When Michael was first seen, he was a very thin young man, wearing a light-weight rigid brace. On examination, there was an obvious operative scar on his back. There was tenderness deep to the left side of the lower vertebral bones.
He believed that there was a physical cause for the pain and he was anxious to find suitable treatment for it. He was also extremely concerned about the effect the lost time was having on his career.
On assessment by the in-patient team the use of alternative medication was investigated and he was prescribed the antidepressant Sinequan in a therapeutic dosage. Next, it was decided to increase the dosage of Sinequan to even higher levels and also put him on high doses of Valium three times a day to reduce his muscle spasm.
As an alternative to his narcotics, he was given an amino-acid, L-Tryptophan (which activates the brain’s natural pain defences) to help control pain. He was advised to take up to ten a day because, being a natural product, they could not do him any harm. Recently L-Tryptophan containing preparations have been withdrawn in Australia and the United States due to the occurrence of blood disorders in patients taking L-Tryptophan for pain or sleep disorders.
However despite strong evidence to the contrary he still believed his pain had a physical cause. He was told he would have to be withdrawn from opiates to establish whether alternative pain control mechanisms could work. This would also help to get him to a stage where if an operation was necessary it would be psychologically successful.
Michael then stopped the Omnopon by using TENS therapy and relaxation tapes. It was recommended that no surgical treatment should be performed until all attempts at alternative pain control were made.
After a month of constant supervision he was taking the major tranquilliser Largactil and mild sleeping tablets and was coping without narcotics. He now had a positive attitude. However, he still thought that as his pain was very localised it had a physical cause.
Another two months saw a further marked improvement. He was still taking high dosages of antidepressants and tranquillisers to change his awareness of pain. One positive improvement was that his pain was now limited to an even smaller area on the left side of the lower back.
Three months later he still expressed the view that he would probably need to have surgical treatment. But he was now considering going back to work on a part-time basis.
Some months later, he returned to hospital practice to continue his training. He had just come to terms with the fact that he would always have some pain. But his situation was vastly better than before and he was off narcotics which he believed would have slowly destroyed him.
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