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

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Everything folks are saying here is so interesting to me. I have "returned" to investigating the physical underpinnings of my symptoms found more jackpots. I am beginning to understand better why so many medical/psychiatric/psychological people haven't been more helpful to me (even though I have some good folks with whom I am working). It is extremely complicated, and the lack of understanding is made so much worse by western medicine's continuing inability to see the profound interrelatedness of mind and body--and that these are connected via the central nervous system. When that goes out of whack, for whatever reason, and then gets stuck out of whack, all kinds of problems ensue. And psychological trauma of any sort can get the central nervous system "stuck."

One of my "jackpots" I hit in my reading and research is something called POTS (postural orthostatic tachycardia syndrome). Tah-dah! I may have found the cause of one of my most difficult symptoms...and perhaps the root of the panic attacks which are (for me) exquisitely different from flashbacks or switching parts. I think I never would have even known this was an issue except that I have been wearing a fitbit regularly for a while now, and have been stymied as to why my heart rate is normal/low (in the 60s) when I am lying down, but spikes up over a hundred and sometimes higher when I am standing or even sitting for any period of time beyond 10 or so minutes and l feel physically and mentally exhausted. And panicky. And in pain. And then I feel better after I lie down. This new realization is now pushing me toward trying to find a decent physician who may be able to help me with all these physical symptoms (which I have mistakenly chalked up to my PTSD and DID for so long).


myofascial unwinding.
YES! Thank you for the link! A lot of my PTSD symptoms went haywire when I started doing body work. I have a lot of "memory" stuck in my body.

I have a different relationship to pain than you do.
Yes, I know! I have read about some of these issues and have learned that it stems from similar causes even though that seems counter-intuitive.

some of my pain was hypothyroidism. As soon as I got on the proper dose, which took longer than it should've, the rest of my pain disappeared
I'm so glad you were finally properly diagnosed and that your pain disappeared! I went and had a full workup a while back. I was so disappointed when I found out that my thyroid seemed to be in good working condition. I was hoping it might be the answer for me as it was for you. I have just about every symptom of hypothyroidism, but I went to a specialist go. But I'm so glad you wrote about this on this thread because it is often something that gets missed by doctors.

I never thought too much about the relationship between my CPTSD and my pain/fatigue. I have TMJ
It's worth investigating further. (TMJ is one of the common pain issues related to the nervous system issues as well).

I am also celiac. I very strongly believe that there may be a connection between the myofascial pain,
I agree that there is still so much research to be done in this area. The new approach I'm gradually working up to includes doing elimination diet protocols to see if any positives happen. I did go gluten-free and then gluten-free and vegan for around three months a long while back (4 years ago) and it didn't seem to help much, but then again, that was long before I started learning to reconnect to my body. So I'm going to try again.

If anyone is interested, I am undertaking this regimen. I have done lots of pieces of this in a sort of higgledy-piggledy sort of way, but am now going to try putting it all together for a month or two and see if I feel better. Dr. Cheney, the man who wrote this protocol, was my good friend's physician for many years. She said it was following this that led her back to a functional life again (at least as far as her physical issues--she doesn't "do" mental health...not into talking feelings at all...and it seems likely that her physical issues were an outgrowth of a viral infection). Anyway, this protocol covers much of what I have learned from various health people over these past few years. Dead Link Removed


I have RSD in my leg following a five year battle with a hospital acquired infection, involving 23 operations. The pain is excruciating when it flares. Not as bad as when I had my last two surgeries that finally removed all of the infection, but bad enough to drive my blood pressure up into the 200/160 range. And my pulse into the 200's. I am fortunate in a way to have the diagnosis, as I've never been accused of drug seeking. For a long time, I was on a daily dose of 60 MG of hydrocodone and 40 MG of time release oxycodone. A couple years ago I went through intense physical therapy, and my therapist has really worked on helping me change my mindset. The two combined (I do the exercises daily and go in for iontophoresis when things start to flare) have gotten me down to a daily dosage of 20 MG of hydrocodone and no oxycodone. If I'm having a flare up, my doc gives me a short course of hydromorphone and three days of IV antibiotics. We do the antibiotics because the start of a flare looks and feels just like the start of another abscess.

My doc will be retiring soon and to be honest I am terrified of what will happen to my pain management.

Some things I do to help with the pain that are non drug related - regular (daily) stretching and exercise, meditation, heat or ice on the area, squeezing ice in my hands to try to interrupt the pain loop by focusing on a different pain, accept that it's awful and it WILL lessen again, complain a bit, and just "suck it up."

I'm sorry for all of you that also deal with chronic pain.


I have TMJ and issues with my nervous system. You say that these are directly related?
In all my obsessive researching about the connections between chronic pain and fatigue and trauma and PTSD and dissociative disorders...I come across TMJ mentioned again and again (along with fibromyalgia, chronic fatigue syndrome/ME, and many others) as a documented symptom that falls into the category of issues with the central nervous system. IF you feel brave enough to poke through the link I posted in the orignal post on this thread, there are some visuals that show these overlaps. This is NOT to say that TMJ is the same as PTSD etc., just that there is connection. The "new" way some physicians are describing these overlaps (of chronic pain/fatigue and psychiatric issues) seems to be the term central sensitization syndrome because although the physical conditions are separable from the psychiatric ones, they overlap considerably via the central nervous system and the brain's neurotransmitters. I continue to read about this stuff whenever I can find well-researched pieces on it, and I am certainly not an expert. That's actually why I posted this thread in the first place--not only to share what I am learning, but also hoping to learn from others who have all these symptoms that exacerbate each other!

What intrigued me about seeing TMJ as part of the constellation is that I was diagnosed with it when I was a young teen. I suffered terrible pain, and my jaw would often get "stuck". My dentist diagnosed it and filed my back teeth down a bit. It was miserable for a month afterward, but then the pain (at least as it had been) resolved, and I have never again had the clicking or the getting stuck issue. But later, I developed chronic neck and jaw pain and stiffness--which I still suffer from. I had dismissed the TMJ as being unrelated to my adult pain issues, but I do recall that one physical therapist I worked with when my neck pain got very bad used to work on my jaw muscle (the one between the jawbone and the ear) and he joked that I had knots in the weirdest areas he'd ever encountered. Then, just recently, I came across something that mentioned that TMJ is not a structural issue, but rather one of the musculature that controls the jaw... Now I'm returning to wonder about the TMJ, because the issues I have with my hips and pelvic and sacral area (the pain and the getting "stuck") are very similar to what I experienced with the TMJ when I was young.

Anyway, that's probably more than you wanted to know.


@ShodokanJenn what a horrific experience you've survived, and how very brave you are to be working your way off the pain killers as much as possible. I understand only too well the "suck it up" approach. I hope you don't have to do this too often and that you take good care of yourself. It is very scary to have to search out a new doctor. I wish you the very best in your efforts and that you can find someone who will provide excellent support for you!

Have you ever looked into Peter Levine's and Maggie Phillips's work on dealing with chronic pain? It's called Freedom from Pain. It was one of the first "self-help" books I bought, and it's quite good and comes with a CD with lots of meditation suggestions for shifting away from the pain loop. It has been very helpful to me.


@Hope4Now , I have not looked at their work. It's a great suggestion, though. My goal is to eventually come off the hydrocodone and move down to tramadol, and then slowly taper that down until I'm just on the diclofenac (anti-inflammatory). So I can use all the help I can get.

I have another doctor in mind, one who I saw for a year when my regular doc was out of work following a massive head injury. He'll be retiring in about 5-10 years, but that would still be plenty of time to figure out who I want for a new primary.

I have noticed that when the PTSD symptoms flare, so does the pain. I know they are connected; I'm just not sure how to UNconnect them.


I have noticed that when the PTSD symptoms flare, so does the pain. I know they are connected; I'm just not sure how to UNconnect them.
Yes, I wish I knew how as well. This seems to be a major focus of my life these days. The answer seems to lie in calming the nervous system. The right kinds of meditation help a lot (but I've found that some types make things worse for me). And rest. And not sucking it up and pushing through the pain, but working with it in various ways so it isn't your enemy but rather your body sending desperate signals. I take a lot of supplements--have been learning more about this recently (e.g., only a certain type of magnesium is helpful for pain...magnesium glycinate, not magnesium I'm hopeful about that!). Acupuncture. Essential oils. Gentle stretching. I am not on any prescription meds at all right now--have yet to find something that helps. I'm glad you have a doc in mind.


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.

I have to agree with you 100% that there is a complete disconnect between treating the physical, the psychological and everything inbetween. This became very apparent to me when I initially got my cancer diagnosis and I saw the oncologist, the surgeon, the nutritionist, the radiologist, the GP, the social worker, the pain management specialist, and on and on. It was totally overwhelming and what was worse is some of them were on completely different pages than others, so I decided the only one who could make decisions for me was me. I can listen and take into consideration all of the advise and recommendations, but I had to cobble together my own version of integrated oncology as there isn't that resource available locally.

Five years out, I have learned a lot. For me, the bone pain and fatigue from the chemo I take daily, are a fact of life. Each day I can wake up with a different body and I don't have a lot of control over that, but I do have control over my own thoughts and how I am going to approach the day. I have learned what works for me and what doesn't work and to keep new options open, because there are times things that worked don't work so well any more. I am fortunate that I have a very high pain tolerance and I also learned to use what I have called controlled disassociation to manage pain. (personal adaptation of my own disassociation and what I picked up with natural child birth).

With the psychological, I just don't have the time or the desire to work through the past traumas and made the personal choice of just managing what comes up when it comes up. I took what I learned in therapy and adapted it to my own personal needs and situation. With a terminal diagnosis, time takes on a different meaning and I didn't want to spend any more time dealing with a past that had robbed me of so much life as it was. However, that is just my personal take on my own situation and not something I would recommend to others as I feel there is great value in therapy, but everyone has to find what works best for them.

My own treatment is a hodge podge of life style changes, stress reduction, yoga, exercise, surgery and RX meds when I need them. My monthly blood work pretty much governs my "social" life as too low of white, red, platelet or neutrophils cells will dictate what I can and cannot do and where I can and cannot go. Pain is a variable and up to me how much I can or cannot take. Mentally, there I find I have some control and exercise what I can. Mostly, I just try to take each day as a gift and live it as fully as possible. On the bad days, I try to cut myself some slack and remember that tomorrow can and most likely will be different.


@intothelight, what an amazing post. Thank you. You clearly have found a way to make some peace with the chaos life throws at you. You're inspiring.
It was totally overwhelming and what was worse is some of them were on completely different pages than others, so I decided the only one who could make decisions for me was me.
Yes, I've found this too. And for me, the frustrating part is that because I was sent off primarily in the psychological/psychiatric direction (which has been both a horrendous slog and a wonderful help) where I ended up with a bucketful of diagnoses, including DID, I kind of assumed that all I needed to work on was the psych issues and the physical issues would resolve as I healed those. Um. Wrong. Except that I am now learning to be in my body and listen to it instead of pushing through the pain. But NOW, because my disability company told my primary care doc (illegally I think) about my psychiatric diagnoses recently, I am fairly sure that he will dismiss my physical issues as psychiatric ones--just at the time when I think I have finally figured out that what I have is not just fibromyalgia, but also CFS/ME. Ugh. And, of course, all along, the fibromyalgia doc and my PCP have been pushing me to exercise, which works for fibromyalgia, but exacerbates CFS/ME symptoms. Argh.

controlled disassociation to manage pain.
This is great that you can use these techniques to manage your pain! I am pretty good at this. Unfortunately, I was too good at it (well, bad at the controlled part, I guess) for too long and would careen through my life until the pain got so severe I literally couldn't.

Mostly, I just try to take each day as a gift and live it as fully as possible. On the bad days, I try to cut myself some slack and remember that tomorrow can and most likely will be different.
This...This is what we all need to learn how to do!

ground crew

Reading this thread has been very useful to me, it is reassuring others are having a similar experience and coping. (Sorry you are suffering.) So, after I found out I had CPTSD and before I got decent therapy I was injured in a car bike accident which sprained my whole body. And after the accident I was put on a back board cause it looked like I might need one. I should have been up stretching but there was some threat of vertebra damage. I did what I was told and everything seized up. Unbearable pain, prolonged and all the VA had for me was pain pills and ibuprofen. I refused the opioids.

It eventually cost me my job and then I was homeless. (vet status got me into a shelter. Thanks tax payers, very nice of you.) in pain. But I was ready for some self realization. So I worked on flexibility, and kept up with cardio on a bike. Got some shrinkage at the VA that included EMDR, learned about meditation and thankfulness. Odd place to learn thankfulness. I did get a job. and out of the shelter.

Chiros, message therapy, theraputic massage, daily workouts increasing in intensity as mobility increased. That went on for a while, about four years and I decided it was as good as it will get. Pain feeds depression I find. It is a drain. And when you are in pain, the lymbic system seems to be more irritable. I think I understand why old dogs are often growlly and “mean”, they are in pain and limited in mobility, they are afraid, the lymbic system is in protect mode.

But in my enlightenment period, I guess I was using radical acceptance though I have not looked into that line of reasoning. I just felt this was what was and nobody else cares weather or not I walked straight but me, so I better do what I can to be able to walk. So, stretching, gym weights, biking, avoiding prolonged standing or carrying more than 25lbs. I accepted my limits, I accepted my self care requierments, I sucked it up and didn't complain.

I did last year decide I wanted a note from my doctor explaining what was wrong with me. Now the VA is not your normal doctors office. The injury was 5 years old at the time. So, the doctor put me in for an MRI, and that took a particularly long time to get, but the doctor was very disturbed by the findings. Damage to many disks in my lower back.

I mean really, I was counting on the va to offer some reasonble level of care, but after the injury they did no therapy or follow up, I refused pain meds so I was a win in their book. So when the va became aware of my back damage, I got referred to recreation therapy and they signed me up for non VA chiropractors. The first one was good, but the spa lost their lease and that was over. This new one used a new technique. A spring loaded hammer thing, in place of the usual bone popping hugs and compression. Then I was introduced to myofacial work.

Wow did that hurt. Remember how I said I sprained my whole body? Well that was pretty much the part he used his ointment and a steel torture device on-my whole body. I can take a lot of pain, but that was a definite 8.5 on the oucy scale. So the first time was reasonbly brave, I was ignorant of the level of pain. The second time was definatly brave because I was not ignorant of the pain. The third time the pain was less, maybe a 6. But the effect has been wonderful. My lower back is still screwed up, but the muscels are a lot less painful. I can walk further and stand longer, I can walk first thing in the morning without much pain. I have been 2 days with out the need for ibuprofen. I will never run a marathon but I never wanted to. I am better than what my radical acceptance was willing to settle for.

I sucked it up and didnt make my doctor do their work and find a therapy for my injury. An injury I had sucked it up for 4 or so years, long enough they thought I was healed of it already. And the cure was by accident, the last chiro did not use this therapy. I have been to 6 chiros and no two use the same methods. I am told this is pretty comon in Rolphing but the guy I met who did that wanted to play with my recently inflamed PTSD at the same time, and I did not want some quack playing with my PTSD, I had been in a pretty deep depression w/SI and thought playing with that part of me is best left to a professional. So maybe that would have made me better sooner, or I would be much much worse. I think I made the right call.

I am not sure how often I will need this painful procedure in the future, but I am fortunate to have found a therapy for the most pervasive part of my pain. I can manage the disk pain for a while. I mean it will degrade in time. I would have had some of it without the accident. And my stretching and workout routine are designed to maximize the useful life of my back and other parts, not to get on the cover of a muscle mag. The workouts also provide dopamine to combat depression.

Oh, on my journey over the last several years, I found that vitamin D moderated my depression. I have tried various doses and found about 2000IU to be useful. It is not a cure, it moderates depression. Depression is the number one complaint in America, and vitamin D deficiency is very common in America. I suggest trying vitamin D. Or go lay in the sun. That's good therapy all by its self.


@ground crew, that is awesome that you worked your way back to where you were comfortable. Radical acceptance is not accepting that this is as good as it gets, rather accepting that it is what it is, then moving forward from there. It is a starting point, not a stopping point. You did it, accepted it, and then moved forward finding a life that works for you. Excellent.
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