STORY OF SOMATIC SYMPTOM DISORDER

An Unusual cause of chronic pain, be it back pain, coccydynia or other chronic pain -problems

29 yr. old female a mother of 2 kids aged 7yrs and 5 yrs.from a well-educated financially stable family visits my spine and pain clinic with severe low back pain with her husband. It’s been a common problem in my OPD for which patients consult us. I started taking the history and found out that this problem has been there for almost 5 years now. She has consulted orthopedics, neurologist, neurosurgeon, physicians but failed to find relief. This is not new for me and I had better interventional management procedures to cure such patients. I started chatting and found that she had:

• Severe low back pain to the extent she says she is unable to perform her routine household work. Pain is there in all positions whether sitting, lying down, standing or walking. Anxiety and misery was clearly visible on her face. She is not able to stand for more than 15 min. Any exercise she tries to perform increases her pain, so she had stopped doing it now for past few months.
• Neck Pain is also there but quantum is much less as compared to low back pain
• Fatigue
• Sleep is markedly disturbed. The whole family sleeps well but she has sleepless nights despite taking medications for sleep.
• Depression has crept in as her back pain problem is not getting resolved and she is unable to enjoy life now.

The husband an educated businessman seems understanding and caring enough, says “Sir I amtired of showing her to doctors, sadhus, chiropractors, ayurvedic doctors, homeopaths, acupuncturist and whom not. Nobody is able to diagnose her problem, everything comes normal in investigations. One of your patients told me about you and you are our last resort. Please diagnose and cure her”.

I started examining her and found grossly normal examination apart from paramedian tenderness in her lower back muscles.

I started scribbling her past medical records and found she has been thoroughly investigated numerous times by various specialty doctors. Her MRI whole spine screening, MRI Lumbosacral spine, NCV all four limbs, HLA B27 and other rheumatological tests have all been normal.

It was not hard to realize that I was dealing with somatic symptom disorder. I didn’t order any further investigation and wrote a prescription with antidepressants, anxiolytics and neuropathic pain medications and a higher dose of melatonin. I explained to her that her problem is due to imbalance of certain neurotransmitters (chemicals) in the brain and with medications, cognitive behavioral therapy she will start to improve but it is a tough and long road we had to travel and we should be ready for it. 

What Is Somatic Symptom Disorder?

Somatic symptom disorder is diagnosed when a person has a significant focus on physical symptoms, such as pain, weakness or shortness of breath, to a level that results in major distress and/or problems functioning. The individual has excessive thoughts, feelings and behaviors relating to the physical symptoms. The physical symptoms may or may not be associated with a diagnosed medical condition, but the person is experiencing symptoms and believes they are sick (that is, not faking the illness).

A person is not diagnosed with somatic symptom disorder solely because a medical cause can’t be identified for a physical symptom. The emphasis is on the extent to which the thoughts, feelings and behaviors related to the illness are excessive or out of proportion.

Diagnosis 1

• One or more physical symptoms that are distressing or cause disruption in daily life
• Excessive thoughts, feelings or behaviors related to the physical symptoms or health concerns with at least one of the following:
• Ongoing thoughts that are out of proportion with the seriousness of symptoms
• Ongoing high level of anxiety about health or symptoms
• Excessive time and energy spent on the symptoms or health concerns

At least one symptom is constantly present, although there may be different symptoms and symptoms may come and go.

People with somatic symptom disorder typically go to a primary care physician rather than a psychiatrist or other mental health professional. Individuals with somatic symptom disorder may experience difficulty accepting that their concerns about their symptoms are excessive. They may continue to be fearful and worried even when they are shown evidence that they do not have a serious condition. Some people have only pain as their dominant symptom. Somatic symptom disorder usually begins by the age of 30 year.

There are several types of somatic symptom and related disorders.

• Somatization disorder usually involves pain and severe neurological symptoms (such as headache, fatigue). Other symptoms include:

1. Digestive symptoms (such as nausea, vomiting, abdominal pain, constipation, and diarrhea).
2. Sexual symptoms (such as pain during sexual activity, loss of sexual desire, and extremely painful periods in women).

• Hypochondriasis or illness Anxiety Disorder occurs when a person believes that normal body functions (such as a grumbling stomach) or minor symptoms (such as a common headache) are symptoms of a very serious disorder. To a person who has hypochondriasis, a grumbling stomach may mean stomach cancer. A headache may mean a brain tumor.
• Body dysmorphic disorder occurs when a person becomes obsessed with a flaw in his or her physical appearance. The flaw is either a minor flaw or a flaw that doesn’t exist. He or she constantly worries about the perceived flaw, which can be any part of the body. Common concerns for people who have body dysmorphic disorder include:

1. wrinkles
2. hair loss
3. weight gain
4. size and shape of feature like the eyes, nose, and breasts

• Conversion disorder is when physical symptoms that are similar to a neurological disorder develop even though no neurological disorder is actually present. Common symptoms include:

1. paralysis of an arm or leg
2. vision loss
3. hearing loss
4. seizure

Stress may make the symptoms worse. 😒

Treatment

Treatment for somatic symptom disorder is intended to help control symptoms and to allow the person to function as normally as possible.

Treatment for somatic symptom disorder typically involves the person having regular visits with a trusted health care professional. The physician can offer support and reassurance, monitor heath and symptoms and avoid unnecessary tests and treatments. Psychotherapy (talk therapy) can help the individual change their thinking and behavior, and learn ways to cope with pain or other symptoms, deal with stress and improve functioning. Antidepressant or anti-anxiety medications can be useful if the person is also experiencing significant depression or anxiety.

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