Psychosomatic Pain and PTSD: The Mind–Body Connection

"The doctors have discharged me, yet the pain hasn’t gone away. Could it all be in my head?"

The prefix 'psycho-' originates from the Greek word psyche, meaning mind or soul, and refers to a person’s mental or emotional state. The term 'somatic' is derived from the Greek word sōma, meaning body, and pertains to the physical body or its symptoms.

Although psychosomatic pain has a psychological origin and medical investigations often return normal results, the pain experienced is real and physically felt. It is not imagined or fabricated. A commonly used alternative term is functional pain.

Common locations affected by psychosomatic or functional pain include:

1. Head

2. Neck and shoulders

3. Back, particularly the lower back

4. Abdominal area or digestive tract

5. Chest

6. Jaw or facial region

One recognised cause of psychosomatic or functional pain is post-traumatic stress disorder (PTSD).

Cortisol plays a central role in the body’s stress response, and its dysregulation is closely associated with the hyperarousal commonly observed in trauma-related conditions and chronic psychosomatic pain. PTSD is a psychological disorder that develops following exposure to traumatic events, but its effects extend beyond emotional and cognitive symptoms. It may also present with distinct physical symptoms.

PTSD disrupts the normal functioning of the body’s stress response system, particularly affecting the regulation of cortisol, a hormone released in response to stress. In individuals with PTSD, cortisol levels may become abnormally low or erratic over time. This contrasts with the elevated cortisol levels typically observed during short-term stress. Such hormonal imbalance contributes to symptoms including hyperarousal, insomnia, heightened anxiety, and physical discomfort or pain.

In essence, PTSD modifies the way the brain and body manage stress. Cortisol is a key component in understanding the full psychological and physiological impact of the condition.

Here is how PTSD contributes to psychosomatic/functional pain:

1.  Chronic Stress Response

2.  Dysregulated Nervous System

3.  Body Memory of Trauma

4.  Co-occurring Conditions

Treatment options for PTSD include the following:

1. Psychological therapies (considered first-line interventions):

(i) Trauma-focused Cognitive Behavioural Therapy (TF-CBT)

(ii) Eye Movement Desensitisation and Reprocessing (EMDR)

(iii) Narrative Exposure Therapy (NET)

2. Medication (for persistent or severe symptoms):

(i) Selective Serotonin Reuptake Inhibitors (SSRIs)

(ii) Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs)

(iii) Prazosin, which may be used for trauma-related nightmares and sleep disturbances

3. Supportive approaches:

These include mindfulness-based practices, guided relaxation techniques, and controlled breathing exercises, all of which may help regulate the nervous system and support psychological wellbeing.

Psychosomatic or functional pain highlights the profound interconnection between the mind and the body. When psychological distress is unexpressed or unresolved, the body may internalise and manifest it physically. Effective treatment must therefore address both mental and physical components in order to achieve authentic recovery.

Photo by Yuris Alhumaydy on Unsplash