Today, we’re going to talk about something a bit different, but relevant–it’s been front and center in my life this month. PTSD and its connection to chronic pain, as well as my (very recent) experiences in treating both.
One aspect of PTSD-related pain should be pretty easy to understand–the trauma itself can cause pain, Surviving combat leaves a body scarred. Physical abuse can break bones, and so on. These things are obvious, and usually to an extent, treatable. What I’m more concerned about is how trauma and stress actually affect the nervous system. The very action of vigilance puts the body in an excited, non-stable state, (‘amping up’ for survival.) But after fight or flight has passed, we are left with tense muscles, a rapid heart rate, sick stomachs, and god knows what hormonal imbalances. This article succinctly states concerning PTSD: “these diagnostic criteria are primarily psychological. Nothing is mentioned about the body: the chronic pain, muscle tension, movement limitations, outbursts of energy followed by listlessness, not to mention consequent illnesses of the cellular pathways in the neuromuscular, digestive, cardiovascular, hormonal, and immune system.”
The same article talks about how pain, as a symptom (or an ailment in itself) is often ignored in mental health patients. I have very limited experience in this from a medical practitioner standpoint–as an EMT I’m not necessarily required to ‘get to the bottom of the pain’ but that is truly a good summary for most doctor visits. Pain has to come from somewhere, and in the case of a mental illness, whether it’s depression or anxiety or PTSD or whatever–the answer always defaults to “you aren’t mentally well.” We’re led to believe and think, even as providers, that if a mental patient can just fix their brain with the right therapy or pills or religion or whatever, then bam, the pain will go away. It’s just the nature of medical deduction and problem solving, but it is unfortunate, because the chronic pain can be dismissed as “in your head.” That delays treatment, which worsens symptoms….you get the idea.
I personally don’t remember life before chronic pain, but I also don’t remember life before chronic trauma and abuse. As many probably do, I thought as an adult that it was normal to be in pain constantly. I forget who it was, probably a chiropractor, who told me at some point that pain is not normal, and constant pain is really not normal for an 18 year old. Cue massages and adjustments and workouts and painkillers and years of treating something that I didn’t even really understand.
But everything always fell short. I would be hurting hours at most after that relaxing massage, or injure myself again and again no matter what weight and reps I cut down to. I accepted that my body was broken and hated me and moved through it, years of debilitating pain that has likely contributed to episodes of depression and lethargy. Even when I had energy, I would pay for it later with twice the amount of pain after something fun like hiking or biking.
After understanding that I had post-traumatic stress and seeking treatment for it, I began to understand more about how the body actually works during stress and wondered if that was part of this fog of painful exhaustion. My current therapy sessions include some somatic awareness–in other words, while talking of a trauma or an emotion, either I will notice or my therapist will point out that I have pain or stiffness in a certain body part. I actually tense up and bristle when certain triggers are even insinuated. The pain that comes from tensing your neck and shoulders hours at a time cannot be stated enough! The shit hurts.
So I had enough, and went into a physical therapist for evaluation. I didn’t mention PTSD beforehand, just that I had been eating a good 1000mg of ibuprofen a day for ten years, and then we did a bunch of tests–range of motion and all that. After years of hearing “you’re young, you’re strong!” or getting shrugged off by doctors who looked at blood charts and said I was good to go and figure my shit out (paraphrasing here…) I got sat down and told that my pain level was intensely high, and my mobility was low. My muscles were tense and my joints likely ached (you bet your ass they do) and I would receive treatment at “the same level we go for fibromyalgia patients.”
It took a lot to not cry during that visit. The therapist completely validated everything I’d felt my entire life, physically. I got told that I wasn’t crazy. It wasn’t my fault. It wasn’t normal, and I was suffering. After a session I did fess up and told him I had pretty bad PTSD and he wasn’t even fazed. I do feel better since starting, though it’s only been a few weeks. The important thing is that I’m treating pain in addition to PTSD–I don’t know that I’ll ever fully heal, but instead of getting cracked and having every chiropractor scratch their head why I’m tense and broken again 4 hours later, I understand why I need to focus on my mind and body.