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Pain is a complex experience that includes both physical and psychological factors. Pain can be defined as "an unpleasant sensory and emotional experience associated with actual or potential damage, or described in terms of such damage." Acute pain can frquently lead to emotional reactions such as fear and anxiety.

A large part of the fear and anxiety is the unknown underlying cause of the pain and the uncertainty sround the effect that this may cause the patients normal daily activities and even life-span.

Knowledge about the condition, the treatment and expected outcome is paramount is countering the emotional reaction accociated with the pain and aids in faster and more complete recovery.

Important steps to conquering the emotional effects of pain

The underlying condition must be diagnosed and defined.
The expected treatment and possible success should be outlined
The prognosis should be established.
Both physical therapy and treatment to reduce pain should be instituted as promptly as possible, as this will prevent a cycle of ongoing pain and fear to develop.

What do you need to know?

Knowledge is power and understanding your condition is paramount for successful treatment. It is important to ask your doctor as many questions as you can - this is no time to be bashful or shy. When you have asked all your questions and have made sure that you understand the answers, you should write them down and then do as thorough research as you can. Talking to other patients is rarely helpful as they would most likely have a different cause for their neck pain and misinformation is much more dangerous than no information. Other patients will also frequently have preconceptions and misconceptions about the nature of neck pain as well as it’s treatment.

The internet is the greatest source of information as are information leaflets and books like these prepared by professionals. It is extremely useful to go back to your healthcare provider at this syage and clarify anything that has remained unclear at this point.

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The (vicious) cycle of pain

The effects of acute pain are many and varied. Acute pain can cause enormous amounts of stress and anxiety in patients. The factor of the unknown, the reduced ability to deal with everyday life, anger and uncertainty and fear combines in a heady cocktail that can spell disaster. Certain types of personalitiy traits and also certain perceptions or misconceptions add fuel to the fire. Think for instance of the anxious type of person who has seen a family member have a bad experience with neck pain, perhaps compounded by unsuccessful treatment or surgery.

The enormous amount of stress that the pain, the associated fear and anxiety and burdens of everyday life can place on a person is usually detrimental to a normal sleeping pattern. If you add the physical effects of pain, a vicious cycle develops.

During certain stages of deep sleep, an important hormone called serotonin is released from the body. This is a natural pain killer (endorphin - so called because it is the bodies own morphine) and also is important to combat depression. The reduced sleep leads to fatigue which makes the perception of pain more acute and also reduces the levels of endorphins (serotonin) secreted because of lack of sleep, reduces the bodies ability to fight pain and also causes depression.

Making sure that you sleep properly is therefore of paramount importance. This can be achieved by making sure that you have adequate pain relief from anti-inflammatory medication as well as simple analgesics and that their administration times allow you to have a good nights rest. Certain drugs such as amytriptiline increase the levels of serotonin and are also sedative without having addictive properties and can be taken on a chronic basis.

In patients where neglected pain is not managed properly and promptly, chronic pain may develop. The problem with chronic pain is that instead of becoming used to pain, patients become less able to deal with pain and their perception of pain changes. This means that instead of being able to tolerate pain better, they become less tolerant of pain and even if treatment at this stage is partially successful, the level of pain that would previously been perceived as acceptable or tolerable, now is perceived as untolerable.

Action plan to avoid depression and anxiety associated with pain

  1. Know and understand the source of the pain
  2. Understand the consequences of the condition as well as the long-term outlook
  3. Understand the possible treatment as well as your individual treatment plan and make sure that you do noy have unrealistic expectations.
  4. Make sure that you follow the treatment to the letter as well as any physical therapy that is prescribed. Report back if the treatment is not effective so that your healthcare worker may adjust your treatment.
  5. Sleep is of paramount importance, this cannot be stressed enough.
  6. Adjust your daily activities to cope with your condition. Be frank with your employer and make them part of you rehabilitation process. Keep them updated and they will support you much better than when you hide your condition or keep them in the dark.
  7. Depression and anxiety is a normal response in sever pain and if this manifests, treatment by a professional that may include counselling as well as anti-depressants can be invaluable.
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Dr Liebenberg consults from selected clinics, when he is in South Africa. Please inquire if you would like to see him specifically.