Trauma, Addiction and Chronic Pain
Stress is considered a consequence of a failure to respond appropriately to physical or emotional threats, whether actual or imagined. It has been recognized for a number of years that chronic stress plays an important role in both addiction and chronic pain. Much of the research related to chronic stress has focused Posttraumatic Stress Disorder (PTSD). PTSD may occur as a result of a single or multiple traumatic events. Children who suffered abuse at a young age may have poor trauma recall. The condition leads to avoidance of situations or thoughts that provoke painful memories or emotions, and by “hyperarousal”—a state of increased psychological and physiological tension that can cause reduced pain tolerance, anxiety, exaggerated startle responses, and insomnia.
The association of addiction with PTSD is well documented, with studies reporting PTSD in 25-50% of patients receiving addiction treatment. Individuals who suffered childhood physical or sexual abuse are at significantly increased risk for developing chronic pain. When patients are being treated for chronic pain, PTSD may be overlooked because physicians, patients, and the families may focus on the physical problems such as disc bulges on a MRI overlooking psychological factors. PTSD significantly increases disability, worsens the pain experience, interferes with efforts to restore function, and increases the likelihood of opioid dependence in patients treated with these medications.
Although medications (e.g. Paxil) are used to treat PTSD, the clinical evidence supporting their effectiveness is weak. According to the most recent treatment guidelines, psychological interventions are first line treatments. These include trauma-focused cognitive behavioral therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR).
Although research is limited, many believe that complementary
treatments such as yoga meditation and massage therapy help relieve
stress, reduce pain and promote recovery. Often, low back pain
attributed to arthritis or disc disease is caused by spasm of muscles
with low back attachments. Some trauma specialists theorize that our
fear instinct causes spasm of the psoas muscle, and have developed
“trauma recovery”
protocols involving massage and exercises.
Screening Questionnaires Have been developed to assess whether patients might be suffering from symptoms of trauma or PTSD.
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