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Psychosomatic Pain?

Talk to me about psychosomatic pain.

My 15 y/o daughter has been debilitated by back pain (pain level 7-10) for the past 6 months. It interferes with everything. She can't sit, stand or lay down comfortably and the pain is constant. She cannot even sit in the car for 10 minutes without extreme pain.

She has been to a Pain Mangment Ortho doc who has done an x-ray, MRI and CAT scan and aside from bulging disc (which he dismisses as a non issue,) and arthritis in her SI Joint. Pain injections have done no good and pain meds and anti-inflammatories barely take the edge off. Because of this, he told me today that he suspects she may be having psychosomatic pain that is stemming from avoiding school. (if this were so, why would she have had it most of the summer too?)

I'm open to exploring this as a cause but I'd like to hear more. I just don't want to dismiss a physical cause and go straight to a psychological cause without making sure we're not missing something.


  • Well, it is hard to say. As an adult in her 40's, I did have to finally realize that a lot of my pain was pain I probably had as a normal part of life and that my back issues just made me ultra sensitive of ALL my pain. I was miserable all the time and just would leave any store after 15 minutes and sit in the car and sigh b/c I hurt.

    I had to realize and teach myself to 'ignore' the daily little aches and pains' and only allow myself to hurt when the pain was atypical so to speak. There is such a thing as bio-feedback or neuro-feedback where you can teach the mind to handle pain better.

    However, considering your daughter is so young...I would wonder too. Could it be psychosomatic? Possibly because she is at an impressionable age where the stress of being a teenager in high-school can produce more 'symptoms' of malaise. But, could it be that she has other issues? Has she been tested for lupus or have enough things been ruled out to where she may be someone who has early signs of fibromylagia?

    I guess my questions would be -
    - does she get any relief from rest?
    - does she get relief from physical therapy or massage?
    - does she get relief from medication?
    - Does she have friends and when she does stuff with them, do you see a change in her attitude or personality? Can she forget about her pain now and again to enjoy friends or family?
    - does the doctor worry that she is depressed?

    I guess for a teenager you do have to consider all options as you would with an adult but with a little more caution.

    You mentioned ortho pain doctor. Have you tried a new doctor? Perhaps a neurosurgeon? What about a physiatrist (muscular/skeletal doctor)? You also said she has X-ray, mri, cat-scan. The bulging disc is not uncommon, not even at her age...the question is, are there any other tests they can do to rule out issues? Perhaps a discogram or other test that might help them see if there is a particular level of the back causing the issue?

    I might start with a 2nd opinion from a neurosurgeon. They are like orthopedic spine surgeons but study a bit long and have a bit more expertise with nerves. That, or consider a physiatrist who focuses on muscular/skeletal...I found pretty good relief after 2-3 months with one (going 2x/week).

    Good luck. It must be so frustrating as a parent to see your child in such pain.
  • Thank you for the thoughtful input.

    In all honesty, no I don't think they've done all the possible tests they can do to rule everything out. I've asked for a referral to a rheumatologist but her PC said she doesn't feel it's necessary. She's seen this doctor once and was seen by her PA all other visits, so she made this decision after seeing her for about 10 minutes. Her main concern was not the extreme pain my daughter was in, but rather the fact that she was on hydrocodone.

    To answer your questions:
    - does she get any relief from rest?
    No, it is really hard for her to get to sleep because of the pain, she wakes up several times a night in pain and has a hard time trying to fall back asleep. She wakes up in pain.

    - does she get relief from physical therapy or massage?
    She gets a mild amount of relief from chiropractic traction, PT makes the pain worse, we haven't tried massage

    - does she get relief from medication?
    She gets mild relief from medication, from maybe a level 9 pain to a level 7-8. The pain is constant. She tells me every hour or so that she's in pain. She tells me this even when we have no obligations and there is nothing in it for her to avoid. This kid is in pain!

    - Does she have friends and when she does stuff with them, do you see a change in her attitude or personality? Can she forget about her pain now and again to enjoy friends or family?
    She has friends, they call her often to spend time together but she often can't due to the pain, when she does, she pushes herself and is able to tolerate short visits but never without pain. In fact, her favorite holiday is Halloween, she plans for it all year. She had her costume and we usually go to an incredibly fun street fair. She was so excited to go this year but was barely able to tolerate 30 minutes before she had to go to the car and lay down. She was in tears. She had tickets to her favorite band and a meet and greet to meet the band, she pushed herself to go but could barely tolerate it. She had to leave early. This is NOT like her.

    - does the doctor worry that she is depressed?
    She's had depression in the past, her previous primary care doctors recommended she go back on Prozac when she initially presented with the back pain. They said it was her weight and depression. They didn't even do a physical exam before they immediately attributed the pain to weight and depression. She's been back on Prozac for the past 6 months with no change in pain or noticeable depression. I've seen her depressed before, this is not the same.

    I also gave her the choice this year of doing virtual school at home or going back to her regular high school and she was adamant about wanting to go to her regular school. If she was avoiding school, why wouldn't she choose the easier option? "NO, I want to get better and go to school! I want this pain to go away! I want a normal life!"

    So, I guess, the more I think about this, the more I don't buy the psychosomatic stuff.

  • Hmmm, I would consider another opinion then.
    I would also think about finding a physiatrist (muscular/skeletal doctor) and I do think that a rheumatoid doctor or endocrine type doctor wouldn't hurt. She is 15. IF she is in pain on on medication and it is not helping, then something is up.

    And as for doctors saying pain is weight and depression, could it be they are not listening to her?
    Have you considered a child specialty clinic? You need to keep searching for doctors that are willing to figure out how to minimize her pain (without drugs preferably). She sounds like she has a zest for life and things in it but just can't get comfortable enough to enjoy them for more than a short stint.

    Is it all her back? Or does she have other pain in her joints? Could she have had lymes disease earlier in life and have residual effects that seem like arthritis? If it is just back pain, there are many specialty hospitals and clinics and those that may specialize in pediatric patients. Keep searching...she needs you as her advocate.
  • I was thinking...when did the pain start? By chance did it start when she went through puberty? Could she have fibroids or some other female issue or hormonal imbalance that is causing periodic pain? Silly, I know but just posing the question as a way to get you to think about what may have changed when she started having pain.
  • DNice, Thank you for the comments. I've sent you a PM. You could be on the right track and I will certainly be pushing this with the doctors.
  • have u looked into fibromyalgia? in my case, my pain started at 16 or so... as a teenage girl, docs told me depression, artheritis in hip... they treated with of coarse anti depressants. and said weight loss would help ..needless to say, i was finally diagnose at 22. DDD, fibro, DJD...its very common for fibro to start in women at ver young age on offten mis diagnosed.again..just a thought and good luck!
    In doing research on a new med i found this forum... Excited to learn more about my condition and share my expiriences with anyone willing to listen..haha
  • I've asked the doc about fibromyalgia and they poo poo'd that. They didn't do any tests for it. She has many symptoms resembling fibro. She also has symptoms resembling MS which scare me. I understand both are pretty much diagnosed by ruling everything else out, no?

    She does have arthritis in her SI joint, at 15 that seems crazy.
  • As a retired high school principal and educator for 34 years, I have come across many kids with "school phobia" issues. After reading what you wrote about your daughter, she just doesn't fit the school phobia profile that I used. If she mysteriously felt better on weekends or during school vacations, then I'd start to believe it. By what you wrote, her pain is 24/7. So, she is missing everything about being a teenager, the good and the bad. I'd follow up on some of the suggestions other members have made. Good luck.

    Emergency surgery in March of 2006 for spinal infection of L 2 and L 3. During surgery, discovered I had Cauda Equina Syndrome. Spine became unstable after surgery and had 360 fusion with 10 pedicle screws, plates and rods in April of 2007.
  • CMCCM Posts: 100
    edited 11/26/2012 - 9:04 AM
    "bulging disc (which he dismisses as a non issue,)"

    That's what they say about my T4 bulging disc, so why do I have intense pain at that level?

    "I've asked for a referral to a rheumatologist but her PC said she doesn't feel it's necessary."

    That's infuriating. You daughter is in terrible pain and the PC doesn't know what is causing it. Why not explore every possible avenue? Doctors ought to make every effort to help their patients, but especially so I think for young patients considering they are still growing and have so much life ahead of them.

    The implication that it is psychosomatic is really insulting IMHO.


    When did your daughter begin having pain?
    Did some injury/accident happen shortly before the pain started? Did you daughter have a fall, or was she in an accident?
    Is the location of the pain limited to the same area as when it first started, or has it progressed to more areas?
    At approximately what level (spine level) is the pain at?
    Is there any particular position which makes the pain worse?
    Is there any position which relieves the pain, such as lying flat on the floor (or some other hard surface)?
    Does your family or husband's family have a history of back problems? I believe DDD is inherited.
  • Thank you Dick for your insight into the school phobia. I really appreciate input from a former school principal! I really don't feel like she's trying to avoid school. And you're right, she's missing out on a "normal" teen life! It helps to hear some support of this.

    Thank you CM! I agree, I feel like they need to exhaust every possibility before dismissing it as psychosomatic. I would be happy to explore that and would have an open mind about it indeed they had exhausted all possibilities but I really don't feel like they care.
    To answer your questions...
    She began having the pain at the beginning of the year following but it has gotten progressively worse. At that time she also had debilitating fatigue and recurrent infections such as strep. I thought perhaps she had an immune problem but she was found to be anemic and hypothyroid and lab tests supposedly did not show any immune system issues. She did have a pretty hard fall in June and it seemed to get more unbearable from that point forward. By July, she was unable to do much of anything.
    The pain is mostly in the lower lumbar area where the disc bulge is but also radiates down her leg and her hip and neck hurts sometimes too. That pain is intermittent but the low back pain is constant.
    Laying down is the only position that relieves the pain mildly.
    I have had back pain for years which I largely ignore because basically I was told the same thing...they couldn't do much for me and it was more degenerative disc than anything. I live with constant pain but I rarely complain about it and because I'm a single mom, I have to work through it.
  • "The pain is mostly in the lower lumbar area where the disc bulge is but also radiates down her leg and her hip and neck hurts sometimes too. That pain is intermittent but the low back pain is constant."

    And because the MRI show "only" a bulging disk they think it's not significant. Sounds very familiar. I've been very, very disappointed with my MRIs. I am not a medical professional. The following is my opinion based on my personal experience as a patient who has had at least two ruptured disks and three cervical spine surgeries.

    The MRI is a wonderful tool, but I think doctors - and us patients too - rely on and expect too much from them. I've seen many doctors and I get the impression that the majority of them think that an MRI image is the "last word" so to speak. Here's a brief example of how what the MRI shows does not necessarily correspond to the pain.

    Before I had my last ACDF my neurologist had me do an MRI of my neck. My main symptoms were pain in my RIGHT hand along a line with my little finger, and also pain in my shoulder and neck. Sometimes I had pain in the same places on the left side, sometimes both sides at the same time, but by far most of the pain was on the RIGHT side. So, after the MRI I went back for the follow-up appointment. The doctor read the report, then looked at me and said, "Your pain is on the wrong side." It sounded so ridiculous it would have been comical if I had not been in pain. He said the MRI showed the nerve compression was on the left side, not the right side. I ended up having the fusion anyway, and it did resolved the pain I was having in my right hand.

    The point is that what an MRI shows does not always explain or correspond to the symptoms. Imagine looking at a photo of beautiful flowers. You see what they look like, but you can't smell them, so just seeing the image is not the same as being there. That's not a very good analogy, but the point is that something else must be going on that images just cannot show. Also, MRIs are done while we are lying very still. In real life we move around a lot, an MRIs can't show what happens when we are moving. Despite the fact that your daughter's MRI shows "only" a bulging disk does not mean the pain is not coming from that region. Very possibly there is something the MRI just can't show. Please tell your daughter I believe her pain is caused by a real physical problem, and that it is not psychosomatic.

    Have they done any imaging of your daughters neck, and if so did it show any problems?
  • BarringtonBBarrington Posts: 1
    edited 11/26/2012 - 6:45 PM
    Has anyone considered ankylosing spondylitis It is often associated with pain in the SI joints.

    Link removed, not permitted
    Post Edited by The Spine-Health Moderator Team

  • CM, I completely agree about the MRI's. They are also very subjective in that doctors can read them differently. The MRI report itself pointed out the disc bulge as well as rightward curvature of the spine. The PM doctor said it wasn't significant. If there's pain in that area, and an MRI shows a bulging disc, wouldn't it be safe to assume that it could very well be causing REAL pain? It doesn't make sense to me that he wouldn't draw that correlation. The only thing I can think of is her Primary Care doc had called him after we visited her in order to get her to write a doctor's note to the school which allowed for a teacher to come to the home to teach her during her recovery since she can't sit for 7 hours. The PC doc seemed very rude (we had only seen her PA's prior to this who were very sympathetic and understanding) and I got the impression she thought the pain was psychosomatic and even that we were drug seekers despite the fact that I told her I wanted her off the pain meds. The PM Doc told me that she called him with this concern. That is when he changed his tune from sympathetic and trying to find a cause to his current "maybe it's psychosomatic" tune. With a Primary Care doc tainting the specialists view, I don't see how we're going to be able to find any doctor who is willing to take a step further and find a cause!

    Also, the MRI was taken laying down and that is when she feels the least amount of pain. The rehab specialist who fitted her for a back brace said that a laying down position usually feels better because it opens the spine and there isn't as much pressure on the disc so it doesn't bulge as much. This makes perfect sense to me.

    I think I need to make an appointment to meet with the PC doc without my daughter present so I can ask exactly what she's doing and ask for the referrals to the specialists. This comes at a very bad time for me though as her insurance runs out at the end of the December and it will cost me $800 a month to get her insured after that. That's about 1/3 of my salary. If it hadn't taken them so long to get moving on this, I feel like we'd be much farther along than we are now. :(
  • "Also, the MRI was taken laying down and that is when she feels the least amount of pain."

    Exactly! I've made that same point many times. If your daughter consistently has pain while she is sitting, considered finding a medical imaging place that can do an "upright" MRI. With an upright MRI you sit upright while they do the MRI. Just do an internet search with the words upright and mri.

    The insurance situation is scary. Even if you can pay the monthly payment, you also have pay the annual deductible and co-pays. On the other hand, don't make any hasty medical decisions just because the insurance is about to run out. You can always get insurance again, but you can't undo surgical changes to your body.
  • Hi. You mentioned your daughter being hypothyroid. That can cause pain and fatigue. I realize that most Drs. treat thyroid disease as though it were a cold, but it can be more debilitating in some pts, along with compromising the immune system.

    I've had thyroid disease for over 27 yrs., since then I've had Bells Palsy, Spinal meningitis, DDD, OA, Raynaud's, and recently been DX'd with Lupus [sort of]. I'm chronically fatigued and in constant pain.. I cannot remember my last good day, but there was one.

    You are your childs' best and only advocate, so please continue as you have been. She needs to know that you believe & understand her-to feel validated is such a comfort to anyone suffering and feeling as though nobody gets it.

    I admire your parenting and pray that you and your daughter find a good physician in the very near future.

    PS~I don't like to compare, but I too have been suffering from many viruses and infections recently.
    My best to you both.

  • First there are still way to many tests to have. I would start with a brain MRI yearly. I say yearly because lesions have been proven to be to little for imaging as well as come and go. And a bone scan of entire body when you feel her condition is worse. I would have her tested ASAP at a true autonomic lab. To many conditions to mention!
    Lastlty, sad put true you will be hard press to find any Dr. that will think outside the box while she is on the pain med.
    Did your daughter ever have autonomic testing for POTS syndrome? Young teen age children get hit with it hard. listen to stories of teens on Youtube and there will be things that stand out from your posts.
  • manaleriemmanalerie Posts: 549
    edited 03/11/2013 - 11:12 PM
    I can't stand when doctors are so quick to dismiss children. I've dealt with this pain daily for as longas I can remember! No one listened! Please listen to your heart, and stand up for your daughter. From what you've described, she isn't faking. This doesn't seem like drug seeking. I'm notfimiliar with the psychosomatic stuff... my 5 year old started having stomach ailments. It seemed to happen when he didn't want to go to school. We slowly began to see it happened even at times when he would be having fun- like immediatley after arriving to a birthday party. This lasted months. He missed a ton of school. His doctor dismissed it. Told us it was "psychosomatic". Set us up with a therapist. Well after becoming sick at the aforementioned bday party, we took him to the ER. He had a pretty bad bladder infection. His white cells were elevated, and there were a large amt of lymph nodes(?) In his stomach. After a course of antibiotics, ALL stomach issues stopped entirely.
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