Research has indicated that somewhere between 15 and 35 percent of people who have chronic pain also suffer from post-traumatic stress disorder — compared to a much lower two percent of the general population. What exactly is the link between these two conditions? Could the same traumatic event that caused PTSD also have led to chronic pain, or does post-traumatic stress disorder itself have the potential to induce chronic pain? And also, how does living with chronic pain impact PTSD symptoms, and vice versa?
From an academic perspective, the topic is pretty fascinating. If you have both conditions, however, it's your life — and you probably just want to know how to improve your symptoms.
What's the link between chronic pain and post-traumatic stress disorder?
For some people, the same traumatic event that caused them to develop PTSD will also induce chronic pain as the result of a physical injury — think, for example, people who were in motor vehicle accidents, or combat veterans or firefighters injured in the line of duty.
People with PTSD who weren't injured during their trauma can also go on to suffer from chronic pain as a direct result of PTSD, however. For example, one study found that about half of firefighters with PTSD had chronic pain, compared to only a fifth of those without the trauma-related anxiety disorder. Up to 60 percent of combat veterans who have post-traumatic stress disorder are thought to suffer from chronic pain, most often muscoloskelal, along with up to half of vehicle accident survivors.
Research has also uncovered that PTSD sufferers are more likely to have the chronic pain syndrome fibromyalgia — to the tune of 22 to 49 percent. Fibromyalgia is believed to be caused by changes in the central nervous system that make people more vulnerable to pain, and though there's still much to be discovered about the condition, traumatic events are a known trigger.
How does chronic pain tend to impact PTSD symptoms?
People with PTSD who also suffer from chronic pain have been found to be more likely to notice physical reactions when they're reminded of the trauma, are extremely hypervigilant, and tend to display signs of emotional numbness. They also, more than other PTSD sufferers, experience a sense of foreshortened future — the idea that their life will end soon, and that they don't have a future to look forward to.
This all makes sense. When physical reactions to distressing reminders include muscle tension, that's a risk factor for chronic pain. When you're emotionally numb or have alexithymia ("emotional blindness"), you end up in a paradoxical and hard-to-understand situation where you're not sure what emotions you're having — but you still experience them in some way. You may not consciously be aware of anxiety, fear, or even anger, but your body is. You may then feel this as pain, again because your muscles are chronically tense.
Where a person suffers from chronic pain as the result of an injury that occurred over the course of a trauma, their pain may also trigger reexperiencing symptoms such as intrusive thoughts and flashbacks — explaining why people with co-occurring PTSD and chronic pain often have more severe PTSD symptoms.
Overall, people who have both chronic pain and PTSD are more likely to also develop major depressive disorder and substance use disorders, as well as having a lower quality of life in general.
What can you do if you suffer from both chronic pain and post-traumatic stress disorder?
Cognitive behavioral therapy, including exposure therapy, can help you start processing the events that led to your PTSD, and EMDR may also help you. Medications, such as antidepressants, also help some people.
If your chronic pain has an identifiable physical cause, you may be able to receive treatment to resolve it, or you may be prescribed painkillers to alleviate the symptoms. Research also suggests that regular physical activity, stretching, and relaxation or meditation exercises can help people with PTSD and chronic pain find some relief — but as always, folks suffer from chronic pain should consult their doctors before undertaking any physical exercise, to make sure their workout routines are safe for them.
- Photo courtesy of SteadyHealth
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