Why Stress And Pain
Stress-related psychiatric disorders, including depression and posttraumatic stress disorder , are highly prevalent disabling illnesses with limited treatment options and poorly understood pathophysiology. Chronic pain is a widespread pathology afflicting 20%30% of adults. Moreover, while treatment options are available, chronic pain continues to seriously affect the life quality of patients, and almost half of pain suffering individuals do not achieve adequate pain management. Better understanding of the overlapping and distinguishing features of chronic stress and pain could provide greater insight into the neurobiology of these processes, as well as contribute to rational drug development for these often comorbid conditions. In the current brief review, we describe the commonalities and differences of stress and pain, while primarily focusing on the maladaptive processes of chronic pain and chronic stress.
Learning And Neural Remodeling In Chronic Stress And Chronic Pain
The hippocampus is active during acute stress, but rarely seen active during acute pain in humans. An intact hippocampus is important during acquisition of fear conditioning and association of context with stimuli that necessitates decision-making such as finding food or avoiding pain. In addition, the hippocampus contributes to contextual fear extinction., It contains glucocorticoid receptors, projects to the hypothalamus, and is thought to down-regulate the response to stress., Neurogenesis persists in the adult mammalian hippocampus and contributes to learning and memory. In humans, chronic pain and stress-related psychiatric disorders have been associated with shrinkage of the hippocampal volume.,,, Vachon-Presseau et al. demonstrated that hippocampal volume is inversely correlated to elevated basal cortisol levels in CBP patients but not in matched healthy control arguing for a stress model of chronic pain centered on the hippocampus. Interestingly, smaller hippocampal volume predicts the risk of persistence of back pain after three years of a new episode of sub-acute back pain , and is present in individuals at risk for PTSD and depression.,
How Ptsd Treatment Cured My Back Pain And More On The Mind
I was diagnosed with osteoporosis in my early twenties. Why were my young bones already losing tissue? Women who struggle with anorexia nervosa, like me at the time, are at a higher risk of developing the disease.
I also believe that my eating disorder may have contributed to my sluggish thyroid. Many people dont realize that malnutrition in patients with eating disorders can lead to abnormal thyroid function.
An eating disorder is a serious, life-threatening mental illness that directly impacts every part of your body, from the hair on your head to the tips of your toes, and everything in between. After all, an eating disorder impacts eating, and, truly, we are what we eat.
Some additional physical effects of eating disordered behaviors are listed below.
Also Check: Which Eating Disorder Is The Most Common
The Following Are Just A Few Of The Physical Problems Associated With Ptsd:
- Musculoskeletal problems like chronic pain
- Gastrointestinal issues like bloating, heartburn, indigestion, gas, acid reflux and other irritable bowel problems
- Cardiovascular problems
- Compromised immune function
When I entered a treatment program for PTSD, I was surprised that, like me, every single patient suffered from back pain. Our group even began informal research, as wed ask each new person who admitted, Do you have back pain, too?
According to one study, the National Center for PTSD reports that 51% of patients with chronic low back pain also have PTSD symptoms.
The National Center for PTSD also shares that approximately 15% to 35% of patients with chronic pain have concurrent PTSD. Interestingly, only 2% of people who dont have chronic pain have PTSD.
For some with PTSD, chronic pain is a direct result of their trauma . Here, the pain can serve as a reminder of the traumatic event, which can understandably exacerbate PTSD.
The Link Between Mind And Body
We know that our mind and body are connected. They can influence each other in many ways. We also know that stress and pain create a cycle, perpetuating one another. There are many ways in which stress worsens pain, including causing tense muscles and increasing inflammation. Trauma and unresolved emotional issues cause stress, so therefore contribute to the pain and stress cycle.
This means that when we experience trauma which takes its toll on us emotionally, it can also have physical effects. This doesnt make our chronic pain any less valid or mean that its all in our head as stigma so often dictates. All pain is created by our brains. Chronic pain is just as valid as acute pain or any other physical health condition.
Also Check: Brief Psychotic Disorder Vs Schizophreniform
Can A Car Accident Cause Ptsd
After a car wreck, the emotional impact can be just as bad as the physical injuriesor worse. Unfortunately, many car accident victims struggle with undiagnosed and untreated post-traumatic stress disorder . Below, we explain how to identify PTSD, its impact on your claims, and how Crosley Law Firm helps PTSD victims recover from a car or truck crash.
Iv Ketamine: Effective For Pain Adjunctive To Psychotherapy
Researchers observed that the patient showed noticeable improvements, with a decrease in subjective pain by 50%, as well as a significant decrease in PTSD Checklist Scorefrom 74 to 25 which the patient achieved by day 3 of her hospital stay.1 The patient was no longer oxygen dependent, and after 2 years, has maintained these results.
Ketamine has long been regarded as a viable therapy for longterm pain relief of CRPS patients,1 but other studies also have found that ketamine transfusion provided rapid reduction of symptom severity for PTSD patients and significant changes in 24-hour depressive symptom severity.2
According to Dr. Keizer, the combination of a careful ketamine transfusion and evidence-based psychotherapy could be a modality for patients suffering from both CRPS and PTSD. Exposure therapy long has been considered the gold standard of psychotherapy for patients struggling with PTSD.15
The effectiveness of exposure therapy for PTSD depends in part on the patients ability to recall and subsequently extinguish over time the most feared event or events by recalling and processing the trauma, Dr. Keizer explained.
Theoretically, an evidence based PTSD psychotherapy program with a patient on ketamine would set the conditions for enhanced modification of core maladaptive fears underlying PTSD and fear/avoidance thoughts and behaviors that sustain both PTSD and chronic pain, Dr. Keizer told Practical Pain Management.
Don’t Miss: Side Effects Of Prestiq
Anxiety And Pain Perception
Aside from methodology, it is important to recognize that anxiety concerning pain may play a salient role in these associations. Those who develop anxiety about their pain may experience higher levels of subjective pain which may subsequently influence post-trauma symptoms. explored these associations in a study of 301 burn patients who were evaluated shortly following physical injury and at 8-week intervals for up to 1 year. Longitudinal analyses indicated that peri-traumatic anxiety and dissociation, pain-related anxiety, and gender emerged as significant predictors of PTSD severity at 1-year. No objective indicator of physical injury severity predicted 1-year trauma symptoms. This report suggests interesting possibilities about the dynamic between PTSD and pain perception. Clearly, this topic merits further exploration, particularly in light of the counter-intuitive findings that individuals with PTSD report attenuated pain perceptions in laboratory paradigms.
How Is Psychological Trauma Linked To Chronic Pain
This article takes a look at the link between trauma and chronic pain. Discussion of types of trauma and the effects of trauma are included: please read with care if you are vulnerable.
Ann-Marie D’arcy-Sharpe& nbsp& nbspAuthorMarch 21, 2020
The research available indicates that while trauma may not directly cause chronic pain, it certainly makes people more vulnerable to developing chronic pain. There are many studies which link chronic pain to trauma. The Institute for Chronic Pain states that up to 90% of women with fibromyalgia and up to 60% of patients with arthritis report trauma at some stage in their lives. As a point of comparison, people with chronic pain typically have at least double the rate of previous trauma as compared to the general population. The US Department of Veterans Affairs explains that 15% to 35% of patients with chronic pain also have Post Traumatic Stress Disorder .
Lets explore why emotional trauma is so deeply linked to chronic pain, and what we can do about it.
Also Check: What Is The Phobia Of Throwing Up
The Neurobiology Of Stress And Pain
The brain plays a central role in stress and pain processes.,, As individuals interact with their environment, physical and psychological stressors can lead to adaptive or maladaptive neural and hormonal responses. Acute stress triggers the activation of the hypothalamic-pituitary-adrenal axis leading to the release of adrenal glucocorticoids. These hormones have receptors concentrated in the limbic brain including the hypothalamus, amygdala, hippocampus, and prefrontal cortex ., In the limbic system, glucocorticoids act as transcription factors and have therefore long-lasting effects on cellular function. Acute stress also activates the autonomic nervous system regulated by the brainstem, leading to increased blood pressure and diversion of blood from the gastrointestinal tract to the brain and muscles. In addition, perceived stress is integrated in the limbic brain with past experiences , current physiological state , and decision-making. Subsequently, emotional states are updated accordingly with an ultimate effect on behavior . The limbic brain and HPA axis form an interconnected loop as projections from the hippocampus, amygdala, and PFC feed-back to the hypothalamus and regulate the stress responses and glucocorticoid release . Other brain areas have been also shown to be active during acute stress such as the insula and striatum.
The Path To Ptsd And Its Classifications
The VA describes the spectrum of conditions that may lead to PTSD as starting with an inciting traumatic event, which then leads to an acute stress reaction . This reaction may disappear within days or potentially hours. If not resolved, however, clinically significant impairment symptoms may lead to acute stress disorder , described as symptoms experienced 48 hours to one month following the traumatic event. 13,14
People with ASD commonly report sleeping problems, pain, and other somatic issues. ASD has been shown to be a strong predictor of PTSD.13,14
PTSD is recognized when clinically significant symptoms, causing major impairments in occupational, social, and other critical areas of functioning, persist past one month of the traumatic event. More specifically:
- Acute PTSD is recognized as symptoms lasting greater than one month, but less than 3 months after the traumatic event.
- Chronic PTSD is recognized as clinically significant symptoms lasting more than three months after trauma exposure. It is widely recognized that chronic PTSD commonly needs effective treatment to improve symptomatology.
- Lastly, PTSD with delayed onset is recognized as the onset of clinically significant symptoms at least six months after trauma exposure.13
In this article, we consider PTSD collectively and will not differentiate proposed treatments based on various classifications of post-traumatic stress disorder.
Don’t Miss: Can High Blood Sugar Cause Anxiety
You May Experience A Chronic Illness
Its also common for people with PTSD to isolate themselves, engage in far less physical activity and soothe themselves with food and alcohol, said Amit Etkin, professor of psychiatry and behavioral sciences at Stanford University and an investigator at the Palo Alto VA. As a result of these behaviors, they may become overweight or obese, have metabolic disturbances or develop diabetes and other chronic illnesses.
It can age your body tremendously quickly, Etkin said.
Exercise tends to play a huge role in how people feel, so if a person exercises less as a component of PTSD, this can lead to a negative cycle thats hard to break away from.
The less you exercise, the more itll exacerbate your illness and the more it will reinforce the tendency of patients with PTSD to isolate, Etkin said, adding that he often advises patients to force themselves to engage in physical activity. Even if that means just walking around somewhere.
Cardiac issues are a risk, too.
You struggle sleeping
People with PTSD may experience sleep apnea or have difficulty maintaining a healthy sleep schedule.
Insomnia often comes just from the state of anxiety and distress that somebody with PTSD, also somebody with depression, might be experiencing, Etkin said.
Ptsd And Pain Frequency
Studies show that pain is one of the most common physical problems reported by people with PTSD. This finding holds true no matter what types of traumatic events they experiencedfor example, a motor vehicle accident, physical assault, or combat injury. People with PTSD are also more likely to report pain-related disability.
- In one study of volunteer firefighters with PTSD, approximately 50% were having pain compared with only about 20% of firefighters without PTSD.
- In two other studies, from 20% to 30% of patients with PTSD had frequent and chronic pain symptoms.
You can also look at this situation in reverse. Many patients with chronic pain problems also have PTSD. In fact, from 10 percent to 50 percent of people getting treatment for chronic pain have PTSD as well. These rates of PTSD are higher than those found in the general population.
Recommended Reading: How Long Do Depressive Episodes Last Bipolar
What Can Healthcare Providers Do
Healthcare providers can increase the chances of improved health outcomes for their patients by following these steps:
- Identify behavioral health professionals in the healthcare system or community who work with patients who have PTSD
- Screen for trauma
- Discuss the results openly with your patient
- Provide a referral when appropriate
- Provide educational materials
Change Over Time In Ptsd And Pain Following Trauma Producing Physical Injury
Although the co-morbidity of PTSD and chronic pain is well recognized, only recently has research explored the course of these two conditions over time. One of the earliest efforts followed patients who sought care at a hospital emergency service following a motor vehicle accident . Individuals were assessed initially and again at three and twelve months afterwards. At three and twelve months, 7% reported difficulty in physical recovery. At the three month assessment, 23% reported PTSD at diagnostic severity on the PTSD Symptom Scale â Self Report , which reduced to 17% at 1 year post-MVA. Self-report of physical recovery at 1 year was significantly predicted by PTSD at the 3-month assessment. Considering psychological recovery at 1 year, the severity of physical injury and on-going health problems emerged as significant predictors of PTSD. A similar report sampled more severely injured hospital inpatients . Approximately 23% of survivors had a probable diagnosis of PTSD 12 months after their hospitalization based on structured interviews. A number of factors were associated with PTSD, including greater post-trauma levels of physical pain as well as greater physical pain at 3-months post-trauma. Importantly, the trajectory of physical pain complaints appeared to parallel post-trauma symptomatology.
Recommended Reading: Celine Dion Anorexia
You Worry About The Future Too
Typically, intrusive PTSD memories and triggers are about events that happened in your past but are now over. When your chronic illness and triggers are ongoing, however, your intrusive thoughts may be both past and future-oriented , El-Gabalawy said. One study found that 81% of intrusive thoughts associated with illness-induced PTSD were related to fears about the progression of their condition.
All of the trauma symptoms I experience have their root cause in the fact the threat of mortality is still present, ongoing or may return, wrote Mighty contributor Colin Justin. My intrusive thoughts and fears dont focus on past trauma at all but instead consist mainly of fears about the future. So, if you feel in a panic but arent particularly troubled by memories of what has already happened to you, youre in good company.
Why Do Insurance Companies Deny Car Crash Ptsd Claims
Insurance adjusters are skeptical of PTSD injury claims. They unfairly argue that PTSD is always exaggerated to maximize a personal injury claimand victims will miraculously improve after a settlement. This argument isnt just unfair, its also contrary to clinical studies on PTSD and car accidents.
In one multi-year study, researchers followed a group of 171 accident survivors. Just over half of the victims filed a lawsuit.
- Three years after their car crashes, there was almost no difference in the frequency of PTSD and psychological injuries in the two groups.
- After six years, approximately 85% of the victims had settled their lawsuits, but they did not show any dramatic improvement in their PTSD, chronic pain, or other symptoms.
Based on this study and others, researchers believe that there isnt evidence of widespread fraud in PTSD accident claims.
However, insurance companies dont always care about facts and data. If they can find inconsistencies or problems in your medical records, or if you have a preexisting mental health issue, the adjuster will probably deny your claim.
Recommended Reading: Mary Kate And Ashley Eating Disorders
When Chronic Pain Leads To Post
Whenever I have to schedule a doctor appointment, I cry. When you have chronic illness, you rarely call to schedule a check-up. Most of the time, something is wrong. And most of the time, youre at the doctor so often that any check-up duties happen right on schedule because youre there anyway.
I used to think that I was afraid of some new diagnosis, or that Id need another unexpected surgery. I used to think maybe it had something to do with my fear of needles. But in my own mind, those were pretty weak excuses. They were very real issues, but they didnt instill fear in me to think about. Not like phoning the doctor did.
Whenever I call, its because something has gotten worse, or I have a new symptom. After the call, I tend to get worse and worse leading up to the appointment. Again, I pinned all this on some kind of phobia I must have and just dont realize. It wasnt until the other day when I read a tweet about chronic pain and post-traumatic stress disorder that my reaction began to make sense to me.
Ive heard a lot about PTSD but never considered I might have it. I thought people who see war or abuse get PTSD, and my happy little existence didnt seem to be in the same ranks. The only horrible thing that ever happened to me was getting sick. Illness, pain, hospitals, and surgery are daily parts of my life. They seem so. common. Not traumatic, and everyday things cant be traumatic. Can they?