Chronic Pain and PSTD

Living with Pain: PTSD and Chronic Pain National Pain Report — 06 January 2013 By Mark Maginn, Columnist Over the last decade we have seen and heard about the horrors of people living with unimaginable pain and disability. We’ve watched as research after research presents us with conflicting ideas on what pain is and how to treat it. But there is one aspect of pain and its treatment that has barely caught our attention: Post-Traumatic Stress Disorder (PTSD). We hear about PTSD in soldiers returning from war, but it can occur when anyone experiences a traumatic event or sees someone killed or injured. Often they fear being killed or injured themselves, and they are overwhelmed by helplessness and fear. Between 20 to 35 percent of people who survive a traumatic event will develop PTSD. People with chronic pain often have symptoms very similar to those with PTSD. We suffer from anxiety, depression or flashbacks of the medical procedures we endured to reduce our pain. We’re often moody, withdrawn, explosively angry or unaccountably sad. We appear hyper-vigilant and always on guard. We may have recurring nightmares and/or suffer from sleeplessness. Our sexuality lies in tatters and relationships with partners, family and friends deteriorates as we isolate ourselves to cut down the stimuli that can send us over the edge. We may watch TV all day and often sit staring into space. We sometimes become violent with family or friends and often have a higher risk of suicide. Often we turn to alcohol and drugs. Our families watch in dismay as the person with pain gradually becomes unrecognizable. Loved ones may feel punishing guilt for not being able to do more to save someone or come to their aid. It’s also widely recognized that pain is also present in those diagnosed with PTSD. Facing a combination of chronic pain, depression and PTSD, physicians are faced with a difficult diagnosis and confusing treatment options. This disorder often appears in spouses and children of pain patients who gradually become hyper vigilant about the patient’s health. Family members can feel helpless, angry, withdrawn, anxious and sleepless. It isn’t uncommon for the patient or family members to develop suicidal ideation. They too can turn to drugs and alcohol to dull the pain. PTSD in children living with a parent in pain can develop behavior problems at home and in school. Kids may withdraw from friends and previously enjoyable hobbies. Like adults, they can develop sleep and digestive problems, as well as anxiety disguised as hyper vigilance. They may also isolate themselves by disappearing into videogames and television. Nightmares and fears of leaving the house may ensue. Truly, chronic pain is a family disease. People suffering trauma and PTSD often re-evaluate their identities, values and beliefs. They may also rethink their relationships with family and friends. Under this duress, they may make sudden rash decisions that can have a major impact on themselves and others. This can be seen in the prevalence of disrupted relationships and divorce. Not all physicians are aware of or trained in the diagnosis and treatment of patients suffering from PTSD. An assessment of stress and PTSD should be required when they evaluate a patient suffering from chronic pain. Without this assessment the presence of undiagnosed PTSD can be a huge complication – leading to more pain and inadequate treatment. We as pain patients need to educate ourselves about PTSD. A useful discussion of the connection between PTSD and chronic pain can be found here. It’s imperative that we look as closely as we can at our feelings and behavior, those of our caregivers and families, and discuss what we know with our physicians. PTSD is most often treated with cognitive and psychodynamic psychotherapy. Individual, couples, family and group therapy are good treatments options. It is also treated with psychotropic medicine, hypnosis and with eye movement desensitization Reprocessing (EMDR) which shows promise in treating the symptoms of PTSD. In choosing a therapist we should ask the them how many cases of PTSD they have treated, what treatment they use and their success rate. Don’t be shy in asking the therapist questions. When I was practicing I welcomed these questions as they were appropriate and often indicated a knowledgeable and motivated client. If after reading this you or a family member suspects the presence PTSD, it is a good idea to learn as much about it as possible. Good therapists can be found through the National Association of Social Workers, the American Psychological Association and the American Medical Association

Chronic Pain Syndrome

Chronic pain can feel like slow torture, making it difficult for you to go to work, exercise, or even take a shower and dress yourself.

If your pain is out of control, it can also take an emotional toll on you, undermining your self-esteem and coloring your outlook.
Sometimes pain evolves into a poorly understood condition known as chronic pain syndrome. Unlike acute pain, this condition doesn't go away after your initial injury or illness has healed. It's marked by pain that lasts longer than six months and is often accompanied by anger and depression, anxiety, loss of sexual desire, and disability.
Chronic pain syndrome may occur along with conditions that involve long-term pain, including certain cancers, stroke, fibromyalgia, chronic fatigue syndrome, endometriosis, and inflammatory bowel disease. Experts don't yet understand how or even if these conditions are related.
Contrary to some opinion, research suggests that psychological problems alone are not behind chronic pain syndrome. Rather, the syndrome appears to be linked to abnormalities in the interaction between certain glands – the hypothalamus, pituitary, and adrenal glands – and the nervous system, known as a type of stress axis. The abnormalities seen in this stress axis, which controls our reactions to stress, injury, and trauma, may explain why certain people experience pain differently.
Studies have also found that people who suffer from chronic pain have abnormally low levels of endorphins in their spinal fluid. Endorphins are chemicals in the body that help to naturally control pain.

Symptoms of chronic pain syndrome

Symptoms vary from person to person, but may include any or a combination of:

• Low back pain
• Headaches
• Joint pain
• Muscle aches
• Burning or tingling pain in different parts of the body
• Jolts of sharp pain

Treating chronic pain syndrome

Medications aren't the only way to manage chronic pain, and they typically don't work when used alone. In most cases, you can better manage chronic pain syndrome with a combination of different therapies to reduce both pain and stress.
These are possible treatment options:

• Behavior modification, such as cognitive behavioral therapy
• Acupuncture
• Psychotherapy
• Biofeedback
• Hypnosis
• Occupational therapy
• Physical therapy
• Relaxation techniques, such as meditation, visual imagery, or deep breathing
• Medications to help control pain, such as anti-inflammatory drugs, antidepressants, anticonvulsants, and opioids
• Nerve blocks
• Surgery to treat any underlying conditions

 

Lifestyle changes and chronic pain

Lifestyle changes are often used to ease chronic pain, as well as physical and mental health problems that may come with it. Managing stress, for example, may help control your pain by improving your mood.
These are other ideas:

• Get regular, low-impact exercise, such as walking, cycling, swimming, or yoga.
• Get plenty of sleep on a consistent schedule.
• Avoid napping during the day.
• Quit smoking, if you smoke.

Getting up and moving around is one of the most important things you can do because not moving can result in additional pain and disability.
Although treatment and lifestyle changes can help reduce pain and allow you to resume many of your daily activities, these therapies often can't rid you of pain entirely. Working with your doctor to determine the appropriate treatment plan can help get your pain to a level that is bearable.