waiting for a cure to appear. With agency, you can:
Actively participate in your treatment plan
Experiment with new movement and coping strategies
Learn to self-regulate during symptom flares
Build evidence that your body is more resilient than you think
John emphasizes reframing trauma as part of a growth process:
“When resistance settles down, insights start popping up. People realize, ‘I don’t want to go back to the person I was — I want a calmer, more relaxed life.’”
Practical Tools for Calming the Nervous System
Both John and Charlie shared techniques for downregulating the nervous system, which is key to reducing pain intensity and frequency.
John’s 5-Minute Compassionate Inquiry Exercise
Close your eyes and notice what’s preventing you from feeling perfectly relaxed.
Ask that sensation: “What are you afraid of right now?”
Validate the feeling — whether it’s pain lasting forever or a completely unrelated fear.
Respond with calm reassurance: “We’re okay.”
Breathe slowly and relax your muscles, letting your body feel safe again.
This helps address the emotional drivers behind pain, rather than only the physical sensations.
Charlie’s Movement-Based Anger Expression
Charlie uses guided movement to help patients express and release stored emotions — especially anger, which is often linked to chronic symptoms in neuroplastic conditions. This can be as simple as:
Pushing against a wall
Using resistance bands
Throwing soft medicine balls against a wall
The goal isn’t aggression — it’s safe expression that communicates strength and safety to the nervous system.
Mental Rehearsal & Visualization
Both guests recommend imagining yourself performing movements or activities pain-free. This “brain rehearsal” rewires the nervous system’s expectations, making the real movement less threatening.
Living with Uncertainty
A recurring theme in recovery is learning to tolerate uncertainty. Many patients seek an exact diagnosis or complete clarity before moving forward — but sometimes that certainty never comes.
John reframes it this way:
“It’s not about finding certainty — it’s about increasing your tolerance for uncertainty.”
Dr. Tovah adds:
“Can we be certain that we’re uncertain? Secure that we’re insecure? It’s a mindset shift that puts the brain in perspective.”
Building this tolerance:
Accept that you may never have all the answers.
Focus on what you can influence today.
Recognize that not knowing doesn’t mean you’re in danger.
This shift often frees patients from the endless cycle of seeking “the one missing piece” and instead allows them to invest in strategies that actually help.
Final Words of Hope
Charlie’s message to anyone living with chronic pain after medical trauma:
“If you’ve been through medical trauma, I’m sorry that happened to you. But there’s a lot of hope and a lot of options for recovery.”
John’s encouragement:
“If you’ve been struggling for a long time, experiment with being kinder to yourself. For many, that’s the hidden key to breaking free.”
Both agree that recovery isn’t about erasing every trace of discomfort — it’s about regaining your freedom, your confidence, and your trust in your body.
