Dr David McGrath

Spine Physician

MB BS (Hons) FAFOM, RACP, FAFMM
Master of Pain Medicine

Worry and Fear can be very valid and useful emotions. Like all emotions, they are arise in a context and prepare the body for certain useful actions. (see The Why of Emotion or the Power of Curiosity)
The question is, are they useful in a chronic pain context ?
Pain is generated by abnormal geometry and disturbance pathways. Actions which are appropriate to correcting that situation may not be supported by worry and fear.
We might obtain an insight into its usefulness, by analising the origin of this emotion.
Worry and Fear is the emotion of flight or fight. As a hunter we demonstrate agressive behaviour. As the hunted we either flee or defend. The emotion sustains primitive reflexes such as an increase in heart rate and increased energy supply,needed for the emmergency action. Over long periods however it may contribute to sustained levels of high blood pressure.
People are unique,in the ability to sustain a threat by imagination. The physiological preparation is identical to the presence of an actual threat.The question to be asked is: Is the emotion worth it ?

Looking at the contingency table:

Worry Outcome	Problem Solved	Problem Unsolved
Worry Prominant	a	b
Worry Absent	c	d

Cell "a" indicates that worry was prominant in solving the problem
Cell "c" indicates that another emotion was dominant in solving the problem
Cell "b" indicate that despite worry, there was no solution to the problem
Cell "d" indicates that there was no worry and no solution

The ratio a/(a+b) minus c/(c+d) would be the absolute benefit of worry over some other emotion.

The numbers in this table would be speculative, as we have no reliable method of determining the presence or otherwise of worry.
There is a consenses view (not valid as science) that some worry is helpful, while excessive worry is negative.
The increased energy provided by worry, may lead to greater discussion, more consultations, more therapy sessions,more interventions. Given the increased activity, the probability of a solution might be greater.
On the other hand, worry may increase blood flow diversion , increase cortisol levels, increase adrenaline levels and reduce the healing rate.

This has evolutionary sense. The purpose of worry is to run away not heal internal disorders. Given that worry is a positive and negative situation with
1.a possible increase in finding good advice versus
2.a possible decrease in healing rate
other emotions might be a better bet, if the solution is not found within a relatively short period.