Post-Traumatic Stress Disorder and Its Interrelationship Between Crush Injury and Pain

Abstract

Post-traumatic stress disorder (PTSD) is one of the most relevant disorders of patients with chronic pain, but is often underdiagnosed. There are common factors in chronic pain and PTSD that arise from the avoidance and fear-based processes, and result in overlapping and interactive symptoms. Treatment should take this into account. Every year, millions of people are affected by natural or man-made disasters resulting in crush injuries involving multiple tissues. Crush syndrome is the systemic manifestation of traumatic muscle injury. Early aggressive intravenous fluid administration is needed to prevent myoglobinuric renal failure. Alongside aggressive resuscitation measures, an aggressive attitude in the administration of strong opioids and ketamine is recommended as well, so that the possibility of the acute pain persisting and becoming chronic can be reduced. Victims suffer acute pain (a combination of nociceptive, neuropathic, and inflammatory pain) after crush injuries that can become chronic pain. Nerve damage with neuropathic pain occurs after crush injury by neuro-immune mechanisms resulting in peripheral and central sensitization. Many of the survivors acquire psychiatric disorders such as post-traumatic stress disorder. Individuals with pain and PTSD share some common psychological mechanisms such as avoidance. They allow themselves to be controlled by pain and distress that can maintain or exacerbate each other. This results in more health problems, disability, functional impairment, and absenteeism from work. Psychotherapy [exposure therapy and cognitive behavioral therapy (CBT)] is considered the first-line treatment in the psychological treatment of PTSD and pain. Individuals with severe PTSD or disabling chronic pain (or both) require intensive treatment programs. The pharmacological management of neuropathic PTSD and pain is discussed as well.