4 – The “Modifiers”

There is an anatomic/physiologic injury that initiates a pain impulse. When you feel this pain over a period of time, the nervous system becomes sensitized to the pain impulses. Eventually, your nervous system will memorize part or all of the pain.

This sequence is intertwined with another series of events we’ll call the “modifiers.” The modifiers are the sum of the emotional responses to the chronic pain. Patients often become anxious, frustrated and angry; they lose sleep and their stress level rises.

Pain “modifiers” are important to understand because under stress your body chemistry changes. Your stress hormones, including cortisol and adrenaline, become elevated. Adrenaline is the “fight or flight” hormone; when secreted, it causes your heart to race, your blood pressure to go up, and you experience anxiety. Cortisol has more of a chronic effect by mobilizing energy stores and increasing your baseline metabolism.



As a result, several things happen.  Your pain receptors and nervous system now exist in a different chemical environment, even though there’s no physical affliction. What is the ultimate result? Your senses are heightened and you may experience even more pain. Your decision-making skills are also affected: that’s why it’s crucial to address the emotional aspect of pain before deciding whether to get surgery.

The “modifiers” that we’ll discuss are sleep, anxiety, and anger.