PTSD and Chronic Pain
Post-traumatic stress disorder (PTSD) mostly is known for its effect on overall mental health. There is research, however, to support the fact that PTSD is increasingly being recognized for its effect on physical wellness as well. Many who suffer with PTSD (veterans in particular) have higher lifetime prevalence of circulatory, digestive, musculoskeletal, nervous system, respiratory and infectious disease. There is also an increased co-occurrence of chronic pain in those who suffer with PTSD.
Chronic pain may be defined as pain that persists longer than three months that was initially accompanied with tissue damage or a disease which has already healed.
In 1979, the International Association for the Study of Pain (IASP) officially redefined pain as “an unpleasant sensory and emotional experience associated with actual or potential damage or described in terms of such damage.” This definition takes into account the fact that pain involves thoughts and feelings. Pain is real regardless of whether the biological causes are known, and it is ultimately a subjective experience.
Pain experienced by veterans is reported as significantly worse than the public at large because of exposure to injury and psychological stress. Rates of chronic pain in women veterans are even higher.
Women are known to suffer chronic, nonmalignant pain disproportionally more than men, so it seems intuitive that the high prevalence of chronic pain in enlisted women is merely a consequence of being a woman.
Women veterans specifically diagnosed with PTSD had significantly higher rates of pain and overall poor health than women in the general population. There is not a lot known about the context of military culture that might have implications for women’s health and health behaviors. Veteran women’s increased prevalence of chronic pain probably is because their pain is compounded by extreme conditions that are not experienced by civilian women. The ability to manage chronic pain probably is severely limited within military context, such that pain is probably maintained or progressively worsens with little relief.
When chronic pain cannot be readily explained as the direct consequence of tissue damage, some people treating women veterans are apt to think it is all in the head. Although at greater risk for experiencing PTSD and comorbid pain, women veterans are usually underdiagnosed and underutilize mental health services. A reason cited is that even in our progressed society, women in this position continue to be stigmatized.
Both PTSD and chronic pain sufferers often are stigmatized. They are relegated to the outskirts of the community, and become liminal creatures.
I believe this is mostly a result of the esoteric and existential nature of both. They both defy what we know to be natural phenomena, and if you really think about it they are both really difficult to describe. I see time and again that those who experience either trauma or pain are perceived as victims of their own devices rather than just as sufferers.
Fibromyalgia is a common diagnosis given to women post-deployment. As such, woman are stereotyped as somatisizers (almost like latter-day hysterics) and told that their pain is elicited from the mental construct called the psyche, and not the brain.
Although the concept of somatization does not intrinsically disparage chronic pain, it has acquired a distinct secondary meaning — that pain symptoms are exaggerated or feigned and, ultimately, within the control of the sufferer. A variety of social and medical critics view chronic pain in women as a post-modern illness sharing a lineage with nineteenth-century pseudo-maladies such as hysteria. These illnesses, they contend, originate in vulnerable human psyches.
Central to these suspicions is the seemingly unshakable belief that chronic pain is a psychosomatic disorder, with the implication that the sufferer’s pain is not medically real. Within this conceptual framework is the archetype of the traumatized women who experiences her trauma symptoms in her body. I urge women to take a stand against stereotyping and to pursue quality treatment despite critics who might make it seem unwarranted.
Veterans with chronic pain often report that pain interferes with their ability to engage in occupational, social, and recreational activities. This leads to increased isolation, negative mood, and physical deconditioning, which actually exacerbates the experience of pain.
PTSD, as aforementioned, is itself isolating, as the sufferer disconnects from both the self and others. Those suffering from PTSD as well as chronic pain suffer unfathomably, as they are betrayed by both their minds and bodies.
This premise (that PTSD sufferers suffer more chronic pain) begs the question: Why are veterans and others who suffer with PTSD more likely to experience comorbid chronic pain?
Well, for veterans in particular, the pain itself is a reminder of a combat-related injury, and therefore can act to actually elicit PTSD symptoms (ie, flashbacks). Additionally, psychological vulnerability such as lack of control is common to both disorders.
When a person is exposed to a traumatic event, one of the primary risk factors related to developing actual PTSD is the extent to which the events and one’s reactions to them are unfolding in a very unpredictable and therefore uncontrollable way. Similarly, patients with chronic pain often feel helpless in coping with the perceived unpredictability of the physical sensations.
Some say that patients with PTSD and chronic pain share the common thread of anxiety sensitivity. Anxiety sensitivity refers to the fear of arousal-related sensations because of beliefs that these sensations have harmful consequences.
A person with high anxiety sensitivity would most likely become fearful in response to physical sensations such as pain, thinking that these symptoms are signaling that something is terribly wrong. In the same vain, a person with high anxiety sensitivity will be at risk for developing PTSD because the fear of the trauma itself is amplified by a fearful response to a normal anxiety response to the trauma. It is normal to have a strong reaction to trauma, but most sufferers actually tend to be fearful of their own response.
Suffering, whether readily categorizable or describable, knows no bounds. But there is hope for recovery.
Given the biopsychosocial mechanisms implicated in the co-occurrence of pain and PTSD, there have been models for integrated treatment of both pain and PTSD. These have been more effective than treating them as two distinct entities.
Soldier photo available from Shutterstock
Wolkin, J. (2018). PTSD and Chronic Pain. Psych Central. Retrieved on March 28, 2020, from https://psychcentral.com/lib/ptsd-and-chronic-pain/