I often encounter a perplexing situation: A patient experiencing severe chronic pain on my spine intake questionnaire rates him or herself as a zero on a 10-point scale with regards to anxiety, depression, and anger. They may have even undergone multiple failed spine surgeries. Yet upon further, almost intrusive, questioning by me, they adamantly will stick to their story, “I am just fine except for the pain.” My next question is, “What about your pain?”
Your Hand Over the Heat
If you were to put your hand close to a hot burner on a stove, what would happen to your level of anxiety?
- It would quickly escalate.
- You would withdraw your hand.
- You would protect yourself.
- Anxiety would be alleviated.
What would happen to your anxiety if you were forced to leave your hand over the burner?
- It would go through the roof.
- You would feel trapped and extremely angry.
I don’t believe you’re OK.
Anxiety is a Programming Problem
The changes to the central nervous system during chronic pain represent a programming problem rather than a psychological problem.
- Anxiety gains strength with time and repetition.
- Anger is a powerful force that covers up the feeling of anxiety
- Anger spins anxiety-inducing neurological circuits more quickly.
- We deal with anxiety by exerting some form of control.
- If you are successful in controlling the situation or yourself, then your anxiety is alleviated.
- Without control, you become frustrated or angry. Anger = loss control
With chronic pain, you have, metaphorically, lost your ability to “withdraw your hand from the red hot burner.” How can you rate yourself as a zero on anxiety and irritability? If you had no other stress in your life, chronic pain alone would be enough to destroy the quality of your life.
There are several other stress factors to consider with chronic pain.
- People in chronic pain don’t see an end to their suffering. They lose hope in returning to a pain-free life.
- Chronic pain patients are truly victims of pain. So it’s more difficult to let go and not have anger run your life.
- When chronic pain patients suppress anxiety and anger, these negative feelings become much stronger. (2) White Bears and ANTS.
Being Pain-Free is a Basic Need
We all deserve to live free of constant pain. Being pain-free is a basic need. It has been shown that the impact of chronic pain on a person’s quality of life is equivalent to having terminal cancer. (1) We cannot accomplish higher goals and flourish as human beings without first securing the comfort of being in our bodies. I discuss this in “Maslow’s Miss” and in the video: “Your Hand Over the Stove.”
“The Link Between Pain and Anxiety”. Inspire, January 21st, 2013
- Fredheim OM et al. “Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients.” Acta Anaesthesiologica Scandinavica (2008); 52: 143 – 148.
- Wegener, DM et al. “Paradoxical effects of thought suppression. Journal of Personality and Social Psychology (1987); 53: 5 – 13.