One of the more puzzling situations I have run into frequently is that I see patients who have experienced significant disabling chronic pain for many years. Often they have had multiple failed spine surgeries. Yet on my spine intake questionnaire they rate themselves as a zero on a scale from zero to ten in regards to anxiety, depression, and anger. Upon further almost intrusive questioning from me they adamantly will stick it. They are really just fine except for the pain.
I would suggest that we look at chronic pain from a different perspective. I have presented the concept that the central nervous system component of chronic pain is a programming problem rather than a psychological issue. Anxiety is an emotion that gains strength with time and repetition. Anger is a powerful force covers up the feeling of anxiety but spins these neurological circuits more quickly.
The way we deal with anxiety is exerting some form of control. You can control the situation or yourself. If you are successful then your anxiety is alleviated. If you lose control you will become frustrated or angry.
Consider anxiety as a reflex instead of emotion. It is the link that drives much if not most of our behavior and is intended to protect us. The sensation of pain is one of those protective tools.
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 and you would withdraw your hand. You would exert your ability to control the movement of your body and you would be protected. Your anxiety would be alleviated.
What would happen to your anxiety if you were forced to leave your hand close to the burner? Not only would it go through the roof you would feel trapped and extremely angry.
With chronic pain you metaphorically have lost your ability to “withdraw your hand from the stove”. How can you rate yourself as a zero on anxiety and irritability? If you had no other stress in your life, chronic pain is enough to destroy the quality of your life.
There are several other factors to consider with chronic pain.
• Where is the end? Where is your hope?
• You truly are a victim of pain. Remember that when you are truly a victim it is more difficult to let go and not have anger run your life.
• When you suppress anxiety and anger they become much stronger
You are deeply programmed to be able to “pull your hand away from the stove.” There is not a more basic neurological pattern. When you lose that ability to protect yourself from physical harm the effect on your nervous system is profound. Regardless of how well you think you are suppressing the response or not your nervous system is fired up. You are not going to “positively think” your way out of chronic pain.
David A. Hanscom, M.D., is an orthopedic spine surgeon. His focus is on the surgical treatment of complex spinal deformities such as scoliosis and kyphosis. Other conditions he treats include degenerative disorders, fractures, tumors, and infections of all areas of the spine. He has expertise with those who have had multiple failed surgeries. As many revision procedures are complicated he works with a team to optimize nutrition, mental approach, medications, physical conditioning, and overall health as part of the process. Surgery at our deformity center is always performed the context of a sustained pre and postoperative rehabilitation program. http://www.drdavidhanscom.com.