If you have lived through or witnessed a traumatic event or series of events, you may already be familiar with the symptoms of PTSD. But even after the event has passed and your symptoms are identified, you may start to notice another complication: pain. Is there a link between PTSD and chronic pain?
What Is PTSD?
Post-traumatic stress disorder (PTSD) Is a complicated psychiatric disorder caused by experiencing or witnessing a traumatic event. This condition is largely associated with war and combat, but there are a variety of traumatic events that can lead to PTSD, including:
- Sexual assault
- Violent attacks
- Natural disasters
- Serious accidents
- Terroristic acts
The event does not necessarily need to happen to the person affected. The stress of death, sexual violence, or injury can lead to PTSD. Even living in a stressful or violent environment can lead to PTSD.
This type of disorder has historically been assigned to veterans returning from combat, but PTSD is prevalent in every ethnicity, nationality, and culture. You need not go to war or live in a combat zone to develop symptoms of PTSD. There are no age limits or restrictions. An estimated 3.5% of adults in the U.S. will be affected by PTSD annually, with one in 11 people diagnosed with PTSD in their lifetime.
Although PTSD has the potential to affect everyone, women are twice as likely to have PTSD as men, and certain ethnic groups in the U.S. have much higher rates of PTSD than others.
There are four main categories of PTSD symptoms. People may experience symptoms in each category, and they can range from mild to severe.
- Intrusion: Intrusion is more commonly referred to as flashbacks. These are memories or dreams that occur involuntarily. In the most extreme cases, these intrusive thoughts are so vivid that it feels like the event is occurring again.
- Avoidance: To prevent flashbacks, people with PTSD practice avoidant behaviors. They may change their routines to avoid certain people, places, activities, and situations that serve as triggers. Avoidance also includes a reluctance to discuss the traumatic event or their feelings about it.
- Alterations in cognition and mood: Mood disorders are common among PTSD sufferers. They include things like negative thoughts and feelings or an inability to feel happiness. Other types of mood changes include shame, guilt, and self-blame for the traumatic event. In some cases, those with PTSD may not be able to remember the event itself.
- Alterations in arousal and reactivity: Hyper-vigilance is being overly aware of what is happening around the person with PTSD. This leads to difficulty with sleeping and concentration, along with an overactive startle reflex. People may become more irritable and quick to anger.
The above symptom categories deal with the mental aspects of PTSD, but the physical symptoms are real, too. In a condition this complex, PTSD physical symptoms can range from minor challenges to debilitating blocks to your day.
People with PTSD may also experience:
- High blood pressure
- Increased heart rate
- Muscle pain and tension
- Nausea and other gastrointestinal symptoms
- Joint pain
- Back pain
The symptoms above are not uncommon in the days following a traumatic event. A PTSD diagnosis occurs when symptoms:
- Last for a month or more
- Cause debilitating distress
The diagnosis is made by taking a full patient history and assessing the impact of recent trauma.
What Is Chronic Pain?
Chronic pain is different from the normal response to an acute injury. For example, when a person breaks a bone, there is a period of healing that can be painful. In most cases, when the bone heals and the cast comes off, the pain goes away. When pain does not recede and lasts for three months or longer, it becomes chronic.
Chronic pain can occur over time as the body ages and normal wear and tear occurs. There are many causes of chronic pain, but some people may experience chronic pain before, during, and after cancer diagnosis and treatment or with other chronic illnesses including fibromyalgia and diabetic peripheral neuropathy.
In the most frustrating cases, there is no direct link between an injury or long-term wear and tear. This type of chronic pain is idiopathic — it has no obvious cause.
Many people are living with chronic pain and don’t even realize it. An estimated 80% of people in the U.S. will experience chronic neck or lower back pain at some point in their lives. Of all chronic pain sufferers, 25% are unable to go about their daily lives.
Symptoms of chronic pain
The symptoms of chronic pain are as wide and varied as the people who experience them. They can include some or all of the following:
- Sharp, dull, aching pain
- Radiating nerve pain
- Pain that comes and goes
- Pain that is constant
- Pain that gets better or worse with movement
- Extreme fatigue
- Gastrointestinal disorders
The most challenging symptoms of chronic pain may not even be the pain itself. People with chronic pain suffer higher rates of depression and crippling anxiety. They are also at increased risk of developing other comorbid psychological conditions such as PTSD, as we’ll discuss here.
Diagnosing chronic pain
Getting a diagnosis of chronic pain can be challenging, and some sufferers wait for years to find relief. In some cases, a diagnosis occurs by taking a complete medical history and eliminating all other possibilities. Other potential tests look for musculoskeletal abnormalities and can include:
- CT scans
Your doctor may also order blood tests to rule out (or confirm) specific conditions.
Can PTSD Cause Chronic Pain?
When you consider the causes of PTSD, it is easy to see how this can lead to chronic pain, too. In many cases, traumatic events themselves are painful. Consider veterans wounded in combat or survivors of physical or sexual assault. When a person is injured in a traumatic event, and a diagnosis of PTSD follows, maladaptive coping strategies for both can increase pain. Injury that leads to chronic pain and the trauma that precedes it can also lead to an increased chance of both conditions worsening.
For people who witness a traumatic event without sustaining injury, PTSD can still cause chronic pain. Consider the muscles needed to maintain a constant awareness of your surroundings. This can lead to strains, tears, and damage to the muscles as they continue to keep the body on high alert.
Additionally, people who have witnessed a traumatic event, whether it has led to personal physical pain or not, may practice avoidant behavior. This avoidant behavior includes overestimating the amount of pain something might cause and then avoiding that activity. This results in a deconditioning effect that can lead to injury in a previously healthy person.
And since PTSD is associated with an increased risk of depression, this can lead to withdrawal from physical activity and other healthy habits that serve as a treatment for injury. Without regular exercise, pain can increase and become chronic.
Further research clearly shows that PTSD and chronic pain go together, and that PTSD itself can lead to chronic pain.
- Some studies indicate a near 100% occurrence of chronic pain in PTSD sufferers
- People with PTSD report more severe pain
- People with PTSD as a result of an accident report higher rates of disability due to pain
- The presence of PTSD and chronic pain together made treating both exponentially more challenging, with fewer favorable outcomes
Turns out, both of these conditions together have a clearly negative influence on each other.
How Do You Treat Chronic PTSD Pain?
Because treating one without the other is setting patients up for failure, it’s critical that both PTSD and chronic pain be addressed at the same time.
So how do you treat chronic PTSD pain? With a combination approach that is customized and comprehensive for the specific patient. This may include all or a variety of the following treatments.
Medication includes both over-the-counter and prescription options as needed. In some cases, medications for treating PTSD-related depression may also result in a decrease in chronic pain. It is not well understood why antidepressants work on hard-to-treat chronic pain, but many people report good results.
There are a variety of options, but the most common is tricyclic antidepressants. There are some side effects associated with these antidepressants, but starting at a low dose can prevent them from occurring.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) are also becoming popular due to their limited side effects. Other medications include non-steroidal anti-inflammatory drugs and other medications that can be used for better sleep and less anxiety.
Because there is limited evidence that opioids are effective for chronic pain, these are generally not prescribed. If they are, medication management is critical to prevent overuse or abuse.
Your doctor can determine which medications might be helpful in treating both PTSD and chronic pain, along with the other following therapies.
Many people who suffer from both PTSD and chronic pain find that regular complementary care is necessary for relieving both physical and mental distress. These treatments include:
Cognitive behavioral therapy (CBT) is a first-line treatment for both chronic pain and PTSD. This type of therapy helps patients reframe negative, disruptive thoughts. It does not seek to eliminate negative thoughts but to put them in perspective and to right-size their role in a patient’s life.
These treatment approaches may be helpful for PTSD sufferers who are not yet ready to fully discuss their traumatic event. They can occur in conjunction with specific treatments for chronic pain, too.
Interventional pain procedures
Interventional pain procedures are targeted for specific types of chronic pain. The intervention depends on the type of pain.
For example, for PTSD and joint pain that does not respond to conservative treatments, joint injections may provide relief. Back injuries might be treated by spinal cord stimulation. Other common interventional pain procedures include:
- Disc denervation
- Peripheral nerve stimulation
- Vertebroplasty and kyphoplasty
- Trigger point injections
- Intrathecal pump implants
Each of these treatments can help you live a life with less pain. Talk to your doctor about targeted approaches that might work for you.
Living With PTSD And Chronic Pain
Living with PTSD and chronic pain can have a profound effect on your physical and emotional daily life. But you don’t have to suffer anymore.
Our Phoenix, AZ Mercy Care Center of Excellence program approaches complex conditions in a holistic way. We know that comorbid conditions need to be treated at the same time for the best chance at success. To this end, we address the entire person in front of us. Our goal is to help you get your life back if you’re suffering from the dual diagnoses of chronic pain and PTSD.
When you are ready to explore treatment options for PTSD and chronic pain, get in touch to set up an appointment.