Incompetent Physicians, Coming to Terms with Mental Disorders, and Frustration!

[Eye_in_the_Sky]

I’m an LCPC and I see people all the time that have been told their pain is “all in their head(s)”. As someone who also suffers from an ongoing pain issue due to an injury, I find some approaches to treating and managing pain to be quite unhelpful and in some cases, counter-productive. However, as a therapist, I also will say that there is a high co-morbidity of pain and depression/anxiety. There are a myriad of reasons for this, but it doesn’t hurt to try and address each issue with a specialist.

When I see people for pain issues, we do sometimes learn that there are other things going on. If we learn those things are going on, we address them (I’m not a doctor, so I refer to a psychiatrist for medication management), but I never negate a person’s reported pain. It doesn’t matter if I think they are malingering, because there has to be a reason for it even if they are. My job is to help address that reason or reasons.

I am so sorry for the uncool bedside manner you received, OP. I ran into several uncomfortable doctors during the initial diagnostics of my work injury, but I eventually found two fabulous doctors I trust. I wish you the best in whatever you decide to do.

[HOOF123]

HORSES are always there- for whatever reason just like your family pet.

[PaintPony]

I also suffer from chronic pain as well as psych issues. I, like you, did not like the stigma that mental illness comes with and was also told that my pain is in my head.

Once I pulled my head out of my butt and found the right shrink AND therapist it made the WORLD of difference. I am pissed that I let myself suffer for so long. I honestly don’t know how I lived like that.

And if you can find a physical therapist out there who is certified to do dry needling I HIGHLY recommend it. I didn’t like the idea of it at first (and still don’t like having it done :)), but it has been amazing in terms of pain relief for me.

My PT has known me for 6 years now and has come up with some great ideas for managing my pain. Finding the right people is very important!! It may take a while to find them, but it is key. Don’t give up!!

[poltroon]

A reminder about pain.

Pain is what happens when neurons fire and are shouting at your brain.

Thus, all pain is “in your head” whether it’s caused by neurons firing improperly or neurons firing to alert you that your leg has just been crushed.

If it is because neurons are firing inappropriately, your head is only receiving the message, not sending it.

This doesn’t make it less painful, but it does mean that this kind of pain does not imply that your brain is malfunctioning in any way.

Something else to remember is that psychiatrists are MDs first, and they’re one of the few doctors who are paid to sit and listen to you for a full hour at a time. Thus, they will have a chance to get to know you better, and I know a few people who have had root causes of pain or illness missed by a GP who were diagnosed by a psychiatrist. They’re just doctors with different tools, like an orthopedist vs an OB. So, if that’s a direction that’s been suggested, don’t fear it. Embrace it and find yourself someone insightful and terrific who can help.

It sounds like you’re headed on the right track. Good luck!

[Eye_in_the_Sky]

Actually, unless you pay out of pocket and have a specific reason to do-so, most psychiatrists do NOT sit and listen to anyone for an hour. Most appointments with a psychiatrist (except the initial eval) take 20-30 minutes and are known in general as “medication management” appointments.

Psychiatrists (like the one I spoke with today) rely on licensed therapists and psychologists to coordinate care with them regarding their patients. We do the “talk therapy” while the psychiatrists do the medication therapy.

I have worked with many psychiatrists over the years, and not a single one does their own therapy for clients. I’m not saying none do, but even those in private practice seem to refer out to a licensed provider to do the talk therapy.

You are correct regarding the neurons and the pain receptors. However, when a person is told “it’s all in your head”, the meaning is that the pain is not real and thus they should stop complaining. These patients are often categorized as “malingerers” and it can be detrimental to a person seeking help, no matter what the etiology of the pain may be.

[kdow]

[QUOTE=Eye in the Sky;5540947]

You are correct regarding the neurons and the pain receptors. However, when a person is told “it’s all in your head”, the meaning is that the pain is not real and thus they should stop complaining. These patients are often categorized as “malingerers” and it can be detrimental to a person seeking help, no matter what the etiology of the pain may be.[/QUOTE]

Plus the general notion that most people who are claiming chronic pain are “malingerers” makes it a giant PITA to get pain killers from anyone other than your normal regular routine doctor.

(I’m not even talking about super-duper narcotics, here. I’m talking about the other doctor in the practice that I’d been at for years not wanting to write me a refill script for tramadol when I slipped and fell and jarred my back so the arthritis in my spine was really excruciating. Apparently, in the future I need to schedule any accidents and injuries for when my personal GP is on call.) (I would have been fine, even, if he’d only wanted to prescribe a couple to get me through until I could see my normal GP in person, even though I imagine he should have had some sort of access to my file at the practice, which clearly states I have arthritis and take tramadol as-needed for pain.)

The entire attitude towards pain and pain management can be very cranky-making.

(And oh, do I have some words for people who are legitimate drug seekers who just mess things up for those of us with real need…)

[poltroon]

[QUOTE=Eye in the Sky;5540947]
You are correct regarding the neurons and the pain receptors. However, when a person is told “it’s all in your head”, the meaning is that the pain is not real and thus they should stop complaining. These patients are often categorized as “malingerers” and it can be detrimental to a person seeking help, no matter what the etiology of the pain may be.[/QUOTE]

I agree. I think that’s a very improper phrase to use, which was my point.

“I can’t detect the cause of your pain” would be a lot more accurate and a lot less pejorative.

Even,
“I can’t detect the cause of your pain, and science may not be able to right now. Let’s work out what can we do to give you the everyday function you need despite this pain.”

[grayarabpony]

[QUOTE=kdow;5541026]
Plus the general notion that most people who are claiming chronic pain are “malingerers” makes it a giant PITA to get pain killers from anyone other than your normal regular routine doctor.

(I’m not even talking about super-duper narcotics, here. I’m talking about the other doctor in the practice that I’d been at for years not wanting to write me a refill script for tramadol when I slipped and fell and jarred my back so the arthritis in my spine was really excruciating. Apparently, in the future I need to schedule any accidents and injuries for when my personal GP is on call.) (I would have been fine, even, if he’d only wanted to prescribe a couple to get me through until I could see my normal GP in person, even though I imagine he should have had some sort of access to my file at the practice, which clearly states I have arthritis and take tramadol as-needed for pain.)

The entire attitude towards pain and pain management can be very cranky-making.

(And oh, do I have some words for people who are legitimate drug seekers who just mess things up for those of us with real need…)[/QUOTE]

Holy cr@p. That guy should have called in at least a couple to tide you over until your regular doc could see you or call it in.

[Vegas_Sky]

Wow, so this thread got resureccted while I was away!

Spring term has been INSANELY busy! But I’m doing very well.

I really, really agree with poltroon, eye in the sky, and kdow - the attitude of “malingerers” is extraordinarily frustrating, only compounded by drug-seeking individuals or those very few, rare people who consciously and willfully malinger for some sort of gain.

Pain is suck a fickle thing. Is there an identifiable cause? Is it misfiring neurons? Are those neurons sending afferent or efferent signals? From where does the pain originate? How do we treat it?

I think I’ve finally found my answer over the last six weeks.

Really, I just decided that I was going to get on with my life. I wasn’t going to let it control me anymore. It didn’t make the pain go away, but it sure made it a lot easier to deal with.

I think the lamictal I am on for my seizures is helping as well, because things just seem to be a lot quieter lately - not a lot of this firing here and that firing there for no reason…now my pain is localized to specific areas that are located around the main problems from my fall.

I decided not to go back to the pain management dr who lacked a bedside manner - I knew that I would not be able to work with him no matter how helpful his suggestions might have been, although I don’t think that they really were helpful in the first place.

I did go see one of my other doctors at OHSU though - the one I first saw for my head injury back when we thought we were only dealing with a concussion. He knows me better and 100% understands the eventer AND triathlete personalities and how they feed off each other and get the hybrid effect when they’re in the same person. We talked about how I’m one of the lucky ones who will be managing chronic pain for a very, very long time, but that it is going to be manageable. Not cured, but manageable. He knows the doctors who work at the spine center (where dr charm works) and he said “you’re not that kind of patient.” I knew exactly what he meant

He is an osteopath, so his plan focused on manual therapy and myofascial release with a whole slew of exercises to do and combine with my PT. He referred me to another “old school” osteopath closer to where I live. He highly recommends her and sends his own kids to her, so I’m pretty excited for my first appointment next week, even though I know it will be hell working through all the adhesions and tension and misalignments and everything else.

But as far as the rest of my life goes, things are going quite well, really. I’m doing well in my classes at school, my research is wrapping up, I’m getting ready to take the MCAT in July, med school applications open in May, I have an internship with a pediatrician, I am riding my mare regularly getting ready for a dressage show next month, I’m running and swimming and biking to get ready for triathlon season next month, and I even occasionally have time to do fun things with my friends!

Physically I am doing really well. I still get pain after I do a lot - after a long run or ride - but I can do pretty much whatever I want as long as I’m willing to pay the price the next day. But through PT and a system of stretching and icing and foam rolling, I can manage pretty darn well. I think I’m finally ready to start jumping again (I have my eyes on a few horse trials this summer) and my PT is just about ready to discharge me to the personal trainer she works with.

Another neuro appointment is coming up - we’ll adjust medication as necessary and talk about adding an antidepressant/axiolytic to take the edge off and a stimulant for my terrible concentration problems (yes, I should be studying for my microbiology midterm right now)

I have an amazing GP, my concussion/sports medicine dr at OHSU is awesome, my PT has been my go-to person for the last six months, a purportedly fantastic osteopath to start working with, and my neuro is probably the single greatest physician I have ever met. It’s all finally come together.

And you know, I’m really thinking about going into neurology…