The Relationship Between Chronic Pain & PTSD

​       Experiencing trauma can prompt some individuals to develop post-traumatic stress disorder (PTSD) and cause a negative long-term effect on an individual’s health and functioning. Some individuals may experience post-traumatic stress symptoms  without meeting the diagnostic criteria of post-traumatic stress disorder. PTSD is a stress-related condition that may occur when an individual experiences serious injury, violence, trauma, or perceived threat (American Psychiatric Association [APA], 2013). These individuals may experience increased physiological arousal, re-experience the situation, avoid places or concepts that remind them of it, or negative thoughts or feelings, such as anger, sadness, or guilt (APA, 2013). Experiencing trauma can also adversely affect the individual's sleep, relationships, ability to function, cause distress, and contribute to other physical and psychological symptoms.

       While previous research observed that many individuals experiencing chronic pain also suffered from depression or anxiety (Banks & Kerns, 1996, as cited in Linnemørken et al., 2020), recent studies began investigating a potential relationship between chronic pain and PTSD. Chronic pain refers to pain occurring most days of the week for over three months (National Center for Health Statistics [NCHS], 2020). Individuals who experience both chronic pain and  PTSD also reported more extreme pain symptoms, difficulties sleeping, distress, increased disability, and fatigue compared to individuals with chronic pain but without PTSD (Akhtar et al., 2019; Linnemørken et al., 2020). 

       Encountering chronic pain can cause additional challenges in managing their post-traumatic stress symptoms; Accomplishing tasks such as attending appointments, picking up medications, or getting out of bed may be more challenging. Chronic pain can negatively affect their ability to function and care for themselves as well as cause distress. Medical professionals need to consider the possibility of clients presenting with PTSD to avoid misinterpreting these behaviors to depression, or avoidance. Selecting a treatment plan that targets  both the patient's chronic pain and PTSD symptoms is essential to improve their quality of life as many of these symptoms can negatively impact the client's capability to adhere to treatment.

       Research with patients receiving treatment for chronic pain at an outpatient pain clinic observed that 20.7% met the diagnostic criteria for PTSD (Linnemørken et al., 2020). However, other research suggests that the percentage of individuals with PTSD and chronic pain may be higher, as it varies across settings and populations (Akhtar et al., 2019).

       Research is still investigating what approach would most effectively target both PTSD symptoms and chronic pain; Some research suggests that a multidisciplinary approach utilizing cognitive behavioral therapy (CBT) techniques may be helpful (Cosio & Demyan, 2021; Kind & Otis, 2019). Cognitive behavioral therapy focuses on replacing negative thoughts, feelings, or behavioral patterns with more productive ones (Kind & Otis, 2019).

       Many individuals with  PTSD and chronic pain comorbidity are more likely to experience pain catastrophizing than individuals who only experience chronic pain (Linnemørken et al., 2020). Pain catastrophizing affects the individual's coping abilities as the individual tends to experience helplessness, assume the worst possible outcome, and prompt distress. Employing a treatment approach that replaces negative thought patterns, such as pain catastrophizing, may have the ability to decrease the patient's distress response to pain and reduce anxiety.

References:

• Akhtar, E., Ballew, A. T., Orr, W. N., Mayorga, A., & Khan, T. W. (2019). The prevalence of post-traumatic stress disorder symptoms in chronic pain patients in a tertiary care setting: A cross-sectional study. Psychosomatics, 60(3), 255–262. https://doi.org/10.1016/j.psym.2018.07.012
• American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
• Cosio, D. & Demyan, A. (2021). Comorbid chronic pain and ptsd: An update on research and treatment. Practical Pain Management – For Clinicians, By Clinicians, 21(6), https://www.practicalpainmanagement.com/treatments/psychological/cognitive-behavioral-therapy/comorbid-chronic-pain-ptsd-update-research-tre 
• Kind, S., & Otis, J. D. (2019). The interaction between chronic pain and ptsd. Current Pain and Headache Reports, 23(12). https://doi.org/10.1007/s11916-019-0828-3 
• Linnemørken, L. T. B., Granan, L.-P., & Reme, S. E. (2020). Prevalence of posttraumatic stress symptoms and associated characteristics among patients with chronic pain conditions in a Norwegian university hospital outpatient pain clinic. Frontiers in Psychology, 11. https://doi.org/10.3389/fpsyg.2020.00749   ​
• National Center for Health Statistics. (2020). Chronic pain and high-impact chronic pain among U.S. adults, 2019 (NCHS Publication No. 390). U.S. Department of Health and Human Services, National Institutes of Health. https://www.cdc.gov/nchs/products/databriefs/db390.htm