What about chronic pain and post-traumatic stress?

Chronic pain and post-traumatic stress disorder (PTSD) often negatively influence each other. For instance, when pain is directly related to a traumatic event, each pain episode can trigger a flare-up of PTSD symptoms by acting as a reminder of the trauma. Shared characteristics of these two conditions can also intensify one another. Sleep is frequently disturbed in chronic pain and almost always in PTSD.

Both conditions contribute to social isolation and reduced activity levels, often as a way to avoid pain or trauma-related triggers. This avoidance can worsen depressive symptoms. Many patients report that the symptoms of one condition tend to amplify the other. In other words, a bad day in terms of pain often comes with an increase in PTSD symptoms—and vice versa.

Studies show that individuals suffering from both chronic pain and PTSD often report more severe pain than those dealing with chronic pain alone. These two conditions also share a tendency to heighten internal bodily awareness, such as sensations of pain or anxiety. As a result, patients with both conditions tend to experience more severe symptoms and heightened reactivity.

Treating these comorbid conditions is a major challenge. Close coordination between pain specialists and PTSD specialists is essential to ensure a coherent and well-balanced treatment approach. Evidence-based physical rehabilitation and psychological therapies can be demanding for patients. Therefore, it is crucial to plan treatments carefully to avoid conflicting approaches (e.g., trauma-focused psychotherapy alongside intensive physical rehabilitation) and to prevent overwhelming the patient.

If pain acts as a trigger for traumatic memories, it may be beneficial to introduce trauma-focused psychotherapy early on. This could help reduce episodes of re-experiencing and, in turn, support better management of the pain component later. In terms of pharmacotherapy, close collaboration is also required. Since PTSD is often associated with substance use disorders, the use of opioids should be approached with caution.