The next part under this module of social factors is about post-traumatic stress disorder, PTSD, and chronic pain. PTSD often leads to chronic pain. Now there are many different types of trauma that can lead to PTSD. There's both circumstantial trauma, or that trauma perpetuated by people. Some of which I already discussed. Circumstantial trauma occurred such as car or plane crashes, sudden death of a loved one, fire and building collapses. Or natural disasters that happened increasing frequency such as hurricanes, tornadoes, mud slides, tsunamis, and earthquakes. And then there's the trauma that perpetuated by people, such as war and terrorist attacks. I've discussed rape, a, assault and abuse, kidnapping, sexual, physical, and verbal abuse, and childhood abuse and neglect. All of these can contribute to PTSD. But what is PTSD? Well, it is the after effects of trauma, the continue to be perceived as threatening to the physical or emotional integrity of an individual. So PTSD leads to three symptom clusters. One is re-experiencing the traumatic event in nightmares and flashbacks. Number two is emotional numbing. Feeling detached, avoidance of thoughts, feelings and activities, particularly associated with the trauma. And number three is an increased arousal, including insomnia, exaggerated startle reflex. Hypervigilance, paying attention, worried about things all the time, and of course pain, persistent pain. So the problem with the PTSD is not high, but it's significant. There's 6.8% of the people have a lifetime prevalence of PTSD. And the 12 month prevalence in the studies that have been done, and this is a percentage of U.S. adult populations, 3.5%. And the 12 month prevalence classified as severe PTSD is 1.3%. But what's important about PTSD is it's poorly recognized and treated. It's estimated that about 49.9% in the last 12 months of healthcare use were treated for PTSD. And the other 51% were not. And in those with severe who received minimally adequate treatments, was 21%. So most of the people with PTSD do not receive adequate treatment for the problem. And PTSD is, also, very common in chronic pain patients. In this study, done by Sharp, 7% of the population had PTSD in the general population. Whereas in a chronic pain population, almost 30% of those patients had also concomitant PTSD. So what happens after the trauma? What causes PTSD? Well, you can either have a resilient reaction, or you can have a prolonged response to the traumatic event. So in the resilient response to trauma, the mind, the body, and the emotions of course, are in shock, it's a trauma. Your house burns down or you're in a car accident or a plane crash. You survive it, but it's traumatic. But you gradually adjust to what happened. You process the emotions, the thoughts related to it and you gradually recover. Now, in a prolonged response with post-traumatic stress disorder. The mind, body and emotions are still in shock initially just like in a resilient response but, you can not adjust to what happen so the person remains in shock. And the memories of the trauma stay fresh, you disconnect with those feelings because you can't handle those. And you withdraw from relationships. And there can be intense reactions to the trauma. These reactions include persistent, intrusive, and upsetting memories that bring the freshness of the trauma to the present. You can have flashbacks. You can, acting or feeling like the event is happening again. You can have nightmares. Either the event or other frightening things occur while you're sleeping and you have to wake up. You can have intense pain. Headaches, stomach aches, neck pain, jaw pain. And physiologic reaction, such as a pounding heart, rapid. Breathing, nausea, muscle tension and sweating. And these reactions, have also been documented in functional MR scans of brain activity. Here's a study done by the, Ringle and his group. Looking at functional MRI scanning in abuse victims versus normal controls. And you can see in both the MCC and the posterior, the middle and posterior thirds of the cingulate cortex were, activated in patients with abuse versus those who are in a control group. And that these, these areas of the brain are activate apherent pain processing, which is interesting. And so the activation associated with the dorsal signal ganglion are implement implicated in this homeostatic apherent pain processing. So, patients with abuse report more pain, and greater activity of the MCC and PCC activation and they have reduced activity of a region implicated in pain inhibition and result and arousal, which is the anterior cingulate cortex. All these findings suggest an explanation for the clinical observation of greater pain reporting, and poor outcomes in pain patients with a history of abuse. Chronic pain and PTSD is also common among veterans of war. 20% have suffered a traumatic brain injury with persistent headaches. 75% have back, shoulder, and knee pain, often aggravated by carrying heavy packs and wearing body armor. And then there's 19% required orthopedic surgery consultations and 4% needed surgery after returning from combat. And more than 177,000 have hearing loss, and more than 350 report tinnitus. So it's a significant problem among veterans. So what do we do about PTSD? I mean, is there a way to prevent PTSD? And there are several strategies after trauma that can be implemented. One is of course immediately providing some type of psychological first aid, and I'll discuss each one of these. Critical incident stress debriefing. Critical incident stress management. Pre-incident training for those, who are in situations that are prone to trauma. And preventing PTSD from war or terrorism and disaster and recovering from PTSD if you have it. Let me just go through these briefly. One is psychological first aid. This is a set of immediate actions to reduce initial post trauma distress and support adaptive function. Timing is critical. The core actions include initial contact and engagement, ensuring safety and comfort, stabilizing emotional status. Information gathering about the event, practical assistance on dealing with home or work activities, connecting with social support, information on improving coping and linking to support services. So, Critical Incident Stress Debriefing is something that's more of a single session that can occur after the trauma, and after the psychological first aid, that provides debriefing within hours to days after the event can help reduce PTSD. And this is typically completed by a trained professional educating victims about normal reactions to trauma. Encouraging them to share their experiences and feelings, their emotions, and ask them about their behavioural and emotional responses. And discuss how to begin the healing process in each of the seven realms. And this can be continued then in a more expand, expanded program called critical incident stress management. Now, this is our this includes extended sessions with more individual support to encourage healing, and to further deal with PTSD. This can include one on one counseling, small groups, information on processing recovery and expectations, and implement training in the seven realms, such as meditation, exercise, sleep, diet, support from relationships. Dealing with fear, depression, anxiety and creating a safe environment for the future. Now, for those people who often see trauma or dealing with trauma in high risk occupations such as emergency work, workers, there is a way to help prevent PTSD by doing pre-incident training. And this includes, demobilizing, Information about coping and stress to off duty groups. Diffusing or small group interventions with discussion, discussion of an incident. Dne-on-one individual crisis report and implementing training again in seven realms. So the take home, with regard to this part, includes preventing PTSD after trauma. Looking at the seven realms in the body, maintaining exercise. In lifestyle maintaining healthy sleep and diet. Don't drink alcohol. Or drink alcohol responsibly, or don't drink at all. Be active but maintain realistic workloads. Emotional factors: discuss fear, anxiety, and depression. Purse creative activities. The social realm: looking at balancing time between family and friends. Find personal time. Spiritual realm: find hope by defining your purpose and mission. Practice mindfulness meditation and relaxation to help to be centered. And in the mind, talk about traumatic experiences at the right time and place, and focus on positive experiences, memories, and images in life. And then finally create an environment that is safe. Be smart, prevent trauma, and create a safe protective life which we'll discuss in the next module. And recovering from PTSD follows many of the same strategies with regard to the seven realms, in each of the seven realms. So, with that regard thank you for listening and we'll discuss the next part. [SOUND] [BLANK_AUDIO]
