Relationship between chronic pain and PTSD
While chronic pain and PTSD are conditions that may occur together, their relationship to one another is not always obvious and is often overlooked. PTSD can be overlooked because the health care provider, the patient and the family may be focusing on the pain disorder. At times, the patient’s level of disability may be attributed solely to pain. Because there is such a close relationship between PTSD and chronic pain, they have been referred to as mutually maintaining conditions. This is because the presence of both PTSD and chronic pain can increase the symptom severity of either condition.
For example, people with chronic pain may avoid activity because they fear the pain—avoiding activity can lead to physical de-conditioning and greater disability and pain over time. Similarly, people with PTSD may avoid reminders of the trauma. This avoidance of activity can lead to the continuation of PTSD symptoms while also contributing to greater physical disability.
People with chronic pain may also focus their attention toward their pain while individuals with PTSD may unknowingly focus on things that remind them of the trauma. Consequently, people with both PTSD and chronic pain may have less time and energy to focus on more adaptive ways of coping with both their pain and fear. Furthermore, people with PTSD often experience symptoms of arousal and tension, which may decrease their tolerance for handling pain and increase their perception of pain.
Below you will find the recommendations for healthcare providers that were developed for the National Center for PTSD by Lorie T. DeCarvalho, Ph.D. You may want to review this and your reactions to this information with your pain management team.
Dr. DeCarvalho states that when patients are coping with a chronic pain condition, it is difficult for them to hear from a health care provider that they will need to ”live with it” and ”manage the pain” for the rest of their lives. Being faced with the news of impending health problems, ongoing severe pain, and disability is extremely difficult. These individuals may have lost their physical abilities, and they have lost the assurance that they can fully control whatever is going on in their lives. Much like losing a loved one, these individuals will need to grieve their losses. This may take some time and will vary from person to person.
Here are some suggestions for assisting these individuals
Gather a thorough biopsychosocial history and assess the individual for medical and psychiatric problems. Do a risk assessment for suicidal and homicidal ideation. Also ask about misuse of substances, such as drugs or alcohol, including over-the-counter and prescription drugs or narcotics. Taking appropriate steps to ensure someone is clean and sober and not using medications or other substances to self-medicate is a necessary component of treatment.
Assess for PTSD symptoms. A quick screen may involve asking the person these questions: In the past month, have you: (1) had nightmares about__ when you didn’t want to? (2) tried hard not to think about __ or gone out of your way to avoid situations that reminded you of __? (3) been constantly on guard, watchful, or easily startled? or (4) felt numb or detached from others, activities, or your surroundings?
Make appropriate referrals for PTSD, depression, other psychiatric disorders, or significant spiritual issues. Likewise, help build up or stabilize their social support network, as this will act as a buffer against the stress they are experiencing.
Understand that prior to patients being able to come to an acceptance about the permanence of their condition, they will be feeling very much out of control and helpless. Their lives essentially revolve around trying to regain their sense of control, and this can sometimes be difficult, particularly when treatments don’t seem to help or the patient’s support system is weak. There may be times when they become outwardly angry or depressed. Restoring some sense of control and empowering the patient is a fundamental part of the treatment process.
To learn more about using a biopsychosocial approach for chronic pain management please check out my article The Need for Multidisciplinary Chronic Pain Management that you can download for free on our Ariticles page.
You can learn more about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people in chronic pain or living with chronic pain yourself and want to learn how to develop a plan for managing the pain and coexisting psychological disorders including PTSD or addiction effectively please go to our Publications page and check out my book the Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.
To listen to a radio interview I did conducted by Mary Woods for her program One Hour at a Time please Click Here to go to listen to this interview.
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