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.
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, 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