She Couldn’t Go Home: A Friday That Changed Everything

It was almost closing time on a quiet Friday when an urgent message flashed on my screen: she can’t go home. A 31-year-old patient, who had spent most of her life living with pain, had just confided to our counselor that her abuser - her partner - was waiting in the parking lot. Every women’s shelter in town was full. She had no medications with her and nowhere else to go. For the first and only time in my career, I drove a patient directly to the hospital for safety. That drive marked the beginning of her escape from violence and the start of a journey toward reclaiming her body and her life.

Path Block: The Hidden Complexity of Pain

Chronic pain is rarely just about damaged muscles or nerves. Survivors of intimate partner violence (IPV) often live with long-lasting pain, disability, and the biological stress of trauma that can trigger changes in the immune and endocrine systems that amplify pain.

Depression and post-traumatic stress disorder (PTSD) commonly accompany both pain and abuse; meta-analyses estimate that about half of women with histories of IPV have co-existing PTSD and depression. Yet health-care systems often treat physical, emotional, and social wounds separately. This siloed care leaves women trapped in cycles of pain, disbelief, and dangerous home environments.

Case Study

Our patient’s pain began at 18, when a workplace injury forced her to leave her job. Over the next decade, she cycled through physiotherapy, medications, and eventually high-dose opioids. Nothing provided lasting relief. The pain spread from her neck and back to her severe headaches. She needed a cane to walk. As her world narrowed, depression set in, and her partner dismissed her symptoms as laziness. She was pressured to do chores that worsened her pain. Her partner’s emotional and physical abuse escalated as he controlled her finances and medications. She had no money, no safe place to stay, and no advocate.

Diagnosis Journey

At our first meeting, it was clear her situation wasn’t “just a pain problem.” Chronic pain linked to abuse arises from interactions between the body, the brain, and the social context. She carried a triple burden: physical injury, psychological trauma, and a hostile home. Our plan would have to be layered.

• Body: We started advanced pain interventions to lower her pain intensity just enough to let her move. Opioid tapering was paired with nerve blocks and gentle rehabilitation, allowing her to rebuild strength without worsening her symptoms.

• Brain: Depression and PTSD amplify pain and disability. She joined a neuroscience-based group medical visit (funded through British Columbia’s Medical Services Plan) that taught how the brain can change and introduced coping tools like paced breathing and cognitive reframing. She met with a counselor to process trauma and reframe beliefs about her worth.

• Context: The hardest part was finding safety. That fateful Friday, she voiced what she’d been holding in for years: “I cannot go home.” Her words broke the silence and allowed us to act. We helped her access emergency housing and connected her with social workers for financial and legal support. In the months that followed, she secured subsidized housing and community grants to return to school.

Mini-Lesson:

Survivors of IPV often experience chronic pain driven by both injury and trauma. Effective care must address safety, mental health, and social support alongside physical symptoms.

Turning Point

The most profound shift didn’t come from a procedure. It came from her courage to speak up and from the unwavering belief that she could heal. When she told us she couldn’t go home, the room went quiet. We listened, validated her fear, and let her know we would not abandon her. In that moment, she began to trust herself again. As I wrote in my notes later: “The healing all started with words. She bravely broke the cycle, and in that moment, we moved from surviving to rebuilding.” Research shows that the context in which care is delivered—including empathy and verbal support—can alter brain responses and promote recovery. Conversely, indifference and disbelief act as nocebos, intensifying pain and despair.

Resolution

Over the next year, she rebuilt her life piece by piece:

• Rehabilitation: She committed to physical therapy, gradually increased her walking distance, and traded her cane for walking poles. Strength returned, and with it confidence.

• Lifestyle health: She worked with a dietitian to steady her energy, prioritized sleep, and practiced mindfulness to calm her nervous system.

• Psychological strength: Through counseling, she processed trauma and developed solution-focused thinking. Depression lifted as she regained control.

• Community: She enrolled in courses supported by grants, moved into subsidized housing, and formed new friendships. People noticed she walked taller and moved faster—and she noticed too.

Today, she is close to starting a new career and feels hope for the first time in years. Her pain is not gone, but it no longer defines her. Safety and agency have replaced fear and helplessness.

Key Learnings

This story underscores several truths about healing:

• Safety comes first. Chronic pain linked to abuse cannot improve while the threat remains. Recognizing when a patient cannot safely return home is a life-saving intervention.

• Integrated, layered care matters. In survivors of abuse, pain arises from the interplay of physical injury, neurological changes, depression, and PTSD. Addressing all three layers—body, brain and context—creates momentum for recovery.

• Words can catalyze change. A patient’s voice asking for help and a provider’s belief in their ability to heal can be turning points. The treatment context—including empathy and hope—modulates pain circuits.

• Agency drives recovery. External interventions provide a foundation, but long-term change happens when patients reclaim their own power and build supportive communities.

Takeaways for Patients and Clinicians

• Speak up. If you feel unsafe, tell someone you trust. Asking for help may feel impossible, but it opens the door to change.

• Look beyond the symptoms. Clinicians should assess for trauma, depression, and social stressors in anyone with long-standing pain. Patients benefit from care plans that integrate physical treatments with mental health and social support.

• Believe and be believed. A clinician's conviction that healing is possible can ignite a patient’s fight for themselves. Patients should seek providers who listen and refuse to give up.

• Build a support network. Healing thrives in community. Reach out to friends, support groups, counselors, and organizations that specialize in IPV and chronic pain. You are not alone.

Brenda’s Path Forward Reflections

Women’s health - and pain care more broadly - cannot be reduced to body parts or prescriptions. Survivors of abuse live at the intersection of physical pain and emotional trauma; they need systems that recognize this complexity. Healing begins when we treat safety, mental health, and bodily symptoms as inseparable; when we listen to the quietest pleas for help; and when providers stand shoulder-to-shoulder with patients in their darkest moments.

“We must build systems where layered care is the rule, not the exception—because no woman should have to wait until closing time on a Friday to be heard, believed, and kept safe.” Dr. Brenda Lau