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

1. 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.
2. Wegener, DM et al. “Paradoxical effects of thought suppression. Journal of Personality and Social Psychology (1987); 53: 5 – 13.

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Anger

It is my observation that the whole system of care ignores the most significant factor that contributes to the development of chronic pain—anger. Anger is universal and part of the human experience. Some argue for the necessity of anger. In any case, it is not going away any time soon. Anger provides a useful survival mechanism. When you are threatened and feel anxiety, you will take evasive or avoidance action. When that ability to escape is lost, you will become angry, which increases your body’s physical reaction and mental focus to solve the problem.

Control

The antidote to anxiety is control.

Loss of control = anger.

The current disability system strips the worker of control. Additionally, at least in Washington State, the injured worker is at the mercy of a medically unsophisticated claims examiner. That examiner has final say in everything. As “enlightened” as I am, I cannot discuss a case with an examiner for more than a few minutes before I feel like I am losing my mind. I cannot imagine having my well being, as well as my livelihood, at the mercy of this system.

Dealing with the Anger

It will not matter what systems are designed to “incentivize” workers to return to work, unless this core issue of anger is addressed. You don’t have to incentivize any living creature to jump out of a cage. You just have to the door. Anger not only traps workers so they cannot fully engage in their care, but it also robs them of the ability or motivation to become engaged.

Although anger can be a useful survival mechanism, it is usually destructive to you and everyone around you.  Your anger imposes its own will on the immediate surroundings, and you lose all ability to rationally interact with your environment. The consequences are often disastrous. The most well designed programs are not going to be effective unless the wall of anger can be penetrated.

Anger and Frustration with Workers Compensation 

The post Anger and Workers’ Comp Webinar first appeared on Back in Control.

The post Anger and Workers’ Comp Webinar appeared first on Back in Control.

“Not much I can do”

I prepared to walk out the door and have her referred to a primary care physician. He or she could offer some basic care such as medications and physical therapy. But I did not know a way to have this quickly done, and she seemed like she was in a crisis. I turned around and walked back into the room realizing that at least her husband spoke some English. I spent about 20 minutes explaining the relationship between pain and the central nervous system’s response to it and gave them a copy of my book. I asked both of them to at least engage in the expressive writing.

Surprisingly, she and her husband returned. She could walk and conversed with me through the interpreter. Her whole body still hurt but she felt a little better. Her husband had not really engaged in reading the book. I was encouraged by the little progress, but I felt that if I was going to teach her anything about chronic pain, it was going to have to be done by me in the office through the interpreter. I spent about a half an hour going through the relationship between pain, anxiety, and anger. I again asked the husband to assist her in learning and translating the concepts. I also requested that she further commit to writing down her thoughts and immediately destroy them.

It was anxiety

They returned two weeks later and her pain was markedly improved. As I talked to her it became crystal clear that she was being tormented by extreme anxiety. She stood in the opposite corner of the room with her arms wrapped around herself and her whole body was quivering with fear. They had decided to move their family back to Puerto Rico so she could be with her mother. I realized that this was the last chance to turn this around.

I explained to her that although she might have a temporary decrease in her anxiety, she was not going to completely outrun it by being around her family. It was fine to move back home if that was what she wanted to do. If it was to escape anxiety, I felt that was a bad idea and it would follow her. I became very blunt with her and her husband about the whole situation. He needed to engage. She needed to address her anxiety as its own issue and commit to the writing process. I re-explained some of the central nervous system concepts. I was fairly sure they were headed back to Puerto Rico.

Better

Two weeks later they returned. She and her husband were both smiling. Her pain and anxiety were much better. They were not moving to Puerto Rico and were excited about how the situation was turning around. Her husband was more engaged and she had pursued her expressive writing with a vengeance. It had been extremely helpful. Her husband’s comment was, “I have my wife back.”

I have no illusions that she is yet home free. Recovery is not a straight-line endeavor.  But she now had tools and more importantly—hope. Her problem was not chronic pain; it was anxiety. I did not order any tests. I prescribed some medications for sleep and pain. I spent about two hours of my time talking to her. She engaged in the simple but powerful tool of expressive writing and has a high probability of continued improvement.

Back in action

What is this worth? There are two adults and two children in this family who have a higher chance of being contributing members of society. There is less family stress, which improves the behavior of the children, who are going to school with your children. The wife has a better chance of being an effective mother and getting back into the workforce. Minimal medical resources were expended and less will probably be spent in the future.

Four lives affected. Minimal medical resources expended. With her severe language barrier, writing down her anxieties was her only choice of tools. This occurred relatively early in my presenting the DOC process to my patients. I did not anticipate this outcome. Treating chronic pain has become one of the most rewarding parts of my practice.

BF

The post Freed by a Pen first appeared on Back in Control.

The post Freed by a Pen appeared first on Back in Control.

Self esteem involves endless judgment of comparing yourself to others around you. I discuss the negative impact that this concept has on us.

For more, see The Myth of Self Esteem.

The post Video: The Myth of Self Esteem first appeared on Back in Control.

The post Video: The Myth of Self Esteem appeared first on Back in Control.

I talk about how anxiety and stress can lead to certain obsessive tendencies. Some of the tools from the DOCC project are laid out, specifically those that can help break down the circuits that fuel anxious and stressful thoughts and behaviors.

For more, see Your Demons are Robots.

BF

The post Video: Anxiety and It’s Demons first appeared on Back in Control.

The post Video: Anxiety and It’s Demons appeared first on Back in Control.

I talk about how the suppression of negative thoughts associated with chronic pain can really fire up the nervous system.  Dr. Daniel Wegner from Harvard published an elegant paper in 1987 demonstratng the impossibity of trying to suppress thoughts. I’ve talked about it before in White Bears and ANTS.

BF

The post Video 16/19: “White Bears” first appeared on Back in Control.

The post Video 16/19: “White Bears” appeared first on Back in Control.

I discuss how anger is the turbocharger that keeps anxiety both covered up and fired up. Until you turn off anger you won’t be able to get a handle on your anxiety or your pain.

The post Video 15/19: Anger Fueled Anxiety-“The Highway to Hell” first appeared on Back in Control.

The post Video 15/19: Anger Fueled Anxiety-“The Highway to Hell” appeared first on Back in Control.

BF

The post Video 14/19: Chronic Pain: Pain Free is Not Only Possible, it’s Probable. first appeared on Back in Control.

The post Video 14/19: Chronic Pain: Pain Free is Not Only Possible, it’s Probable. appeared first on Back in Control.

Our brain has neurological circuits that can become memorized. In this video I discuss phantom pain, which is more the rule than the exception with amputations. This factor is a significant problem with any chronic pain situation.

The post Video: Memorizing the Circuits: Phantom Pain first appeared on Back in Control.

The post Video: Memorizing the Circuits: Phantom Pain appeared first on Back in Control.

I discuss how the brain becomes more sensitive to pain with repetition. I also introduce the first 3 “E’s” of the 5 “E’s” of chronic pain as well as the evolution of pain. The 5 “E’s” are Empathy, Evaluation, Education, Encouragement and Engagement. For more on this, check out Sensitization of the Nervous System.

BF

The post Video: Your Brain Becomes Sensitized first appeared on Back in Control.

The post Video: Your Brain Becomes Sensitized appeared first on Back in Control.