Breaking the cycle of chronic pain and PTSD

If you encounter Chronic pain and Post-traumatic stress disorderYou may find yourself stuck in a cycle of unhelpful thinking and avoidance behaviors that backfire over time.

Research shows that people with chronic pain and PTSD have higher pain sensitivity, greater psychological distress, and greater vulnerability than those with either condition alone (Reed et al., 2021). Too often, care is isolated – physical pain managed by medical providers, psychological pain managed by mental health providers – resulting in the benefits of an integrated approach being lost. The good news: Trauma-informed strategies that address biology, thinking patterns, and avoidance together can lead to real improvements in pain, function, and quality of life.

The intersection of chronic pain and post-traumatic stress disorder

Chronic pain and PTSD are deeply intertwined on both the psychological and brain levels. Abdullah and Jaha (2017) indicate that both conditions:

• Sharing brain circuits: Both involve the limbic system, especially the amygdala, hippocampus, and ventromedial prefrontal cortex, which are essential for learning. memoryAnd emotions.
• Reinforcing negative memories: Both are characterized by recurrence of pain or trauma, which enhances suffering. The brain overgeneralizes, warning us to avoid movement or weakness.
• turn pressure And pain: Each can trigger the other, leading to inflammation, brain changes, avoidance, and increased vulnerability.
• Behavioral patterns: Avoidance, hypervigilance, and catastrophizing are common, making breaking the cycle more difficult.

The thoughts that surround us

Expecting or focusing on the worst is a major risk factor in both chronic pain and PTSD. People with both conditions often feel less in control, more emotionally affected, and accepting Catastrophic thinking More than those who experience pain or PTSD alone (Kind & Otis, 2019).

Common catastrophic thoughts may include:

• Pain equals hurt.
• If the pain is bad, I can’t do anything.
• This is not fair!
• It’s my fault.
• It’s not safe to move.
• My doctors should be able to fix this, they failed me!
• I can’t do what matters unless I’m free of pain.
• When I move and feel pain, I must be hurting myself.
• This will always be unbearable.
• I’m broken.
• There is nothing I can do to reduce the pain.
• I can’t take it anymore!

These thoughts are understandable, but they are not always accurate, and can worsen symptoms.

The body remembers

Trauma is not just a memory, it is an experience in your body. shock Events can leave a lasting mark on how… Nervous system Sensation processes. Sometimes, pain is a symptom of re-experiencing, which is your body’s way of remembering what your mind wants to forget. For some, symptoms such as muscle tension, headaches, or bowel problems are direct echoes of trauma (Kearney & Lanius, 2022).

You may also feel paralyzed and unable to move or act when the pain becomes severe or memories arise. This “freeze” response is common after trauma, and is not a personal failure. Regaining movement, even in simple ways, helps your body know that it is no longer in danger.

Motophobia and avoidance

Many people with chronic pain suffer from a He is afraid Movement (kinesiophobia), the belief that activity will cause harm. This leads to less movement, more weakness, more pain, and more disability – a vicious cycle. Avoiding movement actually increases pain and disability over time.

Likewise, PTSD often leads to avoidance of certain places, people, or situations, for fear that they may cause distress or danger. This shrinks your world, and increases anxietyAnd it reinforces the feeling that you are not safe. Avoiding reminders of the trauma strengthens the fear and keeps the symptoms alive.

Harm versus pain: rethinking communication

• damage: Actual tissue damage (such as a broken bone or traumatic event), often accompanied by pain signals.
• pain: An unpleasant sensory and/or emotional experience that can indicate harm or a reminder of harm (as in the case of chronic pain or PTSD).

With chronic pain and PTSD, your body’s alarm system remains on high alert and sends pain signals even when there is no ongoing injury (Kind & Otis, 2019). Chronic pain says that pain means damage. PTSD says that fear means danger. Learning to distinguish between pain and hurt, fear and danger, is the key to reclaiming your life. Openness to movement and low-risk experiences is called active coping.

The power of active adaptation

People who use active coping activities, seek support, confront reminders of trauma that are not actually serious, and challenge unhelpful thoughts, recover faster and feel less pain (Kind & Otis, 2019). Pace setting is important: break tasks into manageable, time-based chunks with breaks; If the pain increases, dial it down. If the pain is fairly stable, see if you can gently increase it over time. Gentle movement (walking, stretching, yoga) combined with smooth, slow breathing and self-compassion can help retrain your body and mind.

Speed ​​is similar to exposure work in the treatment of PTSD. Facing the safe experiences you’ve been avoiding, little by little, helps you reclaim your life. Over time, your body and mind can learn to distinguish between danger and harm when fear does not indicate real danger and pain does not indicate real harm.

Thoughts that relieve pain

You don’t have to get rid of unhelpful thoughts, just notice them and remind yourself of what is useful and true. tries:

• This pain will pass.
• Pain isn’t always a sign of harm, sometimes my body is just afraid.
• I can handle 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, security, trust, joy, and connection.
• I can find a pace that works for me to take care of myself and maintain my health.

Reflection questions

• What are your most common thoughts related to pain? Thoughts related to PTSD?
• Can you notice the subtle body sensations that come with triggers of pain or trauma?
• Are there activities you avoid because of pain? What could happen if you tried a little too safe?
• If chronic pain and PTSD weren’t a factor, what would you want to do?

Support for both chronic pain and PTSD

If you suffer from chronic pain and PTSD, you don’t have to deal with this alone. Find a provider who understands the mind-body connection and can help you integrate your care. Find someone who is willing to collaborate with other providers and support you as a whole person. Integrated, trauma-informed care is not only possible, it is an essential step toward reclaiming your life.