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What Comes First, the Chronic Pain or the PTSD?

Ladies, we’ve all been there, you go to the doctor with a persistent health problem and hear the words that make your blood boil, “Maybe you just need some rest or an anti-depressant.” Women have been dismissed by medical professionals for decades and for many of us, we are ready for a fight as soon as we walk into a clinic or hospital. In 2022, the Journal of the American Heart Association reported that women waited 29% longer than men to be evaluated for heart attacks in the ER. In an analysis of 981 emergency room visits, women were shown to be up to 25% less likely than men to be treated with opioid pain killers for abdominal pain and the same study showed middle-aged women with chest pain and other symptoms of heart disease were twice as likely to be diagnosed with a mental illness compared to men suffering from the same symptoms. Forgive us if we are a bit on edge when we seek treatment. The Washington Post wrote an excellent expose on this phenomenon and highlighted the case of a neurologist who was continually dismissed when complaining of head pain and pounding in her ears. She was eventually diagnosed with a brain tumor but by the time she finally got surgery, the tumor was so large it could not be removed in its entirety. She now has permanent damage as a result. This woman has a medical degree. What hope do the rest of us have? As a matter of fact, I’m very sensitive to these stories because I was also dismissed about pain symptoms for 19 months. By the time I was finally diagnosed with drug induced lupus and neuromuscular disorder, I had lost my ability to walk and have permanent damage because of the amount of time that passed before I received a diagnosis. I still struggle with anger towards the medical professionals who failed to recognize a known reaction to my medication and am the first person to decry medical professionals for relying on the hysterical woman trope rather than working towards a diagnosis. Please don’t tell me it’s in my head. This isn’t in my head but even I must admit there may be something to the link between pain and mental health. I’ve learned so much over this past year and more and more, I understand the link between depression, trauma, and anxiety and chronic pain. Despite my hesitance to dignify mental health as a cause of chronic pain, I’ve started to become a convert. According to the U.S. Department of Veterans Affairs, approximately 15%-35% of patients with chronic pain also have PTSD. Only 2% of people who do not have chronic pain have PTSD. Harvard Medical School has reported that 65% of patients seeking help for depression also report at least one type of pain symptom. I immediately understood my need for anti-depressants because I could clearly see how depressed and anxious, I was after the reaction to Humira. Who wouldn’t be depressed? I experienced a very traumatic event and struggled to come to terms with what had happened to me. I was not quick to understand the link between my mental health and my chronic pain. As a matter of fact, when my neurologist suggested that I should work to deal with my PTSD from the Army if I wanted to recover from the lupus and neuromuscular symptoms, I nearly lost it. How dare this doctor suggest that my recovery was linked to my mental health? My pain is very real. The reaction to Humira is very real. My fibromyalgia and other diagnosed health issues are very real. The link between my mental health and the pain is also real. My first realization came in the form of anxiety around exercise. It’s difficult to alleviate pain with exercise when you spent 19 months experiencing severe pain and muscle myalgia after attempts to exercise. I worked for many months to overcome my anxiety around exercise and I still suffer from exercise related anxiety at times. I associate exercise with severe pain and I think it may take a long time to work through that trauma. I’ve also learned that my high tolerance for pain may not be so high. As soon as I feel pain, my mind immediately rushes to the debilitating pain I’ve felt over the past few years and I don’t try to give that pain the benefit of the doubt, maybe it isn’t that bad after all. I recently interviewed Lauren Rose, the host of the Podcast, “It Hurts to Mom”, and she spoke about learning how to reframe how she thinks of her pain. The mind is a powerful tool but who could have ever dreamed you could reframe your pain? I decided to give this a try and the first time I tried to reframe my pain, I got in my own head and somehow reframed it to be even worse than I initially thought. The mind work clearly influenced me, it was just in the wrong direction. It did make me think about how much my mind was making me feel worse so I tried it again. This time I saw much more success. I know that therapy takes time and I fully recognize that a traumatic event like the one I experienced doesn’t just go away but I’m addressing my trauma and anxiety and seeing results. My medical problems are not in my head but my recovery just may be.

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