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Anxiety and Stress Disorders

Anxiety and Chronic Pain

08/26/2008

Question:

Hello Doctor, I suffer with fibromyalgia as well as Chronic Pain Syndrome stemming from nerve damage to my left side. On occassion recently,I have had to seek the help of the local Emergency Room because my narcotic meds were not helping and I recently moved from New Mexico to Indiana and was not established with a doctor yet. There have been several times that my chronic pain has become a behavioral health issue in that the doctor is more concerned about my anxiety then the pain that has just gotten too bad for me to bear. One doctor told me I appeared very anxious and I replied, "Yes I probably am. I feel like I am not in control of what is happening with my body, I`m anxious about appearing anxious, and I`m anxious that you might be one of those doctors who thinks this is all in my head and treats me like crap. One doctor had behavioral health come and ask me some questions and was trying to admit me to BH. The therapist asked me if the psychiatrist wanted to admit me would I stay. I responded with I first would like to know why he thinks I should stay not simply because I appear anxious. I have gone to counseling for my depression and mood disorder so the psychiatrist felt it was not needed to keep me. I just don`t understand why my anxiety is such a big issue. Once my pain is tolerable again, my anxiety lessens. Don`t most people become anxious when they are in pain? Everyone is telling me I appear anxious, but no one is giving me their reason they are saying this. Yes, my blood pressure and pulse are high, but isn`t that also a symptom of pain? I`m not grabbing my chest saying I think I am having a heart attack. Can you help me better understand why this is such a big issue?

Thanks

Answer:

Anxiety and depression are closely tied to chronic pain, and it is quite difficult to treat and manage one without managing and treating the other.  In the experience of many medical people, there are patients who ONLY want to treat the pain while ignoring the role of depression and anxiety.  These people generally do not do as well as those who treat all the important issues.

I would applaud health care providers who want to treat you as a whole, entire person and not just as "chronic pain."  Primary care providers who develop a relationship with you will, of course, over time, get to know you and how your own struggle with pain, anxiety and depression are manifested.  In an emergency room, the health care providers are only seeing a one-time snapshot of you and will need to ask more questions, make more suggestions and offer diagnoses that you may have previously answered, considered or tried, but they won't know that in one visit.

Good Luck.

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Response by:

Nancy   Elder, MD Nancy Elder, MD
Associate Professor
College of Medicine
University of Cincinnati