Hello doctor, I have been experiencing severe pain in the back of my head and neck region with dizziness since six months now. I went to physiotherapy and took some muscle relaxants but with no effective relief. With anxiety tablets like Amitriptyline, it felt better for a few days but again it came back when I quit taking that medication. At nights, I feel burning and tingling sensation in the legs. I am suffering from an anxiety disorder since a long time around 10 years now and took several medicines in different times like Amitriptyline, Duloxetine, Pregabalin, etc. for different time lengths whenever I feel very anxious but never in medication more than a month. I did a blood test and an X-ray and MRI (magnetic resonance imaging) of the cervical spine and all are normal as per the doctor. But in the MRI, there seems to be a minor left-sided disc bulge with nerve root compression at C5-C6 with no radiculopathy symptoms and the orthopedic doctor suggested to take a muscle relaxant and simple exercises to cure it. He ruled out that my back and head pain can be created due to this. I also recently consulted a neurologist because I started feeling nausea and blurred vision and loss of focus. He prescribed me Nuhenz and Symbal tablets. With two days of medications, I felt better with the head pain but I still have dizziness and nausea. My questions are:  Are my health symptoms pointing to severe anxiety and is there a way to test the anxiety level? Are the problem of burning legs and back and head pain related to severe anxiety?   Can severe anxiety be cured completely without any medication?   Should I see a psychiatrist and be on a long-term medication given the fact that I am extremely worried about my health issues and all this started to hamper my daily life now?  I can provide all the test reports if required.
Hello. I have gone through the clinical description and attached reports (attachment removed to protect patient identity). My answer to your questions is that we do not have anything to gauge your anxiety with some instrument but it can be detected with a complete history and physical examination. At this level, there is indirect evidence to suggest that your symptoms are largely due to anxiety than anything else. This is evidenced by a good response to almost all anxiety medications in short duration. It is often stated that any symptom related to any system of the body can be explained on the basis of anxiety. The criteria in favor of anxiety are the absence of anything else to explain the system and same is true in regard to your back pain and other symptoms as MRI (magnetic resonance imaging) is quite clear and it cannot be the cause of your symptoms. Yes, it can be treated without medication with the use of cognitive behavior therapy provided you have access to the clinical psychologist in your city. However, I like to make it clear that CBT (cognitive behavioral therapy) is not for everybody and psychological mindedness is a pre-requisite to have a useful CBT. I think you need proper assessment for evaluation of the severity of your anxiety disorder. Then, it will be worth to discuss the need for medication. In fact, your psychiatrist will be glad to discuss these important details which will be useful for long-term care. For more information consult a psychiatrist online -->