A person’s stress level has a marked effect on both your central and peripheral nervous systems. The central nervous system (CNS) consists of your brain and spinal cord. The peripheral nervous system (PNS) includes all other nervous system tissue—the nerves exiting your spinal cord, all sensory receptors, and sensory and motor neurons.
The secretion of survival “flight or fight” hormones such as adrenaline, cortisol and histamines affects every cell in the body, with the potential of creating over thirty physical and mental symptoms. Prolonged exposure has been shown to be at the root of most chronic diseases. One of reasons, as demonstrated in laboratory animal studies, is increased speed of nerve conduction, which intensifies the sensation of pain.(1) From a strict survival perspective, it makes sense: When the situation calls for it, you should be on high alert, in order to defend yourself and whoever else you’re responsible for protecting. But the relentless bombardment of stress hormones takes a toll on your body.
Consider driving your car down the freeway at 70 mph in second or third gear, instead of cruising in fourth or fifth. How long do you think your over-extended engine would hold up? The same is true for your body. Not only will you suffer a multitude of physical symptoms manifested by the burden placed on your body; you will be operating with a weakened immune system. For example, a large study found a clear connection between chronic stress and autoimmune disorders such as rheumatoid arthritis, Crohn’s disease, ulcerative colitis, ankylosing spondylitis, and psoriasis, among others. (2) Research results going back fifty years identify chronic stress as a risk factor for frequent and serious illnesses, (3) and a shortened life span. (4)
Factors that Determine the State of Your Nervous System
- Quality of sleep. Are you getting enough? Lack of sleep compromises every aspect of your treatment, whether it is surgical or non-operative care. Lack of sleep actually causes chronic low back pain.
- Level of chronic stress. Are you chronically anxious, frustrated, depressed, angry, fearful?
- Level of situational stress. Are you dealing with an unusually difficult situation in your life, in addition to the problems created by your pain?
- Physical manifestations. Are you experiencing random symptoms such as rashes, headaches, or tinnitus?
- Commitment to recovery. Are you open-minded regarding learning about the nature of chronic pain and the principles behind solving it? Are you willing to commit to a long-term program that will resolve your pain and improve the quality of your life? Are you addicted to your pain or using it to your advantage? Believe it or not, people often become addicted to being in pain. One’s medical condition can be powerful weapon, and the unwillingness to let it go is the one greatest obstacle to healing.
Considering these five areas is meant to give you a feel for the state of your nervous system and the extent to which protective (harmful when sustained) stress hormones and inflammatory molecules are coursing through your body. This is crucial information for you to know. A hyper-vigilant nervous system negatively affects not only your pain and your surgical outcomes, but your overall quality of life as well.
Expensive and harmful surgery
I ran across yet another case of a woman in her mid-forties who was experiencing chronic neck pain. Her cervical imaging showed some degeneration at several levels, which has been well-documented to not be a source of neck, thoracic, or low back pain. There was no compression of her spinal cord. She had the following additional symptoms.
- Pain migrating over her whole body
- Skin rashes
- On long-term methadone
- Difficult family situation
- Numbness and tingling in her hands
- Swelling of her fingers
- Generalized weakness
- Depression and anxiety
- Chronic headaches
- Ear pain
- Trouble swallowing
- Dizziness/ lightheadedness
- Had two low back surgeries with ongoing low back pain
- Left flank pain
- Thoracic pain
All of these symptoms are typical of a fired up nervous system and sustained fight or flight physiology. With any number of clinicians who are familiar with approaches to calm down and redirect the nervous symptoms, most, if not all of her issues could have resolved. In fact, we love to see and help these patients, as the outcomes are often so rewarding. Seeing someone without hope come out of The Abyss is inspiring. What we are observing is the body’s capacity to heal itself. But what happened?
Instead, she underwent a five-level fusion through the front of her neck and a five levels through the back her neck. This was performed on a spine that was normal for her age and no neurological deficits. There is nothing in our medical/ surgical training that indicates that this is rational and in fact it says the opposite. Performing surgery in the presence of untreated chronic pain will worsen the pain 40-60% of the time.(5) The data also shows that spine surgeons only address the risk factors for poor outcomes less than 10% of the time.(6)
The billed charges for the operation was over $200,000 and the reimbursement was almost $50,000. This did not include the surgeon’s fee or her ongoing medical care. In contrast, her problems could have been solved with minimal resources and no risk. Patients often completely come out of medical care. She predictably is having ongoing neck pain, is actually doing worse, and is having a hard time holding her head up. She is still experiencing rest of her symptoms.
You have to take charge of your care
Before you embark on any spine surgery, unless it is an emergency, please look at my book, Do You Really Need Spine Surgery? It breaks down the decision into four quadrants that are easy to identity. Once you understand you situation in this context, the decision will usually become more clear. I am in favor of performing surgery for a clearly defined lesion with matching symptoms. The results are better if you calm down the nervous system before making the final decision. It is what the data says to do. I call it prehab.
Most of you know, I quit my practice to see what I could do to slow down the juggernaut of aggressive surgery on normally ageing spines. It is why I wrote this book and it is for patients and providers alike. Surgeons must be held more accountable. It distresses me that this level of harmful surgery is continuing to increase, and it should not be in your lap to have to take such a large role in the final decision. This type of surgery should never be offered to anyone. Please don’t let it happen to you, your family, friends, or anyone.
References
- Chen, X et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience (2011); 185: 166 – 173.
- Song, H et al. “Association of stress-related disorders with subsequent autoimmune disease.” Journal of the American Medical Association(2018); 319: 2388 – 2400.
- Rahe, R et al. “Social stress and illness onset.” Journal of Psychosomatic Research (1964); 8: 35.
- Torrance, N et al. “Severe chronic pain is associated with increased 10-year mortality: A cohort record linkage study. European Journal of Pain (2010); 14: 380– 386.
- Perkins FM and Henrik Kehlet. “Chronic Pain as an Outcome of Surgery.” Anesthesiology (2000); 93: 1123-1133.
- Young AK, et al. “Assessment of presurgical psychological screening in patients undergoing spine surgery.” Journal Spinal Disorders Tech (2014); 27: 76-79.