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The PTSD Pain Paradox No One Talks About

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I was diagnosed with complex post-traumatic stress disorder (C-PTSD), or just PTSD depending on the provider, after leaving an abusive relationship when I was in my mid-20s. I have had several incidents since then that have exacerbated my PTSD, from falling 35 feet down a cliff, to breaking my knee in a freak accident.

• What is PTSD?

For a while, I was in a relationship with someone who truly saw my PTSD symptoms at their full strength, and one thing he noticed was my tendency to just “swallow” physical pain after a few seconds, and then just get up and continue on like nothing had happened. He rightly saw this as an unhealthy thing.

It wasn’t until I stumbled across an article in the “Journal of Pain” that I started to gain some insight into this unique ability I had to just swallow my pain and set it aside to deal with later.

The article is called “Paradoxical Pain Perception in Posttraumatic Stress Disorder: The Unique Role of Anxiety and Dissociation.” In it, the authors discuss their findings with PTSD patients and experimental pain, and what they found was PTSD patients can display both hyposensitivity to pain and hyperresponsiveness to pain depending on their mental state at the time.

In times of high anxiety, PTSD patients will experience an oversensitivity to pain. In fact, PTSD patients are two to five times more likely to experience widespread chronic pain than the general population, possibly because those living with PTSD can experience unusual levels of anxiety near constantly.

After the accident I mentioned where I fell from a cliff, my PTSD symptoms were getting difficult to manage again, and I started experiencing widespread chronic pain. Long after my body had healed from the injuries I sustained in that fall, I was still experiencing that all-over-the-body pain. I did sustain a concussion, and it is entirely possible some of that is from some kind of neurological damage, but I continue to experience this pain even though it has been nearly two years since the accident, and it is at its worst when I am in a state of high anxiety.

It feels like there are tiny shards of glass in all my muscles. Occasionally, I will experience a concentration of pain in just one area of my body instead of all over my body for a few days, and then it will shift back to being widespread. While physical factors certainly may play a part, I know my mental state does as well, and when I saw the article in the “Journal of Pain,” I felt like I finally understood what was happening.

As I said, my then-boyfriend noticed I could swallow pain after a few seconds and continue like I was not in pain, which he knew had to be unhealthy. This hyposensitivity to pain can come when people with PTSD dissociate from the pain to continue with their lives. It is a survival-based coping mechanism for me — if the occasion calls for it, I can dissociate from the pain to continue with what I need to do. In an emergency, this would allow me to push past the pain to ensure my survival. In real life, this allows me to go to work or spend time with my loved ones despite the physical pain I am in. Unfortunately, the flip side is, I rarely give myself the rest I need to heal or recover from the pain I have dissociated from, and it can make me feel plain weary after a while.

One final point I noticed is patients with PTSD who tend to use dissociation have much higher pain thresholds than the average population. For instance, I broke my knee and still managed to walk myself (with assistance from my current partner) across the apartment complex, down two flights of stairs, to my car so my partner could drive me to the emergency room. I was extremely uncomfortable, but at that point, I was grinning and bearing it. I was not screaming and crying. I was so calm in the emergency room the doctor initially thought that I had just sprained my knee. The X-ray revealed it was actually a fracture of my tibial plateau, but I was holding myself together so well I was sent home with very little in the way of care instructions pending an appointment with an orthopedic specialist. And I got through two days with a broken knee and no adaptive equipment except for crutches until I had surgery and was ordered a wheelchair. This would not have been possible for everyone and I think my ability to dissociate from the pain made it possible.

When I tell doctors what my pain is on a scale of one to 10, I often elaborate beyond just the number, because a seven for me could be a 10 to most people. For instance, when the pain is so bad I throw up and cry, I will often rate it as an eight whereas medical professionals usually consider those bodily reactions a sign of a solid 10 on the pain scale.

Knowing the information in the article has changed how I think about my chronic pain. I feel I can use this information to come up with a treatment plan for my chronic pain that may not involve any heavy-duty pain medication. I can see there needs to be a marriage between my mental health care and my physical health care to properly address the pain I feel, and it does not seem as impossible to find relief now as it did before. I have hope I may find relief from the pain, and that is priceless.

Getty image by yngsa

Originally published: August 14, 2021
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