Pain and Emotional Distress

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 frequently lead to emotional reactions such as fear and anxiety.

A large part of the fear and anxiety that accompany spinal pain is the unknown underlying cause of the pain and the uncertainty around the effect that this may have on the patient’s everyday life. 

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

Important steps in conquering the emotional effects of pain

1. The underlying condition must be diagnosed and defined.
2. The expected treatment and possible success should be outlined.
3. The prognosis should be established.
4. 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?
Understanding your condition is paramount for successful treatment. It is important to ask your specialist as many questions as you can.

When you have asked all your questions and have made sure that you understand the answers, you should write them down and then do thorough research. Talking to other patients is rarely helpful, as they would most likely have a different cause for their back pain or neck pain and misinformation is much more dangerous than no information. Other patients will also frequently have preconceptions and misconceptions about the nature of spinal pain as well as its treatment.

The internet is a good source of information, as are information leaflets and books written by professionals. It is important to go back to your specialist following your research and clarify anything that you are still not sure about.

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, uncertainty and fear combine in a heady cocktail that can spell disaster. Certain types of personality 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 spinal 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 are 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 by the body. This is a natural pain killer (endorphin, so-called because it is the body’s own morphine) and is also important in combating depression. 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. This reduces the body’s ability to fight pain and causes depression.

Making sure that you sleep properly is therefore of paramount importance. This can be achieved by ensuring 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 night’s 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 have been perceived as acceptable or tolerable, is now perceived as intolerable.

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 not have unrealistic expectations.

4. Make sure 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 specialist 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 your rehabilitation process. Keep them updated and they will support you much better than if you hide your condition or keep them in the dark.

7. Depression and anxiety are normal adaptive responses to severe pain and if these manifest, treatment by a professional that may include counseling as well as antidepressants can be invaluable. 




This website is a patient resource compiled from information from leading spinal surgeons practicing in South Africa and complements the My Spine – Lumbar and My Spine – Cervical information booklets that you can obtain directly from your spinal specialist. You will find information about spinal conditions and treatment on this website.

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My Spine – Lumbar and My Spine – Cervical information booklets are now directly available from your spinal specialist. All patients that are undergoing spinal surgery in South Africa should have access to these booklets. Please ask your specialist at your pre-operative visit about these booklets.