It has become increasingly clear that if a given patient engages in the principles outlined in this book that they will experience a dramatic decrease in pain and improved quality of life.  The richness of their new life often exceeds anything they experienced before their nightmare of pain began.  It is not a matter of “if” they get better it is “when.”  There is not an exact roadmap and often other resources fit a given person’s needs better than what I have suggested.  The key is to first address the anxiety, then the anger, and continue to “shift” the nervous system into a more functional set of circuits.  The plan must be somewhat structured and consistent to be effective.

However, the absolute major block I enounter almost every day is anger.  I honestly do not know how to help a patient get past it.  When anyone is angry they become irrational. When you are chronically angry it is your baseline and you cannot even recognize that you are angry.  I personally had no clue that I had any anger issues until I was 50 years old.  In fact, one of first lines to my wife when I first met her was that I was a “good catch” because  I had dealt with all of my anger issues.  I am glad that neither of us had any idea that I had not even opened the door to my frustrations as we never would have made it.

The problem with anger is that you cannot listen and accurately assess a given situation.  The conversation I have with a patient who is “entrenched” goes like this:

“Doctor, you mean to tell me that there is nothing wrong with my back.  I have been in pain for several years and I know that this pain is not in my head. You must be missing something.”

I reply, “The pain you are experiencing is not imaginary pain nor is it psychological.  We know that if we did a functional MRI of your brain right now that the part of your brain that corresponds to your area of pain would light up brightly.  All that matters is what is happening in your brain.  We also know that the brain can fire spontaneously without an indentifiable source of the pain.  I don’t believe you have the pain I know you are experiencing the pain and are very frustrated about being trapped.”

I also explain to them that degenerated discs are normal as you age and that there is no correlation between a degenerated disc and back pain.  The surgical success of a fusion for LBP is less than 30% with a significant downside of a failed surgery.

They then say, “I don’t want surgery.  I just want to be fixed and get my life back.”

When I reply that we have had very consistent results following the steps outlined in this book they explode saying, “I don’t want to read a book or anything like this. Just do something to fix my back.”  They will then starting ranting and often yelling that no one will help them.  Occasionally the will walk out of the room.

This is a frequent scenario.  I would estimate that at least 50% of my patients fall somewhere in this part of the spectrum.  They are “entrenched.”  I realize that chronic pain causes anger. It is that same anger that is also a complete block to engagement in effective treatment.  Anger is destructive and it is multi-directional.  It is particlurlarly self-destructive.  You also have a strong sense of “being right” when you are angry and even a stronger sense of everyone else “being wrong.”

I honestly do not know what to do to break into this mind set.  I have tried everything from being confrontive to being incredibly patient.  Nothing has worked.  In fact I have found out that the longer I spend trying to convince someone to engage the more angry they become.  It appears that people that are angy don’t like to be convinced to give up their anger.  Maybe they just cannot hear me.

If you are angry or living in one of the above disguises of anger, be careful.  You are trapped.  You are truly stuck and no one can even throw you a lifeline.  What you cannot see is the havoc you are wreaking on those around you and onto yourself.  I am open for suggestions.

NH