Migraine

Thought people might be interested in hearing about the criteria for these disorders as it could be why some aren't receiving treatment. If a doctor feels you have one of these disorders (and all it takes is medically unexplained symptoms) they tend to minimise healthcare, won't do tests, won't treat or monitor things as it's assumed it's all "psychological". In reality someone who's had a past or current depression/anxiety could be incorrectly diagnosed as having this disorder and experience investigation/treatment refusal.
Also people might have some ideas on how to move doctors past this rather than getting stuck in the groove as often they don't even believe in referring for psychological treatment to confirm or deny and then treat so doc can move on.
Pain disorder
http://www.psychnet-uk.com/dsm_iv/pain_disorder.htm
http://www.emedicine.com/ped/topic1706.htm
http://www.minddisorders.com/Ob-Ps/Pain-disorder.html
Somatic disorder
http://www.emedicine.com/med/topic3527.htm

All of these links sound like a book I read, "The Mind Body Prescription" by John Sarnow.

No doubt our mind/body are linked, but the one line in one of you links stood out - that if there was a physical reason for the pain, it's out of proportion to the reason for pain.

I'm lucky that I haven't run into this type of thinking, but I know others have.

Yes I've heard story after story in Australia where people experiencing symptoms have been fobbed off with the "it's all in your head/stress etc" to later be diagnosed with a physical condition.
If you present with contraversial symptoms like migraines or a lot of symptoms you're more likely to be seen as being "psychosomatic" and not have things looked into.
A couple of hints to avoid this that I feel are helpful are:
*minimise past medical history outlines to essential items, ie things that were serious and may reoccur, other things can always be raised on a needs be basis with an explanation of had thought not worth mentioning but now a reason has arisen
*be careful with what medical records you hand over. Make sure you get copies of everything so you can choose what to provide rather than having them request it from a previous medical centre
*only advise of serious current medical problems (especially if you're trying to get them to take the idea of migraine treatment on board, having another contraversial medical condition could make that harder)
*build a good relationship with the doctor by starting with presenting with or needing non contraversial things done
*generally aim to live a healthy lifestyle so you can advise of this if need be (ie relaxation/meditation, diet, exercise, drink plenty of water)

I read that in most current psychological thinking "psychosomatic" is a pretty well discredited term. But drs still use it against us!

- megs

Hmmm... Perhaps this is a subconscious reason I have not been back to the doctor for my neck pain. When I was in college, I NEVER went to the doctor. Then I started having fainting spells. When I fainted at a convention while eating dinner with one of my professors and didn't wake up until hours later in the ER, he MADE me go to the doctor. Suddenly, I was truly sick ALL the time. I felt like I was in her office every other week and on antibiotics, getting inhalers, you name it. (And this was back when I had to pay cash up front and eventually get reimbursed for the visit.)

At one point I saw her colleague, a man, and he told me I was making up my symptoms and they were stress related. (Excuse me, I was complaining of a burning stomach and throwing up my food - either a sign of an ulcer or reflux - this was around 1990 when all you could buy over the counter was liquid maalox type products and tums and I was drinking that stuff constantly!) I suffered for months before I made another appointment with her and had lost tons of weight. She was horrified and it took a year on pepcid before I could eat normally again.

So when I came to VA, I started working FT and it was just hard to make time to see a doctor anyways. I saw him more when the kids were born since we use a family practice doc. I was healthy enough without the stress of school except for my asthma and allergies and pepcid. So until my HA started I saw him once a year for PAP and get refills on everything. (On a side note, we loved this guy and he retired just over a year ago. Sadly he just died of cancer at the young age of 57. Boy were my tears flowing again in church today even though it was in the paper on Monday.) So I haven't quite figured out my new doc in the same practice, since I've only seen him 3 times in 15 months... He's a good listener and thoughtful with me - allergy issues and HA, but I'm not sure about HIM. Hard to explain. And his nurse is a big grouch.

But there's always this subconscious feeling of being that annoying person with "fake" complaints (since there is no labwork/rash/drippy nose/etc for pain). Plus, with so much over the counter now, it's easy (though perhaps generally not safe in the long run) to self treat that burning stomach/headache/neckpain/allergy/ you name whatever happens to be ailing the general public. It's crazy. You'd think since we CAN treat almost anything, that IF we are showing up at the doctor, something must really be wrong!!! Good grief!

Diane, who's also been accused of faking a "stomach ulcer?" (or whatever it was)

DJ, your links are very interesting.

I had an experience with a rheumatologist about 8 months ago. For a number of years, I had been experiencing symptoms of fibromyalgia. I have tons of books on it and when I read them, I thought "this is me."

I started getting more severe pain last year, so I went to my husband's rheumatologist who is highly recommended and on lists of "best dr.s in Chicago".

Unfortunately, once he found out I have anxiety (see a counselor, on medication for it, ect.), he focussed on that and started to tell me that this was the reason for my pain. He went on and on about that I needed to get a new counselor b/c she would have dealt with this by now.

By the end of my session, my husband and I were so stunned/surprised at his treatment of me that we decided that I never would go back to him.

I knew I had fibro. He said I did, but he wanted me to work on my anxiety to fix it. (Which if he had looked further, he would have found that my anxiety is well controlled with the medication and I see a counselor to help me deal with the pain and it's effects.) He didn't give me any helpful solution for the fibro. He was convinced by changing my counselor and decreasing my "stress" I'd improve.

Funny that any "stress" I have is b/c of the pain.

If I ever had gone back to him, I would have been more forceful that I am not there to talk about my anxiety, but to find out what are the best treatments for fibro and how it could help me. If he could not help me, then I am on to another dr. who can.

I do think that my mind game about pain is extremely important. If I have a bad mindset when I'm in pain, it is worse. But, if I have a better mindset, I can handle it better.

And I am truly thankful there are Dr.s out there who understand pain.

Kelly

Megs I've been reading a lot on the subject for a uni assignment. True somatic disorder would be hard to be diagnosed with although when you read what symptoms the person has to meet (and many of them) it could also be the symptoms of someone with severe CFS/ME and ditto with pain disorder which could be someone with severe fibromylagia.

There are naturally several groups of opinions, some saying everything that is unexplained by medical pathology should be called somatoform disorder and classified as psychiatric whilst others feel the percentage with somatoform disorder is extremely small and that unexplained physical symptoms should be actually placed under the physical classification of medical disorders tables (ICD etc)

We also know that increased stress as well as other emotional states (ie increased anger, increased loneliness) can cause illness due to increased cortisol levels and other stress/bad chemicals and the impact this has on the immune system, heart disease and so forth and sociologist's also study this on a societial basis and make recommendations around how to reduce stress levels (ie better working conditions, more sociable society) so why treat some conditions and symptoms differently to others ie be dismissive and refuse to treat some but not others.

Diane that's a terrible experience about your ulcer. And now they've found that ulcers are caused by bacterial infections which are treated by long term antibiotics when before they said it was due to "stress". Of course stress hormones like heart disease and many other conditions would make some one more vulnerable to the virus but certainly no reason to not look into and treat.

Kelly your experience with the rheumo was bad as well. Especially as your anxiety is well under control and being treated. And that there are guidelines and treatments for fibro. It's easy for doctors to make the quantum leap and use it as an excuse to not treat, I'm sure there must be people out there with broken bones and other very obvious things that aren't being treated due to it being seen as an anxiety condition.

And Millsy how frustrating your doctor took that attitude simply because you were negative for mono rather than looking further.
The other concern is the assumption by doctors that people they think have somatoform disorder or other mental health condition is why treat as the person won't respond to treatment.

Oh another hint when you get a referral from the doctor to see a specialist read the referral. I had one to a cardiologist specialising in my arrtyhmia and when I'd first approached a GP for investigation of fatigue she thought at first it was depression but that was later disproved through a questionnaire (I indicated I was only willing to run with that theory IF I was provided with treatment to confirm or deny that possibly and that it wasn't to be used as an excuse to not treat things like migraine) but that was on my record and printed off onto my referral as my medical history. My specialist appt was spent trying to justify why I should have cardiac treatment inspite of having depression written on my medical history. And the specialist wouldn't treat in the end.

Other hints include:
*Ask what else it could be to try to move the doctor past the it's all in the mind diagnosis
*Try to get agreement out of the doctor that if symptoms haven't resolved within a reasonable time period that they will look into it further.

Hi DJ,

I broke up your post so it would be easier to read.

While there is a lot of conversation about how stress impacts our health, stress may trigger illness, not cause it. Stress can certainly trigger a lupus flare for me, but stress didn't cause lupus. The antibodies attacking my body did (just to be simplistic here.)

Life is stressful, for everyone. Stress doesn't cause Migraine, it is a genetic neurologic disease. We work hard to help give people the information and support they need to live healthier, less stressfull lives.