Adding Insult to Injury - Labelling a Problem Psychosomatic

Ms. Sharma walks into the doctor's office.  She is around 18 years old.  She has been having a lot of aches and pains in her back.  The doctor (the family doctor) who has been looking after the family since she was around 5, examines her and prescribes some mild pain killers.  She takes them.  The problem repeats itself after some time.  The same routine follows.  This happens time and again.  The doctor tells her some exercises for her back.  She does them, but the pain persists.  The doctor asks her to get some X-Rays done.  Nothing abnormal shows up.  

So next time Ms. Sharma comes back with the complaint, she is told it is psychosomatic - it is in her mind.  She is probably stressed out about something and hence her muscles are in spasm.

Ms. Sharma is unhappy.  She smarts under the verdict that it is all in her mind.  She finds it unfair that she has to suffer the pain and on top of that be told that there is nothing wrong.  Could it be possible that the X-Ray was not properly read?  Is there something that is not showing up on the film?  It makes her feel like she is being labelled a hypochondriac.

The years go by.   By the time she reaches the age of  36 - 37, she finds herself occasionally getting locked when she lies down.  She is unable to turn to her side or get up.  There is no pain as such, except the usual muscular pain.  Within a couple of minutes, she is slowly able to turn and get herself up.  She is now up and back to her usual self.  She forgets about the episode.  It repeats itself a couple of times.  Each time, she gets up and gets down to business.  CTs and MRIs do not show any problem.

After a few years, she starts to feel a pain at one point on one side of her spine.  Turning to that side is painful.  The pain varies in intensity from day to day.  Sometimes the pain is more intense at other times.  CTs and MRIs when repeated still show nothing.  So she ignores the pain.  She has learnt to shut up and carry on - she does not want to be told again that it is all in her mind.  She does not want anyone to think she wants an excuse to shirk work.  She still carries on with her normal activities.  She is a very busy person who flits from one office to another - she is a consultant.  She normally goes everywhere on her scooter.  One day when going down the stairs in a bit of a hurry, she misses a step and slips down, landing on her back on the landing.  She gets up and manages to carry on with her work.  But it has come as a bit of a shock.  She also has a few falls from her scooter when she is knocked down by some other vehicle, pushed to the edge of the road onto a pile of sand by a speeding bus and so on.  

Gradually her pain increases and starts to spread round the hip.  Then it spreads down the leg.  It becomes increasingly difficult for her to manage her work with the pain.  Her work involves a lot of standing and sitting for long hours every day.  Eventually one MRI shows that she has a condition where the joints in her spine are wearing out.  That is causing pressure on the nerves and hence the radiating pain.  She tries to manage with that for a couple of years.  Following a few smaller procedures which do not give any significant relief, she has to go in for a surgery.  

The question is this.  Did she have something when she was younger, when X-Rays showed nothing?  How could they have been expected to, when even CTs and MRIs took so long to reveal the problem?  Once the problem was revealed, it was at the same spot where she was complaining about the pain.  So was that her imagination?  Was her habit of worrying causing pain at a site where a problem would be detected later on in life?  Was it a fair judgement when she was told it was psychosomatic?

While accepting that there might be conditions which may be psychosomatic, one has to accept that modern medicine and technology have their own limitations.  Just because one is unable to detect a problem, does not mean there is no real basis for the pain - that it is all in the mind.

How many patients suffer like this?  OK, no one is blaming the medical profession for not being able to help her.  That is the state of the art and one has to accept that.  But the least one can do is to give the benefit of the doubt and spare a person who is already in pain from such damning and mortifying judgements, and be a bit more compassionate  That is all one asks for..