Chronic Pain and PTSD

Chronic Pain and PTSD

Chronic pain is an expensive health condition and a leading cause of non-fatal disability worldwide. Many people with chronic pain have PTSD owing to trauma-related suffering, but PTSD is also a prevalent cause of chronic pain. Understanding this comorbidity may help treat both conditions.

Understanding the Overlap

PTSD prevalence estimates in chronic pain patients vary due to sampling and assessment methods. Many research rely on PTSD screening questionnaires to determine prevalence rates.

Two recent systematic evaluations found 11.7% to 19.1% PTSD prevalence in clinical pain groups, with considerable subgroup heterogeneity. Similarly, 80% of PTSD sufferers report chronic pain symptoms.

Chronic pain problems were frequent among PTSD refugees in a recent review. Almost all study participants complained about this.

Several studies have demonstrated that higher levels of PTSD symptomatology in chronic pain patients are related with higher levels of pain, disability, and psychological distress, suggesting the potential that the illnesses may negatively influence one another.

Why the Overlap?

PTSD and pain coexist for unknown reasons. These have generally focused on common, predisposing vulnerabilities or how the circumstances may interact.

Common Flaws

Anxiety sensitivity may intensify the initial emotional response to a stressful incident, raising the chance of developing either illness. Other biological and psychological weaknesses, such as a lowered physiological threshold for alarm responses, have been postulated.

Vulnerabilities and traumatic event circumstances alter emotional responses and generate cognitive bias, hypervigilance, avoidance behavior, autonomic responses, and muscular responsivity. Several vulnerabilities and mechanisms may increase the risk of comorbidity after trauma.

The Mutual Maintenance Model

Chronic pain and PTSD maintain and enhance each other through 7 pathways, says this model. Attentional and reasoning biases toward potentially threatening stimuli and catastrophizing may lead to heightened expectations, overestimations, and negative interpretations of pain- and fear-evoking stimuli.

Pain can trigger dread, PTSD, and hyperarousal, and vice versa. Avoidant coping methods, depressive symptoms, and weariness may lead to deconditioning, inactivity, and impairment, inhibiting fear extinction. PTSD anxiety can affect pain perception. Both diseases are characterized by cognitive overload, which limits coping abilities.

Dysfunctional cognitions, intrusive symptoms, hyperarousal, avoidance, and inaction fuel each other. The paradigm proposes that hyperarousal can cause or aggravate discomfort, leading to fear-avoidance and inactivity.

Fear-learning deficits and reduced capacity to suppress fear in PTSD may contribute to increased pain perception, pain sensitivity, and fear responses to painful stimuli, according to Jenewein and colleagues.

This notion draws on classical fear conditioning theory, which says fear-learning deficits over-associate pain cues and inhibit adaptive safety learning. Incorrect interpretations of symptoms can reinforce and catastrophize. Anxiety-related stress can also cause discomfort.

Pain Sensitivity and PTSD

Experimental investigations indicate increased, decreased, and unaffected pain perception with PTSD.

Distinct pain profiles may be linked to different PTSD symptoms and coping techniques. Hyperarousal is linked to greater pain perception in PTSD, but detachment decreases it. Trauma type may also alter how PTSD affects pain sensitization. Accident-related PTSD was associated with lower pain thresholds than combat-related PTSD.

Dissociation and derealization have different coping techniques. Dissociation reduces conscious attention to physical sensations and incoming stimuli like pain, but worry and frightened evaluations may increase attention to painful stimuli and lower pain threshold.

Accident-related trauma seems to cause an apprehensive and sensitizing reaction, while combat-related trauma may cause a dissociative and habituative response. Experimental investigations can identify variations in pain processing, but subjective pain reporting indicates a more severe symptom profile when PTSD and pain persist.

Complex molecular causes include the hypothalamic-pituitary-adrenal axis, inflammation, immune system suppression, and weariness.

Complex interpersonal traumas, such as physical and mental abuse from war or sexual assault, can harm the ability to trust others, resulting in attachment concerns that increase the likelihood of long-term misery.

Possible Interventions for Managing Chronic Pain

These comorbid cases require biopsychosocial interventions. Few randomized controlled studies target comorbid PTSD and pain, making it difficult to propose therapy. Although each ailment has evidence-based therapies & chronic pain treatment, it’s still debatable whether they should be treated sequentially, in parallel, or with an integrated intervention.

If a sequential method is chosen, which disorder should be treated first? First, treat the primary disorder. Untreated disorders can worsen each other, and it’s not always clear which is main, especially if they occurred simultaneously.

Parallel approaches provide complications. Collaboration and treatment planning might be tough with multiple physicians. Each disorder’s specialists must ensure the patient can afford both therapies. An integrated intervention may solve some of these obstacles, but there are no clear standards.

Evidence suggests using cognitive behavior therapy (CBT) to treat PTSD and chronic pain. However, not all sizes fit.

Consider the trauma’s intricacy. Accident-related trauma (in which the primary symptoms may be musculoskeletal pain with elevated levels of arousal, catastrophizing, and pain-related fear avoidance beliefs) may be treated with psychologically informed physiotherapy or cognitive behavioral therapy focused on pain management and exposure to feared activities.

Physiotherapist-led stress inoculation training mixed with physiotherapeutic exercise has been found to reduce pain-related impairment compared to exercises alone. Complex interpersonal traumas or chronic pain and PTSD that have endured for years may require specialized treatment for both. First, recognize the co-occurrence of pain and PTSD and examine both illnesses.

Comorbid conditions might further complicate pain and PTSD assessment and therapy. Many studies on PTSD and pain are undertaken in military samples, who are at heightened risk of traumatic brain injuries (TBI). Some accidents exhibit this pattern. Some studies demonstrate that veterans with TBI and PTSD experience higher pain than those with either condition alone.

Despite TBI, chronic pain and PTSD are linked to suicide and aggressive thoughts in veterans. While this trio is understudied, narrative reviews and therapy reflections exist.


We hope this post has shed light on the intricacy of chronic pain and PTSD and inspired some readers to learn more for the benefit of patients. While visiting patients with chronic pain or PTSD, physicians should be cautious of symptom overlap when screening for PTSD in chronic pain.

Treatment strategy requires knowing the nature of the traumatic experience. If pain and PTSD are related to the same traumatic incident, integrated or parallel treatment may be appropriate. Complex PTSD owing to interpersonal trauma or events years ago may require trauma-focused care.


For more information on chronic pain management, pain disorders, chronic pain resources, psychogenic pain, effective chronic pain treatment options or other physical therapy, you should book a consultation session with a specialist at Chronic Therapy today, to give you professional advice that will suit your personal experience.

Also, for people with chronic pain who are constantly worried on how to treat chronic pain or get their chronic pain treated, our specialist at Chronic Therapy have made huge success over the year in recommending reliable resources to manage chronic pain from nerve pain or any other developing chronic pain conditions.

Related: Relieving Chronic Pain Without Drugs

Relieving Chronic Pain Without Drugs

Relieving Chronic Pain Without Drugs

Many people dislike taking pain pills routinely. Many pain relievers aren’t pills. Vioxx only came out in 1999, but arthritis, menstrual cramps, post-surgery pain, and other aches and pains have been there far longer.

This article discusses a few common options. Many additional pain alleviation methods exist. Still, it’d be wise to consult your doctor before adopting pain relief methods. Even nonpharmaceutical interventions might be unsafe or ineffective. Your medical condition and history must be examined before therapy.

No resources are the best chronic pain treatment. Not all pain is relieved and everyone’s different. You may need to mix many pain-relieving treatments before getting relief. There are dangers and adverse effects with any medication.

Physical Therapy Relieves Pain

Physical therapists teach self-management, according to the APTA. Therapists help arthritis patients manage daily discomfort. They teach clients how to build strength, enhance range of motion, and prevent arthritic flare-ups.

Physical therapy isn’t a cure-all. Many sees immune-modulating medications as a first choice for treating severe rheumatoid arthritis, which can chop 10 to 15 years off life.

Untreated edema might aggravate osteoarthritis in people. Physical therapy reduces inflammation to a certain amount, but medicine makes the most dramatic alterations, adds Wilson.

First, find out if your health plan covers physical therapist appointments. Next, find a state-licensed professional. Find a therapist experienced with your illness.

Acupuncture for Chronic Pain Relief

Ancient acupuncture uses needles to relieve pain. Acupuncture began in ancient China. Traditional acupuncture involves piercing the skin in precise spots to increase energy flow. Western experts assume the practice may encourage the release of pain-relieving or healing hormones.

The NIH has financed acupuncture studies on arthritis, inflammation, and chronic pain. Until studies can specify how acupuncture relieves pain, doctors like Wilson say patient faith is key.

It can work for everyone, but it will work for those who believe in it. Many therapy procedures are effective because patients believe in them. People who don’t think they’ll get better are less likely to recover.

Relieving Chronic Pain Without Drugs

Acupuncture isn’t suggested for persons on blood thinners or with bleeding disorders. Infection, organ puncture, mild bleeding, and broken or forgotten needles are risks of the operation.

Stress Management is an Excellent Pain Reliever

The fact is, the brain rules pain. You can’t have pain without a brain to comprehend it. This organ helps people interpret unpleasant sensations and assess their severity. Psychological factors can alter how people perceive stimuli, react to them, and interact with their reality.

Stress worsens pain perception. Tensed muscles can irritate already fragile tissues when people are upset. Emotionally, pressure may intensify pain. Emotional arousal or tension may make them see their situation as more difficult and make them avoid particular activities.

Experts suggest changing the stressor to reduce pressure. If you always argue with your partner, try communicating instead. If you can’t change the cause of anxiety, distract yourself with friends, a movie, or music. Pleasure can distract from suffering.

Unwinding is another method. Deep breathing, PMR, meditation, visualization, massage, yoga, and Tai Chi are relaxation techniques. These methods work. Some people find stress alleviation by attending support groups or seeking individual counseling.

Generally, these stress-management tactics work. Not everyone can use every technique. People have different approaches. Going to support groups reduces pain and improves physical and emotional functioning, for example. A person who won’t talk about their illness isn’t suited for a support group.

Relieving Chronic Pain Without Drugs

Exercise to Reduce Pain

Because movement hurts, many in pain avoid exercising. Inactivity may worsen their health. That is because the human body was created to be in motion. Thus, an inactive body degenerate.

Muscle degeneration can cause bone loss, melancholy, and heart weakness. Regular exercise keeps joints flexible and strong, reducing arthritic discomfort. Physical activity releases mood-enhancing hormones that reduce pain perception.

Arthritis patients should do three exercises. Flexibility workouts increase range of motion through stretches. Walking, water exercises, and cycling are cardio workouts. Strength conditioning uses isometric or isotonic exercises.

Isometric exercises utilize resistance without joint movement. By pressing your hands on the wall, you work out your chest muscle. Isotonic workouts involve entire motion. Bicep curls and leg extensions are included.

For less discomfort and fewer injuries, use proper form. Not everyone should exercise. There are always alternative workout possibilities. Consult your doctor and a fitness professional before starting a program.

Improve Your Diet to Fight Pain

Losing weight may lessen pain risk. If you’re overweight and deconditioned, your joints take a tremendous impact. Regular exercise and a healthy diet are proven weight loss measures.

Underweight, poor food, and inactivity might worsen discomfort. In that state, your hormone levels are off. Hormones assist the body fight pains and activate its healing processes.

Experts opine that pain-relief vegetarianism is unnecessary. Rather, they recommend minimizing animal protein and saturated fat and eating more omega-3s, antioxidants, vitamins, and minerals from healthy grains and organic foods. Steroid hormones and preservatives may suppress the immune system.

Pain-Relieving Supplements

Chondroitin sulfate and glucosamine may reduce osteoarthritis pain. Long-term safety and effectiveness need more study.

Headache, motor unease, exhilaration, hives, rash, photosensitivity, hair loss, and breathing difficulty are unusual side effects of chondroitin. People with bleeding disorders or taking blood thinners should not use the supplement.

Glucosamine causes upset stomach, tiredness, sleeplessness, headache, skin responses, and sun sensitivity. Some glucosamine products are produced with shellfish, which can trigger allergic reactions.

Bio-Electric Therapy

Bioelectric therapy may help arthritic patients. People with chronic muscle pains benefit from bioelectric therapy, noting that others with joint inflammation, such as rheumatoid arthritis, may not.

Bioelectric therapy uses electric current to distract the brain from pain. The therapy overloads the brain with feelings to distract from pain.

Bioelectric therapy may cause discomfort and redness. This technique isn’t indicated for persons with pacemakers, pregnancies, blood clots in the arms and legs, or bacterial infections.

A Completely Healthy lifestyle

Your doctor may recommend combining nonmedical and medical treatments. Don’t dismiss drugs. Pain relief should not only relieve discomfort, but also keep you alive and healthy.

Eating well, sleeping enough, exercising, and controlling stress are the easiest ways to relieve pain. Pain treatment is just healthy living, we suffer if we don’t live and pay attention. 


For more information on chronic pain management, pain disorders, chronic pain resources, psychogenic pain, effective chronic pain treatment options or other physical therapy, you should book a consultation session with a specialist at Chronic Therapy today, to give you professional advice that will suit your personal experience.

Also, for people with chronic pain who are constantly worried on how to treat chronic pain or get their chronic pain treated, our specialist at Chronic Therapy have made huge success over the year in recommending reliable resources to manage chronic pain from nerve pain or any other developing chronic pain conditions.

More to read: Chronic Pain and PTSD