In this episode of the PTSD Bytes podcast, host Dr. Colleen Becket-Davenport discusses PTSD and chronic pain with Dr. Jennifer Murphy, national director of VA’s Pain Management program and lead author for the VA’s Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) initiative and Dr. Katie Hadlandsmyth, clinical pain psychologist and health services researcher at Iowa City VA and the University of Iowa.
Understanding chronic pain
When we think of pain, we often think of acute pain, which is typically short-term, caused by a specific injury and resolves within a few months. Chronic pain, on the other hand, lasts longer than three months and often extends years or decades. About one in four people in the U.S. have chronic pain and the prevalence is even higher among the Veteran population.
Pain is not only physical, but can also affect other aspects of life, such as how you interact with your family, your mood and your participation in personal interests. Psychologists who specialize in working with people who experience chronic pain can be helpful. Pain psychologists will listen to the person with pain and offer advice on ways to manage and respond to the pain so it doesn’t interfere as much with your life.
Most of us avoid activities if we think it will cause us more pain. However, too much avoidance can be counterproductive in the long run, because it could lead to greater pain or make us more susceptible to injury. Pain psychologists can help you better understand your own pain, what you can do to manage it most effectively and live the best life possible.
PTSD and chronic pain
PTSD and chronic pain are often linked. Fifty percent of Veterans with PTSD also report suffering from chronic pain. The reasons for this are complex. Some research shows that a history of trauma can alter how the nervous system processes pain, making individuals more sensitive to it. Children exposed to trauma may develop pain sensors that are more attuned to discomfort, increasing the risk of chronic pain in adulthood. The symptoms of PTSD and chronic pain tend to magnify each other.
Like PTSD, chronic pain is often misunderstood because its symptoms are not always visible. People with chronic pain often do not feel heard or believed, and this can make it difficult for individuals to seek help.
Treatment for both PTSD and chronic pain
Treatment for people who experience both chronic pain and PTSD typically includes multiple approaches with multiple types of health care providers. It is common for people to get their PTSD treatment through mental health specialists and pain care either through primary care, specialty pain clinics or rehabilitative services.
This is most effective if the different health care services are working together to coordinate care. Another approach—and this is becoming increasingly available at VA—is combined treatment. This means a Veteran could go to a single provider or team to treat their chronic pain and PTSD simultaneously.
Outside of treatment, there are also many helpful non-pharmacological and self-management approaches geared toward empowering individuals, helping them achieve their goals and providing them with ideas for how to make changes they desire despite the pain.
One helpful self-management tool is VA’s Pain Coach mobile app, which offers a broad range of tools and videos to help with pain management and other areas impacted by pain, such as sleep. The app includes education and resources, such as activity pacing and relaxation techniques, in addition to customizable daily check-ins that are linked to helpful tools.
Additional links
- Learn more about chronic pain and PTSD.
- VA’s research overview on chronic Pain and PTSD (from 2022).
- Resources for Veterans experiencing chronic pain.
- Learn more about VA mental health apps.
- Find mental health treatment at VA.
- Find mental health treatment outside of VA.
- More PTSD Bytes episodes.
If you are a Veteran who is experiencing a crisis or supporting a loved one who is, call 988 and press 1 for immediate assistance, or chat online at VeteransCrisisLine.net/chat.
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Thank you for doing this podcast. I am there and trying to take steps to help myself. This has been a hard road. I believe in my heart that my providers care, but I am not getting what I need. I have started with a program that uses alternative/Holistic approaches. This podcast makes me believe that I still have a chance to improve my situation. It is hard and depressing to walk into a pain provider or my Va provider looking healthy on the outside and trying to explain my issues. The blank looks or changing of conversations and being told sorry is not working. I do know I am my best advocate, and I will work through this. Thank you again right time and place for me.
I’ve got both chronic pain and PTSD. Add in TBI and two joints that need surgical repair, it’s pretty much a crap show. My mental health care is very important and they really help me work through the myriad issues from 25 years in the militaries.
The pain portion is somewhat frustrating. The local VA didn’t have a pain clinic for years. I go to a non-VA provider for pain control. When I heard there was going to be a pain clinic starting up at the VAMC, I was hopeful it would be taking over my pain management. Nope. Their intent was to pull me off all my meds and stick me on a methadone equivalent. When I asked what my options were if my pain wasn’t controlled, I was told I’d have to “suck it up”. Consequently, I stayed with the non VA pain clinic.
Illegally drafted out of the university and sent to Vietnam.
Many, many times wanted to end it all.
I know Many veterans that did end it with suicide!
Permanent changes within the brain but the VA won’t acknowledge that part.
So at 77 yrs old the immense anger still there w/ptsd.
Crops up unexpectedly, spent years in therapy, VA and private….very temporary help.
Unbelievable, ‘pacing and relaxation techniques’?! For chronic intractable pain? Veterans are committing suicide at an astounding rates because of untreated chronic pain and you guys have taken away the FDA approved safe and effective opioid pain medications. Patients are suffering and cannot function because of the VA! What’s next, a consultation with the Easter Bunny?
Well, Since I returned from Vietnam on 9/71 things have never been right. Illegally drafted right out of the University and eventually sent to South East Asia at 20 years old. Everyday conflict and within 4 months the damage was done.
Many years in therapy but the VA never told me extreme stress actually produces a permanent change within the brain?? Why did they keep this secret?
Anyway 2 years ago with an appointment at the VA, it came out of nowhere PANIC. Getting in my car and racing out of there I was half back in Vietnam. The road turned into a dirt road, the Sun was hazy and dusty. I was partially back in Vietnam….for 3 hours!
It blew me away. Scary and weird.
The Trauma is always there….and I’m 77 yrs.
Same with my father being in WWII….he drank his whole life and could never talk about it!
I wonder how many politicans, “Important” people, movie stars etc-are told to open up an ap, when they have a slip disc or Kidney Stone? You can screw around with a person’s head but it does not kill the pain. I understand no one wants anybody addicted to pain meds. But you start degrading the quality of life when you with hold them. I hope all of you holier than thou people get to experience what real pain is. And, then have some donkey tell you you cannot have anything for the pain.
VA Medical has a pain-program which instructs Doctors to not prescribe strong relief medicine. The reasons for doing so are administrative, not medical. No opiods, no Tramadol.
I know this well. I had severe pain in back of head. I also have chronic pancreatitis, back pain, and severe PTSD. I started to figure out whats going on and just took years, and nothing. I started to be suicidal because of all this. i was in VA Hospital for this. they found my 9th cranial nerve. i am a lot better with pain for the therapy and treatments for my pain. I wrote this to let veterans know. If your suicidal please talk to someone family, 988 press 1, PC, and who you trust.
Several years ago while perusing a VA handbook I found chapter that discussed PTSD. In the same chapter was a listing for a similar condition that was named something like operational stress or situational stress. I cannot remember the exact name and I have not been able to find it listed again anywhere. When I read about the two conditions I did not really fit the PTSD description but I fit the other one pretty close. Do you know what it is called and if it is available as a condition anymore? No one I have talked to in the last few years knows what I am talking about and the letters and emails I have sent to PTSD support locations never answer me.
When you actually went to WAR and Killed TALIBAN and WATCH TALIBAN BLOW UP MY BROTHERS AND I! AND WHEN YOU WATCH TALIBAN SHOT 81mm Recoil rockets indirect Mortar! AND WHEN YOU DRIVE AROUND IN A STYRKER OR ANYTHING WITH YOUR BUTT PUCKED 24/7 and Scared! Or 0300 in the morning in the middle of the graveyard! With multiple captured, bound and tied! Fighting 365 days against suicidal taliban…then come write about PTSD!
ONLY JESUS CAN HELP AND SAVE!
I thank him for loving me! Because nothing else matter! Everyone will know Jesus is God!
Hey bud, keep your ears open for Medbeds.
Veterans to be treated first.
Can erase those nightmares.
You are so afraid of getting sued that when an individual is hurt, and in the kind of pain that cannot be pushed aside by the human mind, you just let them suffer through it. News flash! Ibuprofen ain’t gonna handle every kind of pain; especially chronic pain. Thank you for listening.
It’s well known that the DEA is writing pain medicine “policy” now. The subject of my pain, and FIGHT, for a LIFE WORTH LIVING HAS BEEN POLITICIZED.
YOUR PRACTICE OF NOT GIVING WARRANTED PAIN MEDICINE IS LITERALLY DRIVING A VETERAN SUICIDE EPIDEMIC, *PER THE PEER REVIEWED DATA*.
WHAT THE F-CK IS WRONG WITH YOU EVIL CAREERIST GHOULS?
VETERANS ARE DYING BECAUSE YOU LET EVIL AND POLITICS TAKE OVER.
YOU SCUM ARE DESTROYING LIVES EVERYDAY.
Pray to Jesus my friend! We have a great program but people sin makes it not work good! Maybe it will get better once they realize how hurt we are! All the best!