PTSD and Chronic Pain Management Part One
Coping with chronic pain is a difficult struggle that requires a lifestyle management approach focused on caring for both the body and the mind. This struggle can be even more difficult when the cause of the pain involves a trauma, such as a motor vehicle accident, work-related injury, combat-related injury, assault or even complications from a surgical procedure. In some cases, a person who is exposed to a traumatic event can develop an intense fear response to the trauma — a psychological syndrome called post-traumatic stress disorder (PTSD).
Given the high rates of co-morbidity between chronic pain and PTSD, and evidence suggesting that these two disorders interact in some way, efforts to develop more effective treatments for this population are greatly needed.
It is important to recognize that certain types of chronic pain are more common in individuals who have experienced specific traumas. For example, adult survivors of physical, psychological, or sexual abuse tend to be more at risk for developing certain types of chronic pain later in their lives. The most common forms of chronic pain for survivors of these kinds of trauma involve: pain in the pelvis, lower back, face, and bladder; fibromyalgia; interstitial cystitis; and non-remitting whiplash syndromes.
The prevalence of PTSD has been estimated to be between 20 to 34 percent in patients referred for the treatment of pain. The prevalence of pain has been estimated to be between 45 to 87 percent in patients referred for the treatment of PTSD. Data obtained from VA Boston Psychology Pain Management indicate that 50 percent of patients assessed met criteria for PTSD based on PTSD Checklist scores.
Patients with co-morbid pain and PTSD experience more intense pain, more emotional distress, higher levels of life interference, and greater disability than pain patients without PTSD. Due to the interaction of these conditions, these patients can also be more complex and challenging to treat.
Some of the theories as to why this relationship occurs relate to personality development, neurobiology or neurophysiology, memory, behavior, and personal coping styles. If you have a history of any type of trauma it is essential that healthcare providers have accurate information about your experiences.
Symptoms of PTSD
With PTSD, a person is exposed to a traumatic event that involves experiencing or witnessing an actual or threat of death or serious injury.
Secondly, the person may begin to re-experience the event with reoccurring dreams and/or intrusive thoughts or “flashbacks” that can be very stressful.
Thirdly, the person with PTSD may avoid thoughts, feelings, activities, people and places that remind him or her of the trauma. She or he may even avoid talking about the trauma or steer clear of the site of the accident or incident because it is too upsetting.
Fourthly, the person may have symptoms of arousal such as having difficulty falling or staying asleep, irritability and anger, difficulty concentrating, an exaggerated response to sudden loud noises or movements, and extreme watchfulness.
Individuals may begin to experience these symptoms immediately after a trauma or even months afterward (called delayed onset). Additionally, while some people who develop these symptoms recover within a few weeks or months, a number of people may continue to experience these symptoms for longer than three months and even years later (chronic PTSD).
To learn more about the role of coexisting disorders in chronic pain management, please read 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 living with chronic pain, especially if you’re in recovery or believe you may have a medication problem and want to learn how to develop a plan for managing your pain and medication effectively, please go to our Publications page and check out my book the Addiction-Free Pain Management® Recovery Guide: Managing Pain and Medication in Recovery. 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 this interview.
To read the latest issue of Chronic Pain Solutions Newsletter please Click here. If you want to sign up for the newsletter, please Click here and input your name and email address. You will then recieve an autoresponse email that you need to reply to in order to finalize enrollment.
February 7th, 2009 at 5:39 am
Such an important topic! I am a trauma survivor who struggled with undiagnosed PTSD for 25 years. During that time no one understood why I was always in so much pain! I had Chronic Fatigue Syndrome and such a bad case of fibromyalgia I could barely walk down the street — every muscle was always screaming out. (If YOU don’t scream out the trauma, your body finds a way!)
The good news is, when PTSD is treated the physical side effects heal themselves. Now, I’m into my second year of being completely, 100% PTSD-free. The CFS and also the firomyalgia both miraculously disappeared. I dance several times a week, walk on the beach every day and even horseback ride.
I write a healing PTSD blog - I’m going to post your site as a pain management resource. Thank you for highlighting PTSD and for endeavoring to help us — helping the body makes it so much easier to heal the mind.
February 8th, 2009 at 10:44 pm
Thank you Michele,
Could you please give me the URL for your Blog; I’d like to check it out.
Dr. Stephen F. Grinstead
Grinstead Consulting, Training & Coaching Services
Senior Consultant/Trainer
Gorski-CENAPS Corporation
February 13th, 2009 at 6:38 pm
I have to speak up for those of us whose bodies have sustained serious damage due to PTSD, damage for which there is not a known “cure.” It is incorrect to say that if one’s PTSD is treated, the physical “side effects” heal themselves. For some fortunate people, that may be very true. But for others, the damage is so deep that physical problems are likely to remain throughout life. These problems are not “side effects.” Please do not ever diminish the suffering of people whose bodies have been ravaged by severe, prolonged trauma. They may have long ago experienced psychological healing but still have debilitating physical problems due to the powerful hormonal and neurological changes associated with prolonged trauma.
February 16th, 2009 at 5:02 pm
Pat,
I agree with you that “it is incorrect to say that if one’s PTSD is treated, the physical ’side effects’ heal themselves…” I hope you did not think that I implied that is the case. I’ve worked with many patients with severe PTSD and some do resolve the “physical” pain symptoms while others need to learn to minimize the pain as best they can and learn not to “suffer.”
I applaud you for speaking up.
Dr. Stephne F. Grinstead
Grinstead Consulting, Training & Coaching Services
Senior Consultant/Trainer
Gorski-CENAPS Corporation
March 18th, 2009 at 8:11 am
Acupuncture is a very effective way of dealing with the physical and emotional trauma of PTSD. Presently, I am working with a group of acupuncturists in Seattle in starting a free acupuncture clinic for war veterans and their families. The name of our group is Seattle Acupuncturists for Veterans (SAV). We have been networking with several veterans groups and when we open (hopefully sometime this spring or summer) we will announce it to these groups. I will (also) include a notice on this blog.
In my personal practice at Country Doctor community clinic in Seattle Washington, I see many people with symptoms of PTSD. The clinic is a sliding scale clinic and I have been able to give ongoing effective relief to many people.
Thanks for putting effort into this problem to help the community.