The Fear Factor


Kate came into my office in despair. She had suffered with sciatica for several months and she had just seen her MRI which showed a mild lumbar spine disc bulge and some pressure on the nerve root. She was worried that the pain would be there for the rest of her life or she would need surgery in order to get better.

Kate is not alone; many of the people I see in pain are frightened about the diagnosis they have received or by the scans they have been shown. This was my experience too, and remember being stunned and afraid when I saw my cervical disc bulges on MRI and when I was diagnosed with interstitial cystitis.

Kate visibly relaxed when I told her that the level of pain is not always directly related to the  severity of the structural problem in the body. As a physical therapist I have heard stories of clients with scary MRIs that are pain free, and others with just mild issues on the scan who are experiencing major pain. There is also evidence that physical signs on Xray and MRI are not directly related to the onset, duration severity or prognosis of low back pain.

To her surprise, Kate was pain free during yoga, meditation and after our session of holistic bodywork.  I too was surprised when I was pain free during yoga class at the start of my chronic pelvic pain condition. For both of us, the physical condition didn’t fully resolve during these therapies, but the pain decreased and this made us wonder if there was something more to our pain than a physical issue.

While we may have physical problems, pain is transmitted by the nervous system and is interpreted in the brain, and there are many factors related to whether these signals are transmitted. Studies on pain perception from the neuroscientist, Lorimer Moseley suggest that the level of pain experienced by a person may be directly related to the perceived threat of the stimulus. The brain receives all types of inputs and it filters out those that it deems crucial for survival, and when an input is considered threatening we may experience it as pain.

This theory matched my personal experience.  It has been eight years since my chronic pelvic pain began, and even though I am pain free on most days, my bladder pain and pelvic floor spasms rear up occasionally. Even though I have the same symptoms, I am now much less fearful  and can remain calmer in the storm. With this mindset, the condition seems to resolve more quickly, and the same symptoms are not as bothersome. When I worked to heal from my chronic neck pain, I attributed my decrease in pain to my physical therapy and home program and changes at the body level. And while this is true, I can now see how the resolution of my pain was related to mental/emotional factors too.  Finding therapists I trusted and actively working to recover gave me a sense of empowerment, and this decreased my fear. During both of my bouts with chronic pain, there seemed to be a direct feedback loop between my level of fear and the level of pain I experienced.