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Post Traumatic Stress Disorder and Chronic Pain

  

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The DSM IV defines Post Traumatic Stress Disorder as:

"The essential feature of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate" 

Community-based studies reveal a lifetime prevalence for Posttraumatic Stress Disorder rof up to 14% of the population.  Studies of at-risk individuals (e.g., combat veterans, victims of volcanic eruptions or criminal violence) have yielded prevalence rates ranging from 3% to 58%.

Most of us only associate PTSD with returning veterans or those in combat situations.  However, the fact is that PTSD is associated with many events such as motor vehicle accident, witnessing a disaster, work-related injury, combat-related injury or an assault.  Often these experiences bring about a physical trauma as well due to an injury sustained during the event.  However, it is sometimes deemed difficult to differentiate pain associated with a physical trauma and the psychosomatic pain as a psychological response to the trauma.  In either case, the pain must be addressed immediately by a mental health professional and physical health professional.  In many cases, both doctors will work collaboratively to find an effective treatment plan that can address both the physical and mental concerns.

Pain may surface immediately or may lie dormant for a period of time and then is triggered by something that reminds the victim of the traumatic experience. Determining if a person with injury-related pain has PTSD is very important because research shows that individuals with PTSD who develop chronic pain experience greater difficulty coping with the pain, higher levels of pain and distress, and greater interference of pain in their daily lives.

Also, while chronic pain and PTSD are conditions that may occur together, their relationship to one another is not always obvious and is often overlooked. PTSD can be overlooked because the health care provider, the patient and the family may be focusing on the physical pain. At times, the patient's level of disability may be attributed solely to pain. Because there is such a dichotomous relationship between PTSD and chronic pain, they have been referred to as "mutually maintaining" conditions. This is because the presence of both PTSD and chronic pain can exacerbate the severity of symptoms in either condition.

For example, people with chronic pain may avoid activity because they fear the pain and avoiding activity can lead to physical de-conditioning and greater disability and pain over time. Similarly, people with PTSD may avoid reminders of the trauma. This avoidance of activity can lead to the continuation of PTSD symptoms while also contributing to greater physical disability. People with chronic pain may also focus their attention toward their pain while individuals with PTSD may unknowingly focus on things that remind them of the trauma. Consequently, people with both PTSD and chronic pain may have less time and energy to focus on more adaptive ways of coping with both their pain and fear. Furthermore, people with PTSD often experience symptoms of arousal and tension, which may decrease their tolerance for handling pain and increase their perception of pain.

There are many symptoms of PTSD, but some of the most common include:

• The person may begin to re-experience the event with reoccurring dreams and/or intrusive thoughts or "flashbacks" that can be very stressful.

• The person with PTSD may avoid thoughts, feelings, activities, people and places that remind him or her of the trauma. She or he may even avoid talking about the trauma or steer clear of the site of the accident or incident because it is too upsetting.

• The person may have symptoms of arousal such as having difficulty falling or staying asleep, irritability and anger, difficulty concentrating, an exaggerated response to sudden loud noises or movements, and extreme watchfulness.

It is important to seek some form of medical help if you feel you are suffering or have symptoms of PTSD.  For years, Dr. Richard A. Kaul has been working collaboratively with mental health professionals for patients who were suffering from pain conditions coupled with mental distresses.  Also, he has taken part in a program called Treating The Invisble Wounds of War.  If you or someone you love is suffering from any of these conditions it is important to address it immediately.  We urge you to contact us so that we may begin a course of treatment.