The Terrifying Triad

posted in: Stage 1, Stage 1: Step 2

When a basic human need such as air, food, or water is not met, we experience a deep feeling of anxiety.  We then take directed action to meet the need, which allays our anxiety. When the ability to meet our basic needs is taken from us, our anxiety escalates to fear and ultimately anger. I pointed out in the post, “Your Hand over the Stove,” that if you were forced to hold your hand over the hot burner of a stove, you would first experience extreme anxiety, which would be followed by anger.  When you are experiencing chronic pain, you cannot “get your hand away from the stove.”

Both the unpleasant physical pain impulses and your thoughts about your situation are pounding away at your nervous system are causing the secretion of stress hormones and you feel anxious and frustrated. These chemicals compound the problem in that they sensitize the nerves and you feel your pain even more.  There is a single general area of the brain that causes you to feel anxious and frustrated, which means that there is an intersection of pain, anxiety, and anger.

Additionally, we have other sources of anxiety and frustration. Pain sets off anxiety and anger, but so do other stresses. They are now are connected to the pain pathways. When you are under a lot of stress and experience more pain, it is NOT  imaginary pain or “psychological” pain.  These pathways are now just linked together. Neuroscientists have a saying, “Neurons that fire together wire together.” It is this connection between pain, anxiety, and anger that I call “The Terrifying Triad.”




My patients that work with the DOC process become quickly aware of this connection. It is clear that when other stresses rise past a certain point, there is a corresponding increase in their pain. It is unfortunate that the severity of the pain can be so severe that I frequently feel compelled to reorder expensive diagnostic tests, which rarely reveal anything of significance.

One final thought about the intersection of these pathways.  Even when I can surgically remove the source of pain, I think there is a permanent elevation of the intensity of these anxiety and frustration circuits. There is no reason they should dissipate, as there are so many other reasons for these pathways to remain stimulated. I feel that chronic pain is such a terrible experience, the elevation of anxiety and anger is often extreme.  Calming these pathways requires specific strategies that are outlined throughout this web site.