PTSD is an anxiety disorder that can develop after experiencing or witnessing a terrifying event involving actual or threatened death or serious injury. While often associated with combat, assault, or major disasters, PTSD can absolutely arise from medical or physical trauma, such as:
Traumatic Injuries: Severe accidents (car crashes, falls, workplace injuries) that cause significant physical harm and ongoing pain. The event itself is terrifying, life-threatening, and results in lasting physical consequences. Mine started with my fall that broke my ankle, and was followed up 11 months later when I was waiting at a red light and a city transit bus plowed right into the back of me at full speed, sending the back end of my SUV into the air. That impact violently jolted me and caused severe whiplash and tearing of the muscles in my neck, as well as it triggered my CRPS to become worse. Way worse.
Difficult Medical Procedures/Diagnoses: Invasive surgeries (especially emergency or those with complications), traumatic births, frightening diagnoses (like cancer or debilitating neurological conditions), or prolonged, painful treatments can be deeply traumatizing. The feeling of helplessness, fear, intense pain, and loss of bodily control during these events can trigger PTSD.
Medical Gaslighting or Neglect: Experiences where pain or symptoms were dismissed, disbelieved, or inadequately treated by healthcare professionals can be profoundly invalidating and traumatizing, leading to feelings of betrayal and helplessness.
The Chronic Pain Itself: For some, the relentless, inescapable nature of severe chronic pain can become a trauma in itself. The constant bodily betrayal, the loss of function, the fear of pain flares – this ongoing internal threat can mimic the conditions that cause PTSD. I’m so glad that the chronic pain community is acknowledging this very thing because I’ve been saying it for years.
The connection between trauma, PTSD, and chronic pain isn't just psychological; it's deeply rooted in our neurobiology:
Shared Neural Pathways: The brain regions involved in processing fear, threat, and memory (like the amygdala, hippocampus, and prefrontal cortex) are also involved in processing pain. Trauma can dysregulate these systems, making the individual more sensitive to pain signals and heightening their fear response. This most definitely impacts me. I feel like I’m always on high alert for “something”, “anything” that could hurt my legs. My whole system is ready for this danger.
The Stress Response System (HPA Axis): Trauma activates the body's stress response (the Hypothalamic-Pituitary-Adrenal axis), flooding the system with hormones like cortisol. Chronic activation or dysregulation of this system, common in both PTSD and chronic pain, can lead to inflammation, increased pain sensitivity, fatigue, and sleep disturbances.
Central Sensitization: Both chronic pain and PTSD can involve central sensitization. This means the central nervous system (brain and spinal cord) becomes hypersensitive and operates on high alert. This is what I struggle with on an immense level. Pain signals are amplified, and even non-painful stimuli might be perceived as painful, such as the touch and temperature sensitivities I have. Similarly, in PTSD, the threat detection system is overly sensitive. I’m always looking for that danger.
Inflammation: Chronic stress and trauma responses can increase systemic inflammation, which is a known contributor to chronic pain conditions (like arthritis, fibromyalgia) and can worsen existing pain.
Fear-Avoidance Cycle: The fear associated with the trauma (e.g., fear of re-injury, fear of medical settings) can overlap with the fear of pain itself. This leads to avoiding activities, movement, or treatments that might cause pain or trigger traumatic memories, ultimately leading to deconditioning, increased disability, social isolation, and paradoxically, often more pain and distress. This is a really hard way to manage your chronic pain. I too have been there, many many times, and it wasn’t until last year that I began to see tangible progress in myself as I worked on facing those very real fears to me.
When PTSD and chronic pain coexist, they create a vicious cycle, each condition exacerbating the other:
Amplified Pain Perception: PTSD symptoms like hypervigilance can make individuals acutely aware of bodily sensations, often interpreting them negatively and amplifying the perception of pain. This is something I am working on. Just light touches and bumps, things that happen every day, cause excruciating pain, and me to suppress my distress from that slight contact so as not to look like a crazy person for losing it over something so minor.
Increased Emotional Distress: PTSD brings anxiety, depression, panic, irritability, and emotional numbness, layering profound psychological suffering on top of physical pain.
Intrusive Memories and Flashbacks: Pain sensations, medical appointments, specific movements, sounds, or even smells related to the original trauma can trigger intrusive memories or flashbacks, causing intense distress and physical reactions (like increased heart rate or muscle tension, which worsens pain). This is also something that I am working on. I have a lot of distressing and negative intrusive thoughts as well as flashbacks of certain painful and distressing medical procedures and treatments I had to go through and endure. Sometimes it’s like I am right back into that room, being “tested” and I break down and become physically and mentally distressed while images and sensations of the procedure are flashed on and felt on repeat in my brain. I remember every detail of some of those appointments as if they were yesterday, and they are very difficult to manage.
Hypervigilance and Startle Response: Living in a constant state of "high alert" is exhausting and contributes to muscle tension, fatigue, and heightened pain.
Avoidance Behaviors: Avoiding triggers (people, places, activities, medical care) limits life drastically, hindering rehabilitation, social connection, and enjoyment. This can lead to profound isolation, and I’m here to tell you it does. You don’t want it to, but it does. There are many things I could do before my nervous breakdown that I am unable to do anymore due to being so severely triggered.
Sleep Disturbances: Nightmares, insomnia, and difficulty relaxing due to pain or anxiety are common in both conditions, leading to fatigue that worsens both pain and PTSD symptoms. I used to have this recurring dream that I was kidnapped and being tortured in various hideous ways that represent the severity of the pain I was feeling. I never did finish the dream…no one comes to rescue me, I just wake up and that’s where it ends, each time I dream this.
Difficulty with Treatment: Fear and mistrust of medical systems or procedures can make sufferers hesitant to seek or adhere to necessary pain management or physical therapy. PTSD symptoms can interfere with the ability to engage in therapies like Cognitive Behavioral Therapy (CBT) for pain. In my experience, not to sound dramatic, but PTSD pretty much plays a part in every minute detail of my life, whether I like it or not, and I’ll admit, I don’t know how to fix that.
Loss of Self and Hope: The combined weight of chronic pain and PTSD can erode a person's sense of identity, purpose, and hope for the future, leading to feelings of being broken, trapped, and fundamentally changed by their experiences. I’ve learned that losing your sense of self, and giving up on having hope, just makes the pain that much worse, but it can also lead to the realization that making positive life changes in your physical and mental health can be achieved and you can reinvent yourself and re-emerge as the person you want to be, warts and all.
Addressing co-occurring PTSD and chronic pain requires an integrated approach that acknowledges both conditions. Healing is possible, though it often requires patience and professional support. Both patience and support are vital to the healing process.
Integrated Professional Help:
Trauma-Informed Care: Seek healthcare providers (doctors, therapists, physiotherapists) who understand the connection between trauma and chronic pain.
Mental Health Therapy: Evidence-based therapies for PTSD are crucial. These may include:
Eye Movement Desensitization and Reprocessing (EMDR): Helps process traumatic memories.
Cognitive Processing Therapy (CPT) / Prolonged Exposure (PE): Address trauma-related thoughts and avoidance.
Acceptance and Commitment Therapy (ACT): Focuses on acceptance, mindfulness, and value-based living despite pain and difficult memories.
Somatic Experiencing: Focuses on releasing traumatic shock from the body.
Trauma-Informed Cognitive Behavioral Therapy (CBT): Can help manage both pain coping and trauma responses.
Pain Management: Work with pain specialists who understand the role of the nervous system and psychological factors. This may involve medication (used cautiously), interventional procedures, and physical therapy. I cannot stress this enough…get a referral to an actual pain specialist if that is possible. Most doctors are not equipped to manage effective care for their chronic pain patients, and are hesitant to prescribe anything and that impacts that pain warrior. You need someone who will be knowledgeable in chronic pain treatments and someone willing to prescribe much needed medications that a regular doctor would not prescribe.
Trauma-Informed Physical Therapy: Physiotherapists knowledgeable about trauma can help patients reconnect with their bodies safely, manage fear of movement, and gradually increase activity levels without triggering overwhelming distress (often involves pacing).
Coping Skills and Self-Management:
Mindfulness and Grounding: Practices like meditation, deep breathing, and grounding techniques (focusing on the five senses) can help regulate the nervous system, manage anxiety, and reduce the intensity of both pain and flashbacks. I use these techniques proactively to maintain my mindfulness and feeling grounded.
Pacing: Learning to balance activity and rest to avoid the boom-bust cycle that can exacerbate both pain and PTSD symptoms. This is something that is so important, and is something that requires ongoing maintenance, as conditions change. Learning to adapt is key.
Trigger Identification and Management: Recognizing what triggers PTSD symptoms or pain flares allows for proactive coping strategies. Unfortunately I have a long list, but I do what I can to manage the best I can.
Gentle Movement: Engaging in gentle, mindful movement (like Tai Chi, Qigong, gentle yoga, swimming) can help reduce pain, improve mood, and rebuild trust in one's body when done safely and within tolerance levels.
Self-Compassion: Acknowledging the immense difficulty of the situation and treating oneself with kindness rather than judgment is vital for healing. This is something that most pain warriors I know agree with but struggle with.
Journaling/Creative Expression: Processing thoughts and emotions through writing, art, or music can be therapeutic. Journaling literally saved me and is something I urge everyone to do. Find a journaling style that works and run with it.
Building a Support Network: Connecting with understanding friends, family, or support groups can combat isolation. This is made easier by most people’s access to the internet. Having that support, from someone who lives with the pain just like you, is something that everyone needs to have. That unspoken understanding makes such a difference.
Supporting someone navigating this complex challenge requires empathy, patience, and understanding:
Listen and Validate: Believe their experience. Avoid minimizing their pain or trauma ("It could be worse," "Just try to be positive"). Simply listening without judgment is powerful. Validate that their struggle is real and incredibly difficult. We need to be able to share without someone who hasn’t been where we are jumping in with toxic positivity.
Educate Yourself: Learn about both chronic pain and PTSD. Understanding the conditions helps you offer more meaningful support. I also advise getting a workbook on PTSD and working your way through it. When you are done, you will have built some really good coping skills.
Offer Practical Help: Chronic pain and PTSD are exhausting. Offer specific, practical help like driving to appointments, helping with chores, bringing a meal, or just being present. Don’t wait for the pain warrior to ask, offer and follow through. As pain warriors, we are often too embarrassed to ask for help, and feel stupid for needing to ask, so please, don’t put it all on the pain warrior to ask, offer something concrete and specific that you can help with on a regular basis.
Be Patient: Healing takes time, and there will be good days and bad days. Avoid pressure or expressing frustration if progress seems slow. I admit that with all the work I do on my mental health, I wish I had made more progress by now, but that thought isn’t helpful, so I try to remind myself of the huge amount of progress I have made.
Respect Boundaries: Understand that they may need to cancel plans or avoid certain situations due to pain or triggers.
Supporting someone with PTSD’s complex "double trauma" involves empathy, patience, and understanding. Listening and validating their experience, educating oneself about the conditions, and offering practical help, are essential ways to provide meaningful support. Ultimately, with the right professional help, a support system and learning coping strategies, individuals can navigate this complex situation and work towards healing and a better quality of life.