Post-Traumatic Stress Disorder and Chronic Pain

If you have experienced a traumatic event like a fatal car crash, a physical assault or live combat, then you may already be familiar with post-traumatic stress disorder or PTSD. The American Psychiatric Association estimates that 3.5 percent of the U.S. adult population suffers from PTSD. Although it is well known that PTSD sufferers may experience nightmares or flashbacks of the traumatic event, it is less well known that PTSD patients are more likely to encounter circulatory, digestive, nervous, respiratory and musculoskeletal illnesses.  Chronic pain is commonly a feature of the condition as well.

Various studies suggest that there is a strong link between PTSD and chronic pain. Two studies concluded that 20 to 30 percent of PTSD patients also suffered from chronic pain. Another study of volunteer firemen found that about 50 percent of those who had PTSD also struggled with chronic pain, while only 20 percent of those without PTSD experienced similar pain symptoms.

What Is Post-Traumatic Stress Disorder?

Post-traumatic stress disorder is a psychological condition in which someone experiences intense and disturbing feelings and thoughts about a past traumatic event. The most common symptoms of post-traumatic stress disorder include

  • Intrusive thoughts—this may take the form of nightmares, flashbacks or involuntary memories of the trauma.
  • Avoidance behavior—the patient may go to great lengths to avoid people, places, situations or things that may remind them of the trauma. This may also include not wanting to discuss the trauma.
  • Negative feelings—there may be ongoing feelings of fear, horror, guilt, shame or anger. PTSD sufferers may also lose interest in previously enjoyed activities or friends.
  • High arousal—PTSD patients may be irritable and exhibit angry outbursts. They may also startle easily and have difficulty concentrating.

Many people begin exhibiting symptoms within three months following the traumatic event, but for some it may take longer. Post-traumatic stress disorder may lead to other issues like depression, memory problems, substance abuse, sleep disorders and chronic pain.

Why Is Chronic Pain Linked to PTSD?

It is obvious why post-traumatic stress disorder and chronic pain are so often comorbidities—many traumatic events involve painful injuries. Events like military combat, physical assaults and natural disasters often produce bodily injuries that sear the psyche as well as cause ongoing pain.  The greater the pain, the more likely there will be some psychological injury as well as lingering pain symptoms.

Another reason that chronic pain and post-traumatic stress disorder are so commonly associated is that many PTSD symptoms produce or intensify pain symptoms. Hyperarousal, which is a common PTSD symptom, can cause prolonged muscle tension which can produce chronic pain. 

Losing interest in previously enjoyed activities like sports or socializing may also impact pain conditions. Less exercise can worsen chronic pain in many ways including raise the risk of obesity which makes pain symptoms more severe. It may also make it more difficult to fall or stay asleep which can intensify pain symptoms. Loss of interest often leads to a sedentary lifestyle that makes pain and disability more likely.

Finally, anxiety and depression—common features of PTSD—are produced in the brain using similar neural pathways as pain. If a patient is suffering from stress or depression, it is likely to amplify pain symptoms.  That is why doctors must simultaneously treat mental health conditions along with chronic pain.

The Difficulty of Treating PTSD and Chronic Pain

If you are struggling with chronic pain brought on by PTSD, it may be quite challenging to obtain medical care for your conditions. Only 2 percent of the general public without chronic pain suffers from post-traumatic stress disorder, so many general practitioners may not readily recognize the severity of your symptoms and attribute them to post-traumatic stress disorder.

Furthermore, both PTSD and chronic pain lack organic causes, so many physicians are reluctant to acknowledge such ephemeral conditions. They may assume it is a psychological desire for attention or drug-seeking behavior. In such cases, it may be necessary to consult with a pain or psychiatric specialist.

How to Treat PTSD and Chronic Pain

In order to treat PTSD and related chronic pain effectively, it is absolutely essential that a multi-disciplinary that involves both psychiatry and pain medicine is used. Because these conditions are interlinked on many levels, you can’t treat one without treating the other.

Within this multi-disciplinary approach, there may be many potential therapeutic techniques utilized, including the following:

  • Eye movement desensitization reprocessing—this therapy is focused on PTSD patients and uses Rapid Eye Movement sleep—one of the key sleep stages involved in stress resolution—to help alleviate distress. A therapist asks you to follow hand motions with your eyes, similar to how your eyes move while in REM sleep, and ask you to remember the traumatic event. Gradually, the therapist will transition the imagery to more pleasant ones. This therapy helps weaken the emotional weight of traumatic memories.
  • Cognitive behavioral therapy—this treatment has applications for both PTSD and pain symptoms. During these sessions, you may discuss past traumas and how you feel about them. You may also analyze your feelings when your pain flares up. Then, you and your therapist will create a strategy to neutralize negative thoughts and feelings that intensify such episodes.
  • Mindful meditation—this therapy has proven very effective for pain and stress relief, but it has also been successful for many PTSD patients. Mindfulness includes the ability to focus on the present which helps blunt the power of negative memories. It also helps soothe many negative thought patterns common to PTSD and chronic pain patients.
  • Medications—of course, one of the first queries that PTSD and chronic pain patients direct to their doctors is if there are any drugs that can help.  There are several including selective serotonin reuptake inhibitors like Prozac or Paxil that alleviate both chronic pain and post-traumatic stress disorder symptoms. Some anti-psychotics like prazosin have helped some patients. Other drugs like duloxetine, bupropion, venlafaxine and desvenlafaxine have also been used among some PTSD and chronic pain patients.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.  The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship.  Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA and you should not post any of your private health information. 

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