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  • Writer's pictureHannah Neumann

Slow-healing injuries

Why do some injuries take so long to heal? And what do these slow-healing injuries have in common? Chronic pain and PTSD are two types of slow-healing injury. Pain is called 'chronic' if it lasts longer than the expected length of recovery (typically longer than three months). And, for PTSD to be diagnosed, symptoms must be experienced at least one month after the traumatic incident occurs. When these two conditions appear together, the combined burden can further slow the healing process. These conditions are also both examples of broken alarm systems. Pain and fear evolved to alert us to threats. If something hurts like a wolf's bite or scares us like a cliff’s edge, our alarm systems trigger adrenaline, helping us to respond with speed and strength. But, sometimes, when stress is placed on an alarm system, it breaks by resetting itself in a hypersensitive mode. Imagine a smoke detector that goes off whenever you strike a match to light a candle. Similarly, an assault survivor might react to strangers with the same fear response that their attacker triggered. And, for someone with nerve damage to the knee, every step might be experienced as crushing pressure. This leads to the avoidance cycle. The harder we fight not to trigger our alarm systems, the more sensitive these alarm systems become. Fears balloon and muscles atrophy. The assault survivor who avoids public spaces never re-learns how to feel safe in a restaurant. And the person with nerve damage to the knee grows weaker, lying in bed, fearful of their pain. Eventually, this cycle becomes unsustainable. Maybe the sufferers’ loved ones grow impatient or finances force them into action. Unfortunately, pushing blindly past the pain and fear can overwhelm the system, strengthening avoidance. The assault survivor panics at a large family gathering, then vows never to go outside again. The person with the injured knee goes jogging, then collapses, unable to even attempt walking the next day. In both cases, these outcomes lead to a sense of hopelessness. No wonder so many people with chronic pain and PTSD get diagnosed with depression too. The pain and fear responses are harsh teachers; they drill the lesson 'you are helpless' over and over. So, how do we unlearn this lesson? Multiple forms of psychotherapy have proven helpful (cognitive behavioral therapy being the most studied, both for the treatment of PTSD and chronic pain). The types of psychotherapy that work the best are the ones with clear therapeutic targets. For example, it can be extremely helpful to change the way we think about our injuries and traumas. Mindfulness and relaxation strategies can also reduce suffering in response to pain and fear. Once we've developed coping skills and shifted how we think, we can more easily break out of our avoidance cycles. Maybe the assault survivor finds that they're no longer as distressed by thoughts about their trauma; and, with time, the zone in which they feel safe expands, finally allowing them to brave a crowd of strangers. Or maybe the person with nerve damage resumes walking, building strength without triggering a pain flare. In both cases, the aim is not to erase fear or pain. These alarms are still necessary to protect us from danger. But we can learn to tolerate the false alarms, regaining a sense of safety and control. And, as we heal, our lives expand, becoming fuller, until any remaining injury is minor by comparison. With patience and perseverance, we can overcome even the slowest healing injuries.

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