Hey guys! I am starting a new series on the blog called “Let’s Talk About Mental Health”. Chronic pain and mental health are so deeply interconnected, it would be crazy for me to not talk about mental health. I am going to focus specifically on mental health conditions that are known to exacerbate chronic pain. These include post-traumatic stress disorder, anxiety, and depression. I believe that having a better understanding of mental health can help us better understand how to treat and manage chronic pain. Keep searching for answers and hang onto hope!

Post-Traumatic Stress Disorder (PTSD)

What is PTSD?

• PTSD can be defined as a disorder that develops in some people who have experienced a shocking, scary, or dangerous event (NIH, 2023)

• People can develop different reactions after traumatic events and some people develop long-lasting side effects.

• PTSD can develop at any age. Examples of events that can lead to PTSD include but are not limited to, physical or sexual assault, abuse, accidents, assaults, disasters, and other serious events.

• A person can develop PTSD if they learn that a close friend or family member has experienced trauma.

• According to the National Center for PTSD, 6 out of every 100 people will develop PTSD at some point in their lives (NIH, 2023). Another study estimated that 3.9% of people worldwide experience PTSD (Hori et al., 2019)

• Some people are more susceptible to developing PTSD due to environmental and/or genetic factors. Women are more likely than men to develop PTSD.

Symptoms and Diagnosis

• Four categories of symptoms: intrusion, avoidance, alterations in cognition and mood, alterations in arousal and reactivity (Taylor-Desir, 2022)

• Intrusion: involuntary memories, distressing dreams, flashbacks of traumatic event

• Avoidance: this involves avoiding reminders of the traumatic event. This can include people, places, activities, objects, and situations that may trigger distressing memories. They may also try to avoid thinking about or talking about the event.

• Alterations in cognition and mood: inability to remember parts of the traumatic event, negative thoughts or feelings about oneself and/or others; ongoing fear, horror, anger, guilt, or shame; feeling detached from others

• Alterations in arousal and reactivity: irritable and having angry outbursts, behaving in a self-destructive way, problems concentrating or sleeping (Taylor-Desir, 2022)

• Risk factors:

• Being exposed to previous traumatic events, feeling extreme fear, having little or no social support after an event, personal or family history of mental illness or substance abuse (NIH, 2023)

PTSD and Inflammation

• Individuals with PTSD have significantly higher levels of inflammation in their body (Hori et al., 2019)

• There are alterations in the immune and inflammatory systems

• Increased rates of physical comorbidities such as metabolic syndrome, atherosclerotic cardiovascular disease, and autoimmune diseases (Hori et al., 2019)

• This suggests that inflammation may be involved in the development and maintenance of PTSD

• More research is needed on the correlation between PTSD and inflammation

• In the future treatment strategies may involve the use of anti-inflammatory drugs (Hori et al., 2019)

Treatments

• Manualized trauma-focused therapies are the first line of treatment for PTSD (Schrader et al., 2021)

• These include Prolonged Exposure (PE), Eye Movement Desensitization and Reprocessing, Cognitive Processing Therapy

• These therapies have demonstrated a reduction of PTSD symptoms with 12-16 weekly sessions

• Cognitive behavioral therapy for PTSD, narrative exposure therapy, and written exposure therapy have also been effective 

• Using a manual to guide therapy has been shown to improve outcomes by enhancing adherence, attendance, and symptom reduction. It creates a structured approach.

• Individual therapy is more effective than group therapy

• Recommended medications for PTSD include:

• Fluoxetine, paroxetine, sertraline, and venlafaxine (Schrader et al., 2021)

Sources

Hori, H., & Kim, Y. (2019). Inflammation and post-traumatic stress disorder. Psychiatry and clinical neurosciences, 73(4), 143–153. https://doi.org/10.1111/pcn.12820

Schrader C, Ross A. A Review of PTSD and Current Treatment Strategies. Mo Med. 2021;118(6):546-551.

Taylor-Desir, M. (2022, November). What is posttraumatic stress disorder (PTSD)?. Psychiatry.org – What is Posttraumatic Stress Disorder (PTSD)? https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

U.S. Department of Health and Human Services. (2023). Post-traumatic stress disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd