I am an orthopedic spine surgeon who deals with patients in chronic pain on a daily basis. Here’s a puzzling situation I often encounter: A patient is experiencing severe chronic pain on my spine intake questionnaire rates him or herself as a zero on a 10-point scale with regards to anxiety, depression, and anger. They may have even undergone multiple failed spine surgeries. Yet upon further, almost intrusive, questioning by me, they adamantly will stick to their story, “I am just fine except for the pain.” I find myself invariably thinking, “Really??
The Link Between Anxiety and Pain
If you were to put your hand close to a red-hot burner on a stove, what would happen to your level of anxiety?
- It would quickly escalate.
- You would withdraw your hand.
- Your anxiety would be alleviated.
What would happen to your anxiety if you were forced to hold your hand close to the red-hot burner?
- It would go through the roof.
- You would feel trapped and extremely angry.
With chronic pain you have metaphorically lost your ability to “withdraw your hand from the red hot burner.”
How can you rate yourself as a zero on anxiety and irritability? If you had no other stresses in your life, chronic pain alone would be enough to destroy the quality of your existence.
Chronic Pain Changes How We “Feel”
The changes to the central nervous system during chronic pain present a programming problem rather than a psychological problem. Consider anxiety as a “mental reflex” instead of an emotion. It’s a protective reaction that drives most of our behavior. By looking at anxiety from this perspective of “neurological pathways” instead of psychology consider the following.
- Anxiety gains strength with time and repetition.
- We deal with anxiety by exerting some form of control.
- If you are successful in controlling the situation or yourself, then your anxiety is alleviated.
- Without control you become frustrated or angry.
- Anger is a powerful force that covers up the feeling of anxiety.
- However anger spins these anxiety-inducing neurological circuits more quickly.
There are several other stress factors to consider with chronic pain.
- People in chronic pain don’t see an end to their suffering. They lose hope.
- Chronic pain is unpleasant and they are truly victims. When you are legitimately a victim, it is more difficult to let go and not have anger run your life.
- People close to them often do not believe that the suffering is real, as usually an identifiable source for the pain cannot be identified.
- Endless treatments are given with the promise of relief. How many times can one deal with broken promises and maintain any sense of optimism?
We all deserve to live free of constant pain. Being pain-free is a basic need. We cannot accomplish higher goals and flourish as human beings without first securing the comfort of being in our bodies.
Dr. David Hanscom, M.D., is an orthopedic spine surgeon at Seattle Neuroscience Specialists with Swedish Medical Center in Seattle, WA. He specializes in complex spine problems in all areas of the spine, and has expertise in adult and pediatric spinal deformities, such as scoliosis and kyphosis. Many of his patients have had multiple prior spine surgeries. He has successfully treated hundreds of patients for chronic pain. He is author of Back in Control: A Spine Surgeon’s Roadmap Out of Chronic Pain.
Featured photo by mislav-m