This story about how anger can affect the perception of pain involves one of my patients who had a complication from a revision spine fusion. Mike was a 52 year-old respiratory therapist who was very active–the man ran marathons. Years after an initial spine fusion at L5-S1 at age 30, his spine broke down above the level of the prior fusion and became very unstable. He waited almost five years before talking to a surgeon.
I performed surgery through his abdomen to place a hollow cage filled with bone graft at L4-5, the level just above his prior fusion. The purpose of the cage was to both stabilize the spine as well as to improve the chances of a successful fusion. Still, under anesthesia, he was turned over and had screws placed into the vertebrae to further increase the chances of a good outcome.
The surgery went very well, and he felt much better for a few weeks. He felt good enough that he increased his activity too quickly, which placed too much stress on the screws. For reasons that were unclear, he also had very soft bone. The screws broke out of the bone and irritated the fifth nerve root that travels down the side of the leg. His sciatic pain was unbearable.
I took Mike back to surgery to re-do the placement of the screws. Post-surgery, his nerve, already irritated and painful, did not calm down, and he developed a continuous, severe, burning leg pain.
At his one-month check-up, Mike exploded at me. His hour-long rant was not rational. Nothing I could say calmed him down. Afterward, he apologized. He said he was angry at the situation, not at me.
I was not in a great state of mind after the verbal barrage, but I elected to hang in there with him and began to apply the DOCC principles. Mike’s pain improved with aggressive pain medications. We also aggressively addressed his long-term problem with sleep. After some initial resistance, he engaged in the exercises in the Feeling Good book and started to look at his pain from a stress management point of view. He started to consistently write down his disruptive thoughts and then write down more rational thoughts. This process will be discussed further in Chapter Four, Reprogramming Your Nervous System.
At about three months after the second operation, his nervous system had calmed down enough to do aggressive physical therapy. If you do physical therapy too early while the nervous system is still fired up, it just flares up the pain and backfires. About six months into the healing process, he was doing much better. He had calmed down, and so did his leg pain.
The rehabilitation was difficult. Mike would be doing extremely well with little or no pain and then suddenly have severe flare-ups. At first, it wasn’t clear what was causing this back-and-forth. Gradually, however, he began to see the link between his level of stress and pain.
About six months into his recovery Mike went back to his job in the financial world. In spite of the work he had already done, he was still asked by his employer to participate in a month long anger management class. It had a dramatic additional impact on his ability to process his anger.
One year after the surgeries, the program had worked—Mike’s chronic pain was gone. He sometimes had a slight sensation of pain, but only when he became frustrated; it was nothing like the severe pain he had felt before his surgeries. At his two-year follow-up, he was back to work full-time and had improved to the point where he was running marathons. In addition to solving his back problems, he was able to enjoy his relationships and life again. As painful as the experience was for my patient and me, his journey was a gift to both of us.
Another patient stands out when I think of these kinds of turnarounds. This one was a middle-aged woman, who had injured her back lifting on the job about two years earlier. She had mostly low back pain and some pain in her right leg. I am always very careful not to miss a problem that might require surgery. I obtained an MRI scan and it showed a bone spur that might or might not have been causing her leg to be painful. However, as her low back pain was the worst pain, she did not want surgery. I worked very hard with her with the protocols of the DOCC Project. Every visit was negative. She was angry with everyone, especially me for not fixing her. I set my goals lower; I wanted to just keep her at a relatively comfortable level. I did not think I could improve her function. Every time I saw her name on the schedule, I would just mentally give up. I felt my lines were always the same lines.
One day about nine months later, she walked in smiling. She told me that she had found a job. She wanted to stop her narcotics. She had joined Weight-Watchers and Curves. She wanted to see me one more time and that was it. On her last visit, she was on a roll.
When I asked her what had happened, she said that she was tired of being angry and just made a choice to do something different. This encounter occurred well before I had any concept of the role of anger in magnifying the perception of chronic pain. My only concept at the time was that if I couldn’t help someone’s pain with surgery, I would at least offer some stress management skills to help cope with the stress of having chronic pain. I was very surprised, as the DOCC protocol evolved, that a patient’s perception of pain would consistently decrease as their anger and stress decreased.