Breaking the cycle of chronic pain and PTSD

If you experience chronic pain and PTSDyou may find yourself stuck in a loop of unhelpful thinking and avoidance behavior that backfires over time.

Research shows that people with both chronic pain and PTSD have greater pain sensitivity, greater psychological distress, and greater disability than those with either condition alone (Reed et al., 2021). Often, care is siled, with physical pain managed by medical providers and psychological pain managed by mental health providers, eliminating the benefits of an integrated approach. Good news. Trauma-informed strategies that address biology, thought patterns, and avoidance can lead to real improvements in pain, function, and quality of life.

Overlap between chronic pain and PTSD

Chronic pain and PTSD are deeply intertwined at both a psychological and brain level. Abdallah and Geha (2017) state the following for both conditions:

• Share brain circuits: Both involve the limbic system, particularly the amygdala, hippocampus, and ventromedial prefrontal cortex, which are central to learning. memoryand emotions.
• Strengthen negative memories: Both are characterized by reenacting pain and trauma and intensifying suffering. The brain overgeneralizes and warns you to avoid movement and vulnerability.
• cycle of stress And the pain: Each can trigger the other, leading to inflammation, brain changes, avoidance, and increased vulnerability.
• Behavioral pattern: Avoidance, hypervigilance, and destructive behaviors are common and the cycle becomes difficult to break.

Thoughts that seize us

Expecting the worst or focusing on the worst are major risk factors for both chronic pain and PTSD. People with both conditions often feel less in control, are more emotionally affected, and receptive to assertiveness. destructive thoughts more than those with only pain or PTSD (Kind & Otis, 2019).

Common catastrophic thoughts include:

• Pain equals harm.
• I can’t do anything when the pain is so bad.
• That’s not fair!
• That’s my fault.
• It’s not safe to move.
• My doctors should be able to resolve this – they’re ruining me!
• Without pain, you can only do the important things.
• If it hurts when you move, you must be hurting yourself.
• This will always be intolerable.
• I’m broken.
• There’s nothing I can do to alleviate the pain.
• I can’t stand it anymore!

While these ideas are understandable, they are not necessarily accurate. It may also make your symptoms worse.

my body remembers

Trauma is not just a memory, it is an experience in your body. traumatic Events can leave a lasting mark on the way you nervous system Process your senses. In some cases, pain is a re-experiencing of symptoms as the body remembers something the mind wants to forget. For some people, symptoms such as muscle tension, headaches, and intestinal problems are direct echoes of trauma (Kearney & Lanius, 2022).

Also, when the pain flares up or memories surface, the body may become paralyzed and unable to move or act. This “freeze” reaction is often seen after trauma, not personal failure. Restoring movement, even in small ways, helps the body learn that it is no longer in danger.

Kinesiophobia and avoidance

Many people with chronic pain develop symptoms such as: fear Kinesiophobia (kinesiophobia), the belief that an activity will cause harm. This creates a vicious cycle of decreased movement, increased weakness, increased pain, and greater disability. Avoiding movement actually increases pain and disability over time.

Similarly, PTSD often causes a person to avoid certain places, people, or situations for fear of causing pain or danger. This will shrink and expand your world anxietythe feeling of not being safe is reinforced. Avoiding reminders of the trauma reinforces the fear and perpetuates symptoms.

Harm and pain: Rethinking relationships

• harm: Actual tissue damage (such as a fracture or traumatic event). It is often accompanied by pain signals.
• pain: Unpleasant sensory and/or emotional experiences that may signal or remind of harm (such as in chronic pain or PTSD).

With chronic pain and PTSD, the body’s alarm system is on high alert and continues to send out pain signals even in the absence of an ongoing injury (Kind & Otis, 2019). They say chronic pain means pain. PTSD says fear means danger. Learning to distinguish between pain and harm, fear and danger is the key to getting your life back. Opening yourself up to low-risk moves and experiences is called active coping.

The power of proactive coping

People who use active coping (pacing activities, seeking support, confronting traumatic memories that are not actually dangerous, challenging unhelpful thoughts) recover faster and experience less pain (Kind & Otis, 2019). Pacing is important. Divide tasks into manageable time-based chunks with breaks in between. If the pain increases, reduce the pain. If the pain is fairly stable, check to see if it gradually increases over time. Gentle movement (walking, stretching, yoga) with smooth, slow breathing and self-compassion can help retrain your body and mind.

Pacing is similar to exposure work in PTSD treatment. By gradually confronting the safe experiences you’ve been avoiding, you can take back your life. Over time, your body and mind can learn to tell the difference between danger and harm and when fear does not indicate real danger or pain does not indicate real harm.

Ideas to reduce pain

There is no need to get rid of unhelpful thoughts. Just notice them and remember what is helpful and true. try:

• This pain flare-up will go away.
• Pain is not always a sign of harm. Sometimes my body is just scared.
• I can endure this moment.
• I’ve been through it before. I can do it again.
• I can reclaim activities, relationships, and places where I can build comfort, safety, trust, joy, and connection.
• You can find a pace that works for you to take care of yourself and stay healthy.

reflection questions

• What are the most common thoughts related to pain? PTSD related thoughts?
• Can you notice the exact physical sensations associated with pain or trauma triggers?
• Are there any activities you avoid because of pain? What if you safely tried a little?
• If chronic pain and PTSD weren’t the cause, what would you do?

Supports both chronic pain and PTSD

If you are experiencing both chronic pain and PTSD, you don’t have to deal with it alone. Find a health care provider who understands the mind-body connection and can help integrate your care. Work with other providers to find someone who can support you as a whole. Integrated trauma-informed care is not only possible, but a critical step in getting your life back.