The 4 Emotional Dangers Of Chronic Pain Or Neck Pain
Neurosurgeon, Dr. Anthony Virella, has always believed that for many of his patients the effects of chronic back or neck pain is more than just physical. Studies over the past decade have confirmed the link between chronic pain and depression. One study theorizes that chronic pain can alter brain chemistry and that the brains of those with chronic pain may function differently than a “normal” brain.
For most patients dealing with chronic back or neck pain, there are several stages of mental anguish they may experience in addition to the debilitating physical pain. 1. Anxiety One of the most common symptoms among many patients is anxiety. This anxiety often has several contributing factors, namely the unpredictability of the severity of pain. In some instances, patients will have a day where they are only experiencing mild pain that is somewhat bearable. However, a sudden movement, which can be as simple as bending over to tie their shoe, can trigger intense radiating pain. It is this unpredictability that can cause many patients to live in a state of perpetual anxiety wondering when the next bout of debilitating pain will occur. For other patients, anxiety is brought on by the inability to sleep for
One of the most common symptoms among many patients is anxiety. This anxiety often has several contributing factors, namely the unpredictability of the severity of pain. In some instances, patients will have a day where they are only experiencing mild pain that is somewhat bearable. However, a sudden movement, which can be as simple as bending over to tie their shoe, can trigger intense radiating pain. It is this unpredictability that can cause many patients to live in a state of perpetual anxiety wondering when the next bout of debilitating pain will occur.
For other patients, anxiety is brought on by the inability to sleep for a meaningful period of time. Pain as a result of spinal conditions is often worse at night. This is primarily due to the fluid inside the intervertebral discs shifting with gravity and fluid dynamics. Meaning, if a patient lies on their back, the fluid can collect in one section of the disc causing it to become larger in that specific area. If that area of the disc is already irritating a spinal nerve root, the enlargement of that area of the disc can exacerbate the effects of nerve irritation. Most patients describe that they are never comfortable and are awoken several times per night with extreme pain. In fact, studies have shown that those suffering chronic pain have more difficulty sleeping than those that do not.
It has long been thought that there is a link between chronic pain and depression. This has been reinforced by studies showing that those with chronic pain issues are at higher risk of depression, dysphoria, and suicide.
Through trial and error, most patients with chronic pain will learn their physical limitations and the motions or behaviors that trigger more severe pain. For those patients with small children, the simple act of holding your child may be nearly impossible. This leads to avoidance behavior so as not to trigger painful symptoms, however, it does little to usurp the parent-child bond and many parents will feel that they are “bad parents” because they cannot even pick up their own crying child. Women who suffer chronic pain are especially at risk for depression brought about by these feelings.
For those who do not have a small child, they may realize that the activities and hobbies they enjoyed for years are no longer possible. Many miss family milestones, celebrations, and social gatherings and feel socially isolated. This isolation can lead to feelings that life is going on without them and exacerbate feelings of depression.
Fear generally has two components with the first being a fear of an actual diagnosis. Patients will often avoid having their condition diagnosed and instead choose to believe they can self-manage that pain with over the counter medication, herbal remedies or ergonomic devices. The primary reason for this is that acquiescing to be diagnosed means admitting that there is a structural defect in the spine that needs to be corrected with either a non-surgical or surgical intervention.
This leads to the second component of fear. For those who have not found relief with non-surgical modalities, such as physical therapy, the next step may often be surgery. Any form of surgery is often concerning for patients, however, spine surgery holds one of the more negative reputations among surgical procedures. Patients will almost always recount anecdotal stories of a friend or family member who underwent spinal surgery years ago and had less than optimal results.
While it is true that “traditional” spine surgery involved a massive amount of muscle and tissue dissection, multiple nights’ stay in a hospital, significant scarring and a lengthy recovery profile, modern technology has allowed for substantial advancements in this field. Many spine surgical procedures are now carried out using incisions of only a few centimeters and performed on an outpatient basis.
Opioid-based pain medications can play an important role in chronic pain management as they can allow patients to work, sleep and carry out activities of daily living with significantly less pain. However, these medications should only be utilized for a short period of time and be in compliment to a complete pain management protocol that includes physical therapy, non-surgical intervention or surgical intervention. When these medications are prescribed long term they can create issues that extend beyond chronic pain and into addiction and illegal activity.
Opioid-based medications have an incredibly high rate of addiction, as they are molecularly very similar to heroin. When a responsible physician is no longer willing to prescribe these medications due to a patient not following their treatment protocol, many patients will begin to try and purchase these medications on the street. However, these pills are often expensive and difficult to procure as regulations around these medications tighten. As a result, many will instead purchase heroin, which is far cheaper than opioid-based pills, in an attempt to satisfy their addiction as well as find relief from chronic pain. In fact, the use of heroin has risen 62% since 2012 and heroin-related deaths have quadrupled in that time.
Although the purchasing of narcotics to relieve pain may seem unsound, many patients will still opt for this dangerous lifestyle as opposed to agreeing to a surgical intervention. Their fear of overdose and addiction pales in comparison to the perceived drawbacks and risks of surgery.
Another complication as a result of opioid-based medications is they simple spinal conditions can progress into complex spinal injuries, as the patient is unaware of the continued damage being done to the spine. These medications can block the pain receptors to the brain and give patients the ability to have increased mobility. However, pain is the bodies natural alarm system that something is defective and turning those receptors off only masks the problem. For instance, turning off the smoke alarm does not mean the fire is out, as the problem is still there.
With an unstable spine, the forces exerted on it are more likely to cause further injury, which then leads to a more complex diagnosis and treatment. A simple disc herniation that could have been managed conservatively may develop into a multi-level spinal condition that requires an advanced surgical intervention. _________________________________________________________________________________________
Dr. Anthony Virella is a Board Certified Neurosurgeon and Spinal Expert as well as the Founder of Virella Neurosurgery. Dr. Virella encourages patients to be seen at the first onset of symptoms so that the physical and emotional tolls of chronic back and neck pain can be avoided. He also believes that patients should be active participants in their treatment protocols and use conservative modalities to treat spine injuries and only use prescription medications or surgical interventions after all other options have failed to provide relief.