The Pain of Pain

I was recently reminded of a patient that brings to light the power of the mind in pain perception and control. It also highlights the need for physicians to have more time in appointments to elicit a thorough history and physical. I would venture that we rely on the patient giving forth their history, when in reality, we should be the investigators and follow the channels of questioning like so many tributaries flowing into the sea. Obviously, for confidentiality, the specifics and name of the patient will not be revealed, but there is definitely something to be learned form this courageous woman.

As with so many other days in the pursuit of staying on time, I was failing miserably and was about twenty minutes behind schedule. I received a call from another gynecology group in town that they had a woman referred to them through the emergency room and they did not take her insurance, could I see her, now. There was something about the call that peaked my concern since this had never happened before. They were, and still are, an "all female" group and they were asking me to help this particular patient. There are excellent physicians all around in this office and so I felt they were entrusting the care of this patient to me and I accepted the appointment.

The patient was walked to the back of our office to be weighed, and I could see that she had a terrible rictus on her face that she was in dire pain. Her gait was slow and shuffing like when she moved she was being ripped apart from the inside. There are few times in the office when you think, "this person needs to go the the ER'. Then it hit me, she was just in the ER a few hours ago and they sent her home. Something was not fitting with this puzzle. I called over to the ER and spoke with the physician that had worked with her. She had come in for an excruciating pain in her pelvis that had her doubled over. CT scan and ultrasounds of the pelvis and abdomen had shown no acute or chronic disease. Her labwork was all normal. So, there was no evidence of ovarian cyst, bladder infection, kidney stones, ovarian torsion, colon or rectal problems or anything else for that matter.

After hanging up with the ER physician, I proceeded to the room and when I entered I was greeted by the patient pacing. She tried to smile but was in obvious distress. I asked her what brought her in to the ER earlier tha morning and she told me the story in a nutshell. Basically, for the last two days she had had some pain in the pelvis (pointing to her pubic bone), but that it had reached a point where she was crying and could not function. She needed someone to help her since she felt like something horrible was going on inside of her and she did not know what was happening.

During my exam she had no lower back pain to palpation of her muscles. The pelvic exam had little pain to deep pressure, but I could move her uterus and she would not flinch, yet she could literally not straighten out her legs because of the severity of this mystery pain.

I asked her to get dressed as I stepped out of the room. As I waited I wracked my brain for some sort of differential diagnosis. I mean, here was a woman with a million dollar work-up only three hours ago that proved nothing and by the looks of this patient I was thinking I might have to take her the operating room.

Re-entering the room I sat down facing her. I noticed she was looking at a tapestry I had just purchased that was a beautiful rendition of the seven energy centers or chakras. Basically these are seven energy centers in Yogi traditions. These seven centers can also be thought of as seven different consciousness centers and they each have different correlation to the body and mind.

The second chakra (svadisthana) is the area of the sacrum or the pelvis in both men and women. This is the energetic center of personal power, creativity and sexuality; physcial survival, issues of control, and one on one realtionships. I looked at the tapestry and then back at the patient. It was then that I had the feeling that I should ask her a question around the second chakra. Obviously a question like, "So tell me about your second chakra" would not be appropriate, so I fashioned something else. I looked at her and asked, "In the past few weeks have you had any issues with intimate realtionships or trust?" There was a silence, and then a flood of tears and sobbing.

I had pulled the scab off of a wound that was recently reinjured. In the past week, the patient had been told by her husband, that he was having an affair. This is obviously catastrophic for anyone, but she had a second issue. As she was dealing with the emotional rollercoaster of infidelity, she had a memory come back that had been filed away. She remembered and now recently relived, that when she was seventeen, she was raped. During the rape the man involved tried to kill her by drowning her, but he stopped short of her death. When she told me all of his I was dumbstruck and sat there for a few moments collecting my own thoughts.

"If someone goes through a stressful period in their lives, it is not unusual for them to get a headache or migraine correct?' I asked her and she agreed.

"So with all of this coming up two days ago, is it not possible that you could be having a migraine in your pelvis?" She stopped and looked at the wall again and said that she felt this could be possible as well. After a few more moments, I proposed that she see a psychiatrist and allow herself to go through this now that it had been unearthed. I did not want her to suppress this memory again. the patient agreed to the therapy and was scheduled to return to see me in one week.

When she returned she was walking and comfortable. She said that she had seen the therapist three times last week, and while she was still having pain, it was mild at best. She was continuing to with her therapy and was no longer taking any pain medication. Now I understand that this could have been mere coincidence that she improved, but I would like to think that she was now dealing with it rather than medicating it. The conundrum for the allopathic physician is that we have to practice defensive medicine and spend a million dollars for fear of missing something. We must spend less time with patients and order more tests, not because we want to, but because we have lost our connection to spirit. It is this energetic connection that gives us life and it is this energy that might cause pain if unbalanced. It would be my wish that we could all understand ourselves better by understanding other types of medical practice. Simply sticking with the Western medical model with this patient would not have been helpful and may have wound up in a an unnecessary surgery.

It is our duty as physciains to know and care. It is the job of the patient to care to know.