When the volume control for pain gets turned up

By Dr Irwin Lim, Rheumatologist

She reached into her handbag and brought out the token of her appreciation.

It was very unexpected. And I’m been very touched by it.

She has been a “difficult” patient with lots of pain in various areas. Sometimes, there was an explanation such as a rotator cuff tear. Sometimes, her rheumatoid arthritis appeared active, but at other times, the degree of symptoms seemed out of keeping with what I could find on assessing her.

In recent months, I had found myself apologising for not helping her very much. I had tweaked her medication, started then stopped then replaced various drugs.

The preceding consultation, I had a discussion with her about the possibility that her pain was “centralised”. I explained that over time, in patients who suffer chronic disease, the body can become more sensitive to various stimuli and chronic pain seems to snowball.

It’s a situation where the volume control for pain gets turned up.

This seems to occur more often when there are other unpleasant events in one’s life, including but not limited to social and financial stress, anxiety and depression, increasing medical diagnoses, weight gain, poor sleep, poor fitness, etc.

This is not an easy discussion to have but she listened.

I then asked her to visit this website: https://fibroguide.med.umich.edu.

I learnt of this website at a recent meeting and it is now my go-to site for patients with fibromyalgia.

She went home, and worked through the website with her supportive family. Something clicked. She recognised many of the situations described.

She learned that the road forward was hard and involved a lot of self-help and family support. It’s not easy by any means but I think she felt relief.

She could understand. She could see that no doctor would be able to solve the problems with a magic pill.

And, unexpectedly, she thanked me for this.