Blog

Patients in chronic pain often experience significant anxiety which affects their ability to recover. David Hanscom, a spine surgeon and author of Back in Control: A Spine Surgeon’s Roadmap out of Chronic Pain, describes some of the main steps needed to address your anxiety.

1. Education: Unlike patients with an acute bout of usually self-limited pain, it is important for chronic pain patients to understand their diagnosis. They need to have clear guidance on whether they have a true structural abnormality (spondylolisthesis, stenosis), whether they are suffering from soft tissue (ligaments, muscles, tendons), or whether their symptoms might be arising from Mind-Body Syndrome (MBS).

I feel that all practitioners treating spinal patients (trainers, physical therapists, PT-aids, physician assistants, and physicians) should be well versed and able to educate their patients regarding their condition. With over half of the spine surgery performed today being unnecessary, patients need to be educated so they don’t ask for surgeons to operate on what ends up being normal aging anatomy or on patients’ anxiety. Remember that for most patients with significant low back pain there is no identifiable source.

2. Sleep: Adequate sleep is very important for calming the nervous system. Plan for improving your sleep up to 8 hours per day. This may require some temporary use of medications.

3. Neurological pathways: Learn about the formation of neurological pathways. Focus on anxiety and its relationship to pain. This will allow you to reprogram your neurological pathways to prevent anxiety. Dr. Hanscom recommends “free writing.” This is the process of writing down your negative thoughts and then immediately destroying the piece of paper. This allows you to separate from your feelings and to create space between you and the paper with vision and touch. With repetition, you will reprogram your nervous system to stop reacting with nervousness.

4. Medications: If you are already on medications, early on do not try to wean off medications until you get some improvement of your anxiety.

5. Rehabilitation: It is important to understand spine mechanics and anatomy. I agree with Dr. Hanscom to hold off on traditional physical therapy. We at SpineZone are specialized in spinal conditions and have had great success with starting the rehabilitation early. We have had success when our spine specialists provide proper instruction on spine mechanics (for lifting, bending, sitting) and strengthening exercises, along with the proper education about their condition as discussed above.