Relationship between medical (chronic pain) and psychiatric (ptsd)

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Hope4Now

MyPTSD Pro
I am starting this thread because I have been suffering for years now with chronic pain and fatigue issues as well as symptoms of PTSD and dissociation.

I am utterly exhausted by years of trying pretty much all the suggested interventions available for chronic pain and fatigue. My efforts have covered the full spectrum from the conservative (e.g., diet, medication, cognitive-behavior therapy, exercise) to the mainstream alternative (e.g., acupuncture, massage, various body-training techniques such as Alexander), to the more far-out alternative (e.g. various types of energy work, crystals, shamanic healing, etc.).

I am utterly exhausted by four years of psychological and psychiatric interventions. I have been blessed by my luck in working with some good people who know their stuff about trauma and dissociation. I've engaged in really good somatically-based psychotherapy along with the newish addition of EMDR twice per week, and I have an additional weekly visit to a psychiatrist who is...well...trying to help in lots of different ways.

I feel forever caught in a conflicting cycle...in order to help heal my symptoms of pain and fatigue, I have to work on reducing stress. Which means of course (for me), working on trauma processing via connecting my mind and body and releasing what is stuck. Which means, of course, more stress because trauma processing is really, really stressful even when it is done in the gentlest of ways with a kind and trustworthy person. Which means of course as I work on trauma processing, my symptoms of chronic pain and fatigue continue. And so on.

In the meantime, I've lost most of what looked like my life prior to the wild explosion of symptoms. It all just adds up to a f-load of physical and emotional suffering, in spite of my work on radical acceptance and trying (for reasonable lengths of time) just about everything that has been suggested to me.

I. am. really. tired.
My.body.hurts.
My.emotional heart.is.in.shreds.

I would value some discussion on how people with similar issues cope. Not so much on what strategies to try (seriously, I think I have tried everything, and there are some other threads that cover some of this), but more like how do you get yourself through your suffering? How do you find balance between acceptance and fighting?

It seems to me that it is impossible to find a healthcare practitioner of any "flavor" who deeply understands the complexity of the relationship between "medical issues" such as chronic pain and chronic fatigue, and "psychiatric issues" such as PTSD and dissociative disorders. Western medicine continues to separate out issues of mind and body, and those of us who suffer symptoms from both are left to our own devices and best judgments to sort out what to do to help ourselves. It is an overwhelming and exhausting process that I've been working on for years.

Recently, in a last ditch effort to retain my private disability benefits, I had to make an argument that my fibromyalgia/central pain syndrome symptoms are equally or more disabling than my PTSD and DID symptoms. Because...this company limits mental health disability benefits to two years, but not medical disability benefits. Sigh.

Anyway, I started researching again and have been learning a lot of stuff along the way. The other day, I found a really, really good review of research about chronic pain that was published in 2012. It takes a long time before research filters down into the real everyday world, but I thought I'd share a link to the article for anyone brave enough to read scientific/medical writing.

For those who'd rather not wade through it, the takeaways (at least for me), were:
1. all kinds of chronic pain and fatigue issues that are called different things by doctors in different disciplines (e.g., fibromyalgia, TMJ, myofascial pain syndrome, etc.) are linked together by their core generating "spot"--the central nervous system--and ought to all be looked at as a kind of central nervous system syndrome, no matter where the symptoms appear in the body.

2. these syndromes are likely 50% genetically passed down, with the other 50% being the environmental triggers that activate the genes. Among these environmental triggers are stress and trauma.

3. there is a significantly higher percentage of psychiatric disorders present in people who suffer from these central nervous system issues than there are in the rest of the population...BUT this does NOT mean there is a causal effect. The research shows that the medical issues like chronic pain are clearly separable from psychiatric disorders, even though both generally overlap in the central nervous system. So...for all of us who have been told that our physical pain (somatic pain and other symptoms) are caused by our psychiatric disorders...well--that is wrong. There is overlap, but the disorders are different.

4. The medications offered out for sufferers of chronic pain are only effective in about 1/3 of patients. The only thing they know for certain about medications and chronic pain is that any medications considered opiods are not only NOT effective for chronic pain sufferers, but can exacerbate the problems. And other interventions like joint replacements or injections and such are usually not effective either because they are targeting a specific area of pain (like the spine) when really all or at least some of the pain is being generated through the central nervous system/brain.

Here's the link: Central pain mechanisms in chronic pain states – maybe it is all in their head
 
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She Cat

Policy Enforcement
I raise my hand, as I am one of those in the chronic pain, PTSD group. I too feel exactly how you feel, with no relief in sight.

Fibromyalgia
Osteoarthritis
Meralgia Parastetica
Carpel Tunnel
Buldging disc
Facet disease

To name a few..... so YES, I understand how you feel as do many here.
 

Hope4Now

MyPTSD Pro
And...one more quick post to my own thread...

I have an acquaintance via facebook who claims she has recovered from fibromyalgia and chronic fatigue and many other disabling symptoms after six months of taking a supplement developed by Dr. Herbert Nagasawa from University of Minnesota. The supplement apparently contains ribociene which is a substance that allows our bodies to create glutathione.

I am always suspicious of and judicious about adding unregulated supplements to my regime. I have learned to heavily research "miracle cures" for chronic pain such as the frenzy about guaifenesin (which remains very questionable and requires a LOT of focus and energy to implement) This ribociene/glutathione thing, however, has caught my attention. Has anyone had good experiences with it?
 

Hope4Now

MyPTSD Pro
Hi @She Cat, thanks for responding. I know there are lots of us out there, but it really helps to hear/talk directly!

It is so hard to sort out the pain stuff--what is pain caused by damage to nerves or tissues or bones etc. versus what is pain caused by the screwy disruptions in the central nervous system...that is things like fibromyalgia where our brains aren't processing pain properly.

How do you cope?
 

Tornadic Thoughts

MyPTSD Pro
Totally changing my consumption habits, both inside and out, helps me a great deal, but it hasn't erased all of the pain, by any means, and I don't think it ever will at this point. It enabled me to lose over 100 lbs. of excess weight, which helped a great deal since I can actually do things like exercise now, as well as more comfortably getting in and out of the bath tub to soak away many aches.

I'm no longer ingesting things that create a build-up of toxins and energies from the inside out, breathing the things I was breathing causing disruption in many of my systems, marinating and "cleaning" myself in and with things that I couldn't pronounce and were harming me, nor do I still have the same highly stressful job, the offspring have since moved out on their own, I have the hubby here everyday to help when needed, and we now live in a place surrounded by nature vs. a concrete jungle and a bunch of people.

Additionally, I have a whole village of several of those far-out alternative practitioners who are willing to barter in order to help me through their various methods. I feel better now than I ever have, but still feel like shit many days. I try to re-frame my thoughts as they arrive about my attempts at wellness being a fight or a battle to it simply being a labor of love. The love part being rather foreign to me as I was never really nurtured lovingly nor taught how to love myself. It helps some days, other days, not so much. If I were to lose any of the pieces of my current wellness puzzle, I'm not sure which direction I'd go from there.

Not sure what else to offer other than a nod of recognition and to say that I feel your pain.
 

bird_on_a_wire

MyPTSD Pro
Really really well said @Hope4Now .

Please forgive me, I can't express myself well atm (likely a psychological symptom or consequence of an emotional blow more accurately), but JMHO and you've summarized it well, I think much of what is deemed 'mental' illness is very much created or influenced physically, +/ or neurochemically. I think we all recognize the chicken-or-egg syndrome, eg the body reacts the anxiety ramps up with the cognitive meaning we attach; managing physical pain the body depletes of energy for everything, including managing stress. Even people with undiagnosed heart issues and cancer start to act uncharacteristically; anything that depletes oxygen affects us physically and cognitively; sleep, which is designed to help us process as well as rest- Rem and Non-Rem (when it comes) is often fraught with terrors or 'replays', and is insufficient. Etc.

I know you said you've probably tried everything- I believe it. For pain and chronic conditions I must keep moving or I cannot. And fast metabolisms process pain medication far too quickly.

Our body can naturally produce opiods- or for that matter, T-fighting cells, in the presence of what we can cognitively call 'safety', peace, security, enjoyment, fun, relief, comfort, laughter, support, etc, and anywhere we can 'reset' our nervous system, such as nature or peaceful places. And much more.

@Dr.Knowbuddy posted a thread & lecture somewhere about these 2 guys with ptsd that made a program called something like 'Rock to Recovery' (Rock-Music-Water), for veterans where the conventional modalities fell short or did not work. It involves coaching too , also getting a focus- something to live for I think (?, the only time radical acceptance is joyful, I think), and recognizing things like the element of shock is the key start to ptsd, but then to realize (by facing and exploring ones past ) that setting up anxiety and the past- especially childhood- trauma bears on it as well. Versus those with single-incident caused ptsd for whuch the usual modalities work better. And they said the longer untreated and un-addressed the poorer the statistical outcome or more difficult to overcome/ treat.

I'm explaining it poorly, as one guy said there were 5 factors (?) but basically, if we can't talk about or even realize what started the ball rolling therapy won't get to the source. If we can do that, then we have to then learn to look forward, since we 'know' (from shock), or rather 'feel' that these traumas are going to repeat. So we 'drive' watching the rear view mirror and end up in more crashes (than looking forward).

Oh yes, and that we could not de-brief after, so we need to start de-briefing in the present.

It's my experience physical pain is mostly tolerable with movement and meds when emotional pain reduces, or rather what brings us peace or when we are happy, find something to believe in, have a purpose, +/or feel supported or happy.

ETA, they also said we have to be true to ourselves.

I read a day or 2 ago a quote by Dr. Bernie Siegel (and he runs an Exceptional Cancer Patients group so you can imagine the pain, physical, mental and emotional can be immense- most have suffered trauma/ abuse or neglect as children, btw, as well as physical changes and limitations) from a book on how to prevent your own suicide, that love is the bricks and laughter the mortar we build our lives out of, to learn how to live. He also said to be true to ourselves.

:hug:
 
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DharmaGirl

MyPTSD Pro
I have bulging disks at every level, my vertebrae, not disks, but the bones themselves are slipping off each other in 4 places, I have severe facet arthritis all through my entire spine. osteoarthritis of the spine and ankle, and migraines. Oh, and 2 failed back surgeries which is blamed on me. I was asleep during surgery, it was not my fault. My back pain can be amazing, but the more I strengthen my core muscles, the longer I can do things. I have to meditate daily, pace myself, take my meds, eat a non processed food diet and keep up with the amount of exercise I can do. All those things together help control my pain. Help, not eradicate. I decided that since my pain was here to stay, it was a part of my life, and instead of getting myself worked up into believing something could fix it, or there was something wrong they just couldn't find or that my pain was insurmountable, I finally told myself that those things weren't true, and that I had to find a life I could live that was pleasant for me. I had gone to a pain program where the T in charge told us we would always have pain. I cried through the whole hour. That's when I learned about radical acceptance and how I couldn't get better until I accepted that I would always have pain.

I also had to find a life where I could control my PTSD symptoms. I had therapy for 4 years, then on and off until now, trying to find a therapist. I live a very small life, because that's what it takes for me to deal with all my symptoms. I don't stray far from my little homestead in the town, I take time outs during the day if I feel overwhelmed or in pain, by lying on my bed and reading. I joined the library so I would have all the books I could want. I started gardens. That is the back story.

How I cope with PTSD and pain is what I have already said, plus I back off the trauma work when the pain or symptoms are too bad. I become horribly suicidal when I am in bad pain and my PTSD symptoms are off the wall. My PTSD symptoms are always present, but if I get too stressed, I just break down. I continue to go to therapy, but pushing too hard for me doesn't work. I work hard every day on my healing, doing self-care and reframing and looking for cognitive distortions, so backing off in therapy totally makes sense to me and my therapist. I'm lucky I stumbled upon her, she completely gets that your mind is part of your body, not a separate thing. So does my pain doc. My regular doc, not so much. She is afraid of the PTSD stuff, I think.
 

bird_on_a_wire

MyPTSD Pro
Totally relate @DharmaGirl .

Only wanted to add one last thing, I think there is a near-total disconnect, or understanding, in the relay of depth of physical and emotional pain, I find those with the most severe pain +/or illness hide it best and complain the least. In doing so, I don't think others understand the degree. Or rather, most assume were it worse the person would act and express it more, because they couldn't help to do so. But those post-trauma, or especially long-standing +/or from childhood, often have learned to 'suck up' and hide much as possible, in every way and especially publically or to other people. Including especially the pain they're in, chronic or acute. JMHO and experience.
 

DharmaGirl

MyPTSD Pro
It is true. When working ER I have had a person eating Burger King her friend brought her, texting on her phone and chatting, telling me her arm pain was a 9. That makes me want to lower my pain level because she is obviously not a 9/10. I been there, and I've seen it and when you are telling a doc about it and say 9/10 I never think they believe me. People who suck it up are mostly quiet and if you look at them, there is a certain set to their face, a clenching of muscles. I don't know why the docs can't figure this out. But on the other hand, I used to go to a chronic pain group where 6 of the 8 people had 10/10 pain, yet they were laughing and chatting. No, the two are mutually exclusive. By definition, a 10/10 means you are writhing in pain, unable to speak. I don't know, I know there are a lot of people who think they won't be believed, so raise the number up. My mom used to tell me I didn't make enough fuss at the doctors. I never raise my pain number higher than it is, and in public I pretend to be normal. I always hear - but you don't look disabled. I'd like to say that I'm bat shit crazy, but I don't.
 

DharmaGirl

MyPTSD Pro
Ok, the point I started out to make, but got lost, was that for me the worse the PTSD, the worse the pain. Not the behaviors associated with pain, just the pain if you see what I mean. And the worse the pain the worse the PTSD symptoms.
 

Hope4Now

MyPTSD Pro
Wow! Y'all are inspiring!

I try to re-frame my thoughts as they arrive about my attempts at wellness being a fight or a battle to it simply being a labor of love.
This is one of the things I am slowly getting better at. I really like the way you say it, and am going to write it down so I remember. The hard work you do for healing is admirable, and I'm so glad to hear that you have found things that help you!

@search you expressed your thoughts perfectly. Thank you.
Our body can naturally produce opiods- or for that matter, T-fighting cells, in the presence of what we can cognitively call 'safety', peace, security, enjoyment, fun, relief, comfort, laughter, support, etc, and anywhere we can 'reset' our nervous system, such as nature or peaceful places. And much more.
This is so true. So hard to find "places" either inside or out that feel like this.
And they said the longer untreated and un-addressed the poorer the statistical outcome or more difficult to overcome/ treat.
I will look for the thread you mention. Thanks. This bit ^... ugh. I have heard this elsewhere, but have opted for radical hope in the brain's neuroplasticity. My trauma issues go all the way back to pre-natal. And were not diagnosed until a year or so after my physical and mental health did a total implosion around five years ago.
that love is the bricks and laughter the mortar we build our lives out of, to learn how to live. He also said to be true to ourselves.
:) so true.

@DharmaGirl OMG you are traveling a tough path with such courage and resourcefulness.
I decided that since my pain was here to stay, it was a part of my life, and instead of getting myself worked up into believing something could fix it, or there was something wrong they just couldn't find or that my pain was insurmountable, I finally told myself that those things weren't true, and that I had to find a life I could live that was pleasant for me.
Yes, I guess this is radical acceptance. Which sounds like such a nice thing, but is also brutal. I am not there yet. Still convinced I can find a way to get to a better place. But then, I do not have the clearly physically painful issues you have. Sometimes, no often, I do wonder though whether I ought to surrender the hope of recovering from the physical pain and exhaustion. It's harder than it sounds, so I admire you're courage (Someone once told me to surrender. She said "It's a warrior's surrender...you have fought hard and you deserve to rest.") I haven't been able to wrap myself around that one, but it sounds as if you have and probably have to continue to do every day.
I live a very small life, because that's what it takes for me to deal with all my symptoms.
I completely resonate with this. I feel like I make my life smaller and smaller all the time. I think part of the need for this is the issues with the central nervous system that I talked about in my opening post. So much of pain and exhaustion and PTSD symptoms grow from an out-of-whack, hyper-sensitive CNS.
I become horribly suicidal when I am in bad pain and my PTSD symptoms are off the wall.
This is what happens to me too. Perfect storm. It's always getting connected by healthcare people to psychiatric stuff, but often it is the combination that fuels the suicidal fires. I'm glad you are learning how to balance this stuff in your life.
 
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