When Chronic Pain Leads to Post-Traumatic Stress Disorder

Whenever I have to schedule a doctor appointment, I cry. When you have chronic illness, you rarely call to schedule a check-up. Most of the time, something is wrong. And most of the time, you’re at the doctor so often that any check-up duties happen right on schedule because you’re there anyway.

I used to think that I was afraid of some new diagnosis, or that I’d need another unexpected surgery. I used to think maybe it had something to do with my fear of needles. But in my own mind, those were pretty weak excuses. They were very real issues, but they didn’t instill fear in me to think about. Not like phoning the doctor did.

Whenever I call, it’s because something has gotten worse, or I have a new symptom. After the call, I tend to get worse and worse leading up to the appointment. Again, I pinned all this on some kind of phobia I must have and just don’t realize. It wasn’t until the other day when I read a tweet about chronic pain and post-traumatic stress disorder (PTSD) that my reaction began to make sense to me.

I’ve heard a lot about PTSD but never considered I might have it. I thought people who see war or abuse get PTSD, and my happy little existence didn’t seem to be in the same ranks. The only horrible thing that ever happened to me was getting sick. Illness, pain, hospitals, and surgery are daily parts of my life. They seem so…. common. Not traumatic, and everyday things can’t be traumatic. Can they?

But my PTSD from chronic pain is very real, and actually makes a lot of sense. Why does calling a doctor put me in the throes of depression? Why have all my break-down-into-uncontrollable-crying episodes happened in hospitals? Perhaps my brain is perceiving doctors and hospitals as threats. If I was a wild animal human, these are the kind of instincts that would tell me to run from a volcano or fight off a bear. Hospitals are not volcanoes, though, and doctors are not bears. The result? My “fight or flight” reactions in my brain are causing stress. I don’t run from hospitals or fight doctors (usually) so I think my brain keeps releasing the chemicals that say run! Or fight! And eventually the imbalance causes a breakdown.

And that’s just the emotional side. Endometriosis, like so many chronic pain conditions, is very volatile in reaction to stress. Stress can cause my muscles to tense up and irritate lesions, but can also release hormones that, guess what? Make endo grow.

And of course, there’s irritable bowel syndrome (IBS). As my gastrointestinal specialist said, IBS is short for “one of many intestinal tract disorders we haven’t yet discovered, named, or learned how to treat.” IBS is a huge blanket diagnosis that covers a lot of things. My unique brand of IBS is related to an anxiety disorder — now, this was diagnosed by a gastrointestinal specialist, not a psychologist, so we don’t know fancy terms for it, but it’s stress that makes me nauseated, barfy, and sick to my stomach. And not typical stress, undue stress. Stress I can’t control. I know what sets me off, but that only helps so much. It’s more than just doctor visits, it’s everyday life. The only “cure” would be a completely stress-free life. So I started antidepressants, which really helped with the undue stress — stress caused by social interactions, perfectionism, and other every day triggers.

But they really didn’t help much with things like going to the hospital. There seems to be another class of triggers that I still can’t react well to. I can go to the doctor and seem fine on a really good day. Maybe I won’t break down crying until I’m in the car. But a lot of times there are tears in the office, or some poor nurse who gets a claw-swipe from me while we take blood.

I felt better the more I learned about PTSD. All my actions fit the description. I’m hoping the knowledge that there’s a reason for my reactions will give me the balance I need mentally to try and control the fight/flight impulses.

So when I’m in a flare of chronic pain, I take a moment and think “Am I in danger? Is what I am doing dangerous?” Take my doctor phone call, for instance. If I’m calling the doctor, it’s because my pain is getting bad, so I’m likely in pain. It’s not the phone call that causes pain. But it makes me nervous and causes physical signs of stress, which can exacerbate pain. So I’m about to dial and also feeling faint. I take a moment and think the words “Am I in danger?” No. Calling some one is not dangerous. But it scares me. “Ah, wait!” says myself to myself, “It scares you, but is it dangerous?” No, but I don’t like it. “But is it dangerous?” No.

This admittedly silly conversation works for me. Am I still hurting? Yeah. Do I still need to make the call? Yes. But my palms stop sweating, my muscles relax, my breathing slows, and all of that can do nothing but help my endo.