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My brother just had some tests related to his carpal tunnel syndrome. They said he wasn't a good candidate for surgery because of a high level of pain anxiety. What is pain anxiety? Wouldn't surgery relieve the pain and reduce his anxiety?

It's true that pain by itself can increase anyone's anxiety level. And relieving anxiety can often reduce pain by as much as 50 per cent. But pain anxiety is a little different idea than just anxiety caused by pain.

Pain anxiety is a combination of mental and psychologic anxiety, fear of pain, and escape and avoidance behaviors. There are some tests that help sort out pain versus pain anxiety. The Pain Anxiety Symptoms Scale (PASS) measures how often patients have negative thoughts related to their pain.

A subscale also measures the frequency of thoughts that bring on fearful responses. And the test brings out how often dread of negative results of pain occurs. Other measures include physical responses to pain such as increased heart rate, elevated blood pressure, and sweating. All of these are measures of pain anxiety.

Pain anxiety decreases a patient's ability to cope effectively with pain. The person tends to catastrophize their symptoms. This means they think about the pain, focus on the pain, and magnify the pain. They sink into thoughts of helplessness and hopelessness.

Surgery is not usually advised for patients with pain anxiety. Their symptoms are not alleviated. They end up very dissatisfied with the results. A program of behavioral and psychologic counseling is a better choice at first. Once the psychologic factors are overcome, then the need for surgery can be reevaluated.

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