Breaking the Cycle of Chronic Pain and PTSD

If you experience chronic pain and PTSD, you might find yourself stuck in a loop of unhelpful thinking and avoidance behaviors that backfire over time.

Research shows that people with both chronic pain and PTSD have higher pain sensitivity, more psychological distress, and greater impairment than those with either condition alone (Reed et al., 2021). Often, care is siloed—physical pain managed by medical providers, psychological pain by mental health providers—missing the benefits of an integrated approach. The good news: trauma-informed strategies that address biology, thinking patterns, and avoidance together can lead to real improvements in pain, function, and quality of life.

Overlap of Chronic Pain and PTSD

Chronic pain and PTSD are deeply intertwined at both psychological and brain levels. Abdallah and Geha (2017) note that both conditions:

• Share Brain Circuits: Both involve the limbic system—especially the amygdala, hippocampus, and ventromedial prefrontal cortex, which are central to learning, memory, and emotions.
• Reinforce Negative Memories: Both are marked by replaying pain or trauma, reinforcing suffering. The brain overgeneralizes, warning us to avoid movement or vulnerability.
• Cycle of Stress and Pain: Each can trigger the other, leading to inflammation, brain changes, avoidance, and increased vulnerability.
• Behavioral Patterns: Avoidance, hypervigilance, and catastrophizing are common, making it harder to break the cycle.

The Thoughts That Trap Us

Catastrophizing—expecting or focusing on the worst—is a major risk factor in both chronic pain and PTSD. People with both conditions often feel less control, are more emotionally affected, and buy into catastrophic thinking more than those with pain or PTSD alone (Kind & Otis, 2019).

Common Catastrophic Thoughts Might Include:

• Pain equals harm.
• If my pain is bad, I can’t do anything.
• It’s not fair!
• It’s my fault.
• It’s not safe to move.
• My doctors should be able to fix this—they’re failing me!
• I can only do what matters if I’m pain-free.
• When I move and it hurts, I must be damaging myself.
• This will always be unbearable.
• I am broken.
• There’s nothing I can do to reduce the pain.
• I can’t take it anymore!

These thoughts are understandable, but not always accurate—and they can make symptoms worse.

The Body Remembers

Trauma isn’t just a memory—it’s an experience in your body. Traumatic events can leave a lasting imprint on how your nervous system processes sensations. Sometimes, pain is a re-experiencing symptom—your body’s way of remembering what your mind wants to forget. For some, symptoms like muscle tension, headaches, or gut issues are direct echoes of trauma (Kearney & Lanius, 2022).

You might also feel paralyzed, unable to move or act when pain flares or memories surface. This “freeze” response is common after trauma—not a personal failure. Restoring movement, even in small ways, helps your body learn it’s no longer in danger.

Kinesiophobia and Avoidance

Many with chronic pain develop a fear of movement (kinesiophobia), believing activity will cause harm. This leads to less movement, more weakness, more pain, and greater disability—a vicious cycle. Avoiding movement actually increases pain and disability over time.

Similarly, PTSD often leads to avoiding certain places, people, or situations, fearing they’ll trigger distress or danger. This shrinks your world, increases anxiety, and reinforces the sense you’re not safe. Avoiding trauma reminders strengthens fear and keeps symptoms alive.

Harm vs. Pain: Rethinking the Connection

• Harm: actual tissue damage (like a broken bone or traumatic event), often accompanied by pain signals.
• Pain: an unpleasant sensory and/or emotional experience that could either signal harm, or reminders of harm (as in the case of chronic pain or PTSD).

With chronic pain and PTSD, your body’s alarm system is stuck on high alert and is sending pain signals even when there’s no ongoing injury (Kind & Otis, 2019). Chronic pain says pain means damage; PTSD says fear means danger. Learning to distinguish between pain and harm, fear and danger, is key to reclaiming your life. Opening up to movement and experiences with low risk is called active coping.

The Power of Active Coping

People who use active coping—pacing activities, seeking support, facing reminders of trauma that are not actually dangerous, and challenging unhelpful thoughts—recover faster and experience less pain (Kind & Otis, 2019). Pacing is important: break tasks into manageable, time-based chunks with breaks; if pain increases, dial it down. If pain is fairly stable, see if you can gently increase over time. Gentle movement (walking, stretching, yoga) with smooth, slow breathing and self-compassion can help retrain your body and mind.

Pacing is similar to exposure work in PTSD treatment. Facing safe experiences you’ve been avoiding, little by little, helps you reclaim your life. Over time, your body and mind can learn to tell the difference between danger and harm vs when fear isn’t signaling true danger and pain isn’t signaling real harm.

Thoughts That Turn Down the Pain

You don’t have to get rid of unhelpful thoughts—just notice them and remind yourself of what’s helpful and true. Try:

• This pain flare will pass.
• Pain isn’t always a sign of harm—sometimes my body is just scared.
• I can handle this moment.
• I’ve gotten through it before; I can do it again.
• I can reclaim activities, relationships, and places where I can build comfort, safety, trust, joy, and connection.
• I can find a pace that works for me to care for myself and maintain my health.

Reflection Questions

• What are your most common pain-related thoughts? PTSD-related thoughts?
• Can you notice the exact body sensations that come with pain or trauma triggers?
• Are there activities you avoid because of pain? What might happen if you tried a little, safely?
• If chronic pain and PTSD were not calling the shots, what would you like to do?

Support for Both Chronic Pain and PTSD

If you are experiencing both chronic pain and PTSD, you don’t have to navigate this alone. Find a provider who understands the mind-body connection and can help you integrate your care. Look for someone willing to collaborate with your other providers and support you as a whole person. Integrated, trauma-informed care is not just possible—it’s a key step toward reclaiming your life.