Have You Ever Been Referred to a Psychologist Because Your Doctor Couldn't Figure Out What Was Wrong?

General General TN & GPN (Old Site)
1

In the years I've supported facial pain patients and their families, I've lost track of the number who have disclosed that they've been harmed by a doctor who wrote them off as a "head case". There are fancy scientific names for this process. One of the more recent terms is "Somatoform Pain Disorder", which the American Psychological Association is getting ready to write into the Diagnostic and Statistical Manual.

Of late, I have been researching papers which deal with some of the problems of this diagnosis. I am beginning correspondence with researchers and doctors who have published in support of the concept of so-called "psychogenic" pain. One of my emails went out this afternoon, and I thought I would share it with you -- patients who may be affected by the issue. I welcome any corrections or references that others here at Living With TN may be able or inclined to offer. This is long, for which I beg your pardon in advance.

Go in Peace and Power

========================

Subject:
RE: Validity of current somatoform disorder diagnoses: perspectives for classification in DSM-V and ICD-11.
From:
Red Lawhern <■■■■■■■■■■■■■■■■■■■■■>
Date:
Sat, 16 Apr 2011 16:36:11 -0400
To:
<■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■>


Dear Dr Loewe, et al,

I have recently read the abstract of your 2008 article in "Psychopathology". I've copied the abstract below... From that abstract and others which parallel its conclusions, I would respectfully ask four questions and solicit your answers thereto.

First a bit about my background:

I write as a long-time patient advocate and web author for chronic neurological face pain patients and their families. Although my doctorate is in engineering systems, much of my career was spent in technology assessment and operations research. Thus I have skills as both an information miner and a writer for non-technical audiences. My wife has been a trigeminal neuralgia patient for 17 years. At first on her behalf and later in collaboration with other pain patients, I have researched this horrid form of pain on behalf of patients and their doctors, as well as other and co-morbid facial pain disorders. Since 1996, I have corresponded with over 2500 facial pain patients or family members. I was webmaster and a member of the Board of Directors of the US Trigeminal Neuralgia Association in the late 1990s. I continue direct patient support via several online venues, to the present day.

Next, my core concern:

In this work, I have naturally kept an eye on the evolution of practice standards for the treatment of face pain. And it is in this area that I believe the somatization of pain by psychological professionals can have truly terrible consequences for patients. For instance, the following is a quotation from the Website of no less an entity than the US National Pain Foundation, with regard to what is called "atypical trigeminal neuralgia"

=================
"Atypical TN is a term often used to describe pain that does not have the characteristics associated with classic or typical TN. Patients who have atypical TN often have pain that may be continuous and may be described as dull, aching, or throbbing.

Atypical facial pain is a confusing term and should never be used to describe patients with trigeminal neuralgia or trigeminal neuropathic pain. Strictly speaking, AFP is classified as a “somatoform pain disorder”; this is a psychological diagnosis that should be confirmed by a skilled pain psychologist. Patients with the diagnosis of AFP have no identifiable underlying physical cause for the pain. The pain is usually constant, described as aching or burning, and often affects both sides of the face (this is almost never the case in patients with trigeminal neuralgia). The pain frequently involves areas of the head, face, and neck that are outside the sensory territories that are supplied by the trigeminal nerve. It is important to correctly identify patients with AFP since the treatment for this is strictly medical. Surgical procedures are not indicated for atypical facial pain."
==================

While parts of this narrative are of positive benefit to patients, there are also misleading elements here. The description provided for atypical facial pain would apply equally to atypical Trigeminal Neuralgia. And although bilateral facial pain is somewhat less common than unilateral pain, it is by no means a matter of "almost never the case". Most fundamentally, based on my experience with patients, I believe a more accurate assignment of labels would be "bilateral facial pain of unknown etiology" -- a categorization which does not implicitly blame the patient or characterize them as malingerers. I am very concerned that the "somatomization" of pain gives medical practitioners an incentive to write off their failures or their lack of insurance-reimbursable time to monitor and assess complicated cases.

Patients who receive diagnoses of "atypical facial pain" are frequently referred by neurologists and other mainstream physicians to psychologists and psychiatrists. Not infrequently, the primary care physician is at pains to inform the patient to the effect of "I can find no medical explanation for your pain. I want you to see a mental health professional for assessment and counseling". In effect, the patient is being written off as a "head case" and denied further diagnostic investigation or treatment with other than anti-depressant drugs.

For a category of pain that is frequently referred to as "the most severe form of pain known to medical practice", and a disorder sometimes called "the suicide disease", the consequences to the patient can be almost incalculable. After a medical history and perhaps a psychological questionnaire, they are told that they are depressed, and receive a prescription for anti-depressant drugs -- sometimes being denied access to neuro-surgical second opinions as a direct consequence.

From this background, I would ask you as experts, for your opinion on four fundamental questions:

(a) Is there any publicly available body of consistently evaluated and documented case data that reliably establishes the validity of "somatoform pain disorder" as a medical entity? If so, please provide literature references.

(b) Is there any such body of data that establishes the validity of neuropathic pain being caused by the patient's mental attitude or depression (so-called "psychogenic" pain)?

(c) Is there any body of human trials data which establishes a causal relationship in co-morbid conditions such as chronic pain and chronic depression -- i.e., which condition causes which?

(d) Given that "somatoform pain disorder" is a diagnosis by elimination, is it conceivable that what we see in this diagnosis is not a "real" medical entity? Could this be instead an elaborate shared emotional denial by doctors of the reality of imperfect medical diagnostic methods? It seems to me that your abstract comes rather close to supporting that conclusion.

I look forward to hearing your thoughts and opinions on the above.

Respectfully yours,

Richard A. Lawhern, Ph.D
http://www.lawhern.org
"Giving Something Back"

================================================

Psychopathology. 2008;41(1):4-9. Epub 2007 Oct 18.

Validity of current somatoform disorder diagnoses: perspectives for classification in DSM-V and ICD-11.

Löwe B, Mundt C, Herzog W, Brunner R, Backenstrass M, Kronmüller K, Henningsen P.

Department of Psychosomatic and General Internal Medicine, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany. ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■

Abstract

BACKGROUND: The impending revisions of DSM-IV and ICD-10 provide an excellent opportunity to improve the diagnostic accuracy of the current somatoform disorder classification. To prepare for these revisions, this study systematically investigates the validity of the current classification of somatoform disorders.

METHODS: We searched Medline, Psycinfo and reference lists to investigate convergent, divergent, criterion and predictive validity of the current somatoform disorder classification.

RESULTS: Substantial associations of somatoform disorders with functional impairment and elevated health care costs give evidence for the clinical and societal importance of somatoform disorders and for the convergent validity of the current operationalization. The specificity of the current somatoform disorder classification, i.e. their divergent validity, is demonstrated by the fact that functional somatic syndromes and their consequences are only partially explained by association with anxiety and depression. However, the imprecision of the diagnostic criteria, which are not based on positive criteria but on the exclusion of organic disease, largely limits the criterion validity of the current classification systems. Finally, studies investigating the predictive potential of somatoform disorders are lacking, and to date predictive validity has to be considered as low.

CONCLUSIONS: The insufficient criterion and predictive validity of the present somatoform classification underlines the need to revise the diagnostic criteria. However, an abolishment of the whole category of somatoform disorders would ignore the substantial convergent and divergent validity of the current classification and would exclude patients with somatoform symptoms from the current health care system. A careful revision of the current somatoform disorder diagnoses, based on positive criteria of psychological, biological and social features, has the potential to substantially improve the reproducibility and clinical utility of the existing classification system.

(c) 2007 S. Karger AG, Basel.

PMID: 17952015 [PubMed - indexed for MEDLINE]


2

Red Lawhern,

I am humbled, once again. Thank you for using your saavy with working with different pain organizations to go to bat for sufferers of Atypical Trigeminal Neuralgia patients.

Yes, a diagnosis of "Atypical Facial Pain" does indicate that we are somehow head cases, or it is a dismissal of our condition, on their part, due to their ignorance on the subject of facial pain. At least my Neuro, although she gave me an ATFP diagnosis, is sending me to a "Head and Face Pain Specialist". This specialist is so booked up, I could not get an appt. until June of this year, and just got a notice in the mail telling me that the office would be closed that day, to call and reschedule. I am told that this person is a good doctor. Well, I am taking it that she is. If I can ever see her, perhaps I can get better care.

For me, pain managment has surpassed Neurology in it's understanding of ATN. It treats the symptoms of what Neurology, has failed to address. You describe what it feels to have ATN, in your writing, so accurately. It is chilling. Yes, our suffering has a common threads. It all typically follows the path of the TN nerve, as well. The first time I looked at a diagram of the Trigeminal Nerve, in that moment I saw the path of pain, especially in V2 and V3, that had plagued me for 6 yrs. prior. It was as if someone had drawn a diagram of my facial pain.

Your persistence and advocacy is appreciated more than your realize, I believe.

It's a good fight you fight.

Let me know if I can be of assistance in any way!

Best regards and bless you,

Stef

3

Thank you, Red, for speaking up for a group of people who may not be able to fight this fight. It scares me to think that the very people who are supposed to be treating ATF patients may be conspiring to wash their hands of them simply because medical science has yet to fully understand human neurobiology. It feels like a betrayal to me, and I'm one of the lucky ones who has had my pain taken seriously from the start.

Christi

4

Red.

I join Christi & Stef in thanking you for your time, dedication and determination in being our advocate.

I am one of the many that have been caught in this mind-numbing, frustrating situation.

- First diagnosed, in the hospital after an MRI, with Trigeminal Neuralgia due to compression.

- Sent for surgical evaluation and told I was not a surgical candidate and undiagnosed with any TN.

- Primary Care doctor decided I didn't have compression and that I was having migraines.

- Told my PC doc in words of one syllable or less that I didn't have a freaking headache - it's in my face!

- Refered to neurologist who diagnosed me with Atypical Trigeminal Neuralgia.

- Sent for 2nd surgical evaluation, was told I was not a surgical candidate and diagnosed with Atypical Facial Pain.

- Refered to a psychologist (who I chose because he had a specialty in chronic pain) for "cognitive therapy" and was prescribed Ritalin and was told it would help with energy and depression. It did nothing and I quit taking it after a few weeks because my Primary Care said I was on too much medication and my brain was going to turn into Malted Milk Balls. You were the one who sent me to him, you Dolt! I have not scheduled any further appointments with my psychologist. If all he's going to do is throw medications at me that don't have any effect, what's the point?

- Changed neurologists and was given a diagnosis of Atypical Trigeminal Neuralgia.

- My Primary Care is still clinging to the ATFP diagnosis.

So by this time, I'm convinced that the medical community has gone mad. Since the Vicodin is barely working I have asked my primary care if there's something stonger I can take without all the Acetaminophen and his reply is, "Yeah, heroin." and refuses to give me anything stronger than Vicodin to help with break-through pain. I then asked for a referal to a pain management clinic that I have an appointment with. Not really confident that I'm going to get help there because the lady I spoke with on the phone advised they specialize in cervical spinal and back pain and that I needed to bring a driver with me because I'll be getting an injection. I told her I didn't need injections - just a pain medication prescription, so she scheduled me for an evaluation. Don't know if any of the doctors there will have any knowledge of Atypical Trigeminal Neuralgia so I'm expecting the best, but mentally prepared for the worst.

I'm conpletely disgusted with the level of care I've received and the schizophrenic manner of diagnosis.

Thank you again, Red, for your efforts to educate the medical community on their lack of knowledge.

5

Oh, Gloria! Yours is a frightening story. When I wrote my reply last night I should have added two words to my final sentence: It feels like a betrayal to me, and I'm one one the lucky ones who has had my pain taken seriously from the start, SO FAR. I can see a doctor changing their dx when all attempts to stop the pain fail. Doctors do not deal well with failure.

I'm so sorry for what you are going through.

((hugs))

Christi

6

Thanks Christi. Oh, I just remembered, it wasn't a psychologist - it was a PSYCHIATRIST. That's even more of a slap in the face isn't it???

7

Actually, maybe not, Gloria. A psychiatrist can prescribe anti-depressant drugs, whereas a psychologist can't. I'd consider referral to a psychologist as more emotionally loaded than to a psychiatrist.

Regards, Red

8

Good luck Red, I hope you get a response from them. I think point d gets to the heart of the problem, I've seen this happen during my time as a psychiatric nurse in the 1980s, and became a victim of it at the same time.

Despite knowing that I had definite hearing loss and was suffering from bouts of vertigo, my GPs dismissed the problem as anxiety or depression or malingering. I lost my career as a nurse because I could not justify my periods of absense. 5 years later, I was really happy when I was finally referred to a tinnitus clinic. After hearing tests, speech discrimination tests and balance tests, I was told I had conclusive signs of inner ear damage, I was then told that the clinic was a research program looking into the psychological causes of tinnitus. I was not at all pleased with my GP, I was however referred to ENT specialists, eventually getting the proper care and an eventual diagnosis of Meniere's Disease.

I think another name for Somatisation disorder could be Dangerous Doctor Disease, it has as much to do with their social and psychological status as the patients, possibly more.

9

I like the Dangerous Doctor Disease label. I will use it when I assemble enough information to correspond with the American Psychological Association concerning their preparation of standards for the DSM-V.

Regards, Red

10

Now that I think back on it, primary care nitwit said he specifically wanted me to see a “talking” professional, not a medication prescribing professional, but as it turned out the psychiatrist could do both, so it was a matter of my primary care really thinking it was all in my head - not in my face.

11

Red,

Now that I think of it, the GP who referred me to a PM Clinic, due to prodding from his nurses, once prescribed me Amitriptyline and 1 5 mg. Hydrocodone per day calling me a "little woman who is very worried about herself".

I was so frustrated. I fumed to the front desk to tell his secretaries, while he was in earshot, how I now had to go back and try to raise children in constant Lvl 7 pain, "aching, thobbing, burning pain in my face, palate, etc. I need HELP! He won't help me." I must have sounded like a lunatic.

They thought I had TMJ at this point. They explained to me how painful TMJ was. One of his nurses told me in a low tone, "you may want to try to find a new doctor". I replied, "I will", in a low voice as not to get her in trouble. Disgusting when I think back on it.

I do my best to make my physicians understand, before I leave their offices, that I am in genuine pain, and that there is such a thing as "Atypical Trigeminal Neuralgia" ,when all of the literature they read tells them, mostly, that it is called "Atypical Facial Pain", which is defined as sometimes being partially attributed to psychological factors.

When this pain presented, I was having what was one of the happiest times of my entire life. I had just made my mark, I believed, professionally, my youngest daughter had just been born, my eldest daughter was happy and my late husband was taking care of our home in his spare time between. I was happy. No one can convince me that depression, or mental illness caused my Trigeminal Nerve, especially V2 and V3 to suddenly start to present with almost constant pain.

For what it's worth, now that I think of it, I have had a physician basically tell me that it was all in my head.

What is scarier to me, is that, most often we are deemed as having "Atypical Facial Pain", which is associated with depression and oftentimes, and whose victims are often described as having a psychological factors such as "depression and anxiety" which are involved.

What is being taught to these Neurologists and physicians, most of the time, is, what I think, outdated information on facial pain.

With kind regards,

Stef

12

In threading our way through these reefs, I will seek to make the following points in the long article I'm now working on, mentioned in other threads on this site:

(1) Medical practice now acknowledges that chronic pain and chronic depression are co-morbid conditions. They tend to occur at the same time in many people.

(2) We also know that each of these conditions promotes or plays into the other. Pain exhausts us, disturbing our sleep and draining our energy for daily life. Depression can do the same, rendering us more sensitive to pain or more vulnerable to its emergence. This seems particularly true of breakthrough pain in facial neuropathy.

(3) The above being stipulated, the term "psychogenic" may still be inappropriate -- if by using it a doctor implies or legitimates the attitude that the pain is the patient's fault and can be cured by a change in the patient's attitude or obsessional thinking. Attempts to substitute psychiatric therapy for medical therapy are not valid medicine for face pain patients.

(4) When the referring physician makes a psychiatric referral with the parting words "there is nothing medically wrong with you -- you need psychological evaluation", a gross medical malpractice has just happened. Negative consequences to the patient of being explicitly or implicitly labeled a "head case" can be immediate, long lasting, and in some cases life threatening.

(5) Psychiatric or psychological support, counseling, Rational Cognitive Therapy, guided visualization, meditation, anti-depressant drugs, and anti-anxiety drugs for the management of mood, attention and personal energy, are appropriate support measures within a total program of pain management. The explicit goal for using such techniques should be to empower the patient to help themselves live more fully and with less personal suffering and less vulnerability to breakthrough pain associated with fatigue and sleeplessness.

My two Red cents for tonight.

Go in Peace and Power,

Red

PS, Stef: I'm going to be away Tuesday to Thursday afternoon. I may check in briefly from the RV campground where we're taking our granddaughter and her friend.

13

Thank you, Red.

I did forget to mention to you, that yes, indeed, this physician did imply that I might seek the help of a psychologist, or do exercises to make me "happier".

At the time, I exercised daily. I have also been seeing psychologist since the death of my husband in 2006.

My ATN pain presented in 2003, before his death. His death did not cause my pain.

Above you elaborated in eloquent and somewhat technical terms something which is very important to all of us.

Please let me know if I can be of any assistance.

I hope you enjoy your time with your Granddaughter. They always want to bring a friend! I know. I have one. I hope you have nice R & R!

Thank you, sincerely,

Stef

14

What puzzles me is how doctors can diagnose us with "Head Case Syndrome" when we do respond to anti-seizure medications and pain medications. If they think we're psycholgically "faking it" then why do they prescribe the Neurontin and other anti-seizure meds. Do they give us pain meds to shut us up? What is going through the doctor's heads?

15

No single thread of thought describes any two doctors, I think. Some are ill trained. Some are overly suspicious of malingerers. A few are doubtless over-awed by psychological “healers” and their professional associations. As far as I’m concerned, a book out of the 1970s should be required reading for all of them. See “The Psychological Society – the impact – and the failure – of psychiatry, psychotherapy, psychoanalysis, and the psychological revolution” (Martin L. Gross, Random House.

16

Doesn't the fact that the DEA has linked all the pharmacys to catch prescription fraud and monitor doctor's controlled medication prescriptions make it even more challenging for them to prescribe pain meds to atypical facial pain patients? Wouldn't you think that if they really thought we were "head cases" they'd refuse to prescribe those meds? I just don't get it?

They think "atypical facial pain" is a psycholgical diagnosis, but yet they give us anti-seizure and pain medications??? It's a contradiction. If I (for instance) had a condition that was psychological, then why did the primary care doctor take over in managing my medications for the neurologist? The way my medical group has worked is that the neurologist orders for me to be on the Neurontin, then back to the primary care nitwit who manages the continued use of Neurontin and he prescribes the Vicodin that the neurologist won't prescribe.

I was telling Stef about a primary care appointment I had when I asked for a pain med without acetaminaphin since I've been on Vicodin so long and didn't want to damage my liver. I mentioned "Roxycodone" and he whipped his head around to look at me so fast I'm surprised he didn't get whiplash. He said, "Where did you hear that word?" What's the big secret?

I'm surrounded by medical morons!!!

17

Asking this particular Discussion question, prompts me to answer -NO!

No, however, self-referral for my "head case" is 2 out of 3.

April 2007 - For a different prospective in dealing with my PAIN, (TN1 and *Toxic Epidermal Necrolysis) I referred myself and "visited" with a psychologist for five (5) "sessions". Exhausting fishing stories, he referred me to either a psychiatrist, or a pain management center. He was a pleasant man, nervous with me at first. I mentioned to him that he was picking up and mimicking my teeth-grinding at the last appointment that I scheduled.

*IVIG and Cyclosporine NO OTHER MEDICATIONS. This "." means PERIOD!

November 2008 - For a different prospective in dealing with the pain of medication failures, (adverse reactions/direct reaction) and three failed brain surgeries resulting in MY PERMANENT DISABILITIES from the treatment of Trigeminal Neuralgia, the Social Security Administration REFERRED me to a boatload of psychiatrists and psychologists. After the psych eval, (and permanent disabilities) I was referred to Dr. AUTH REQUIRED.

February 2010 - For a different prospective, after "Splotchy Tongue" I had this month-long different prospective http://en.wikipedia.org/wiki/Lorazepam#Withdrawal I referred myself to a psychologist. She was a pleasant lady, I was exhausted after five (5) "visit-sessions" of talking about our children and the Caribbean. When she suggested talking about my childhood, I felt...I felt and reminded her that I was attempting to address MY LIFE over the past three years; that of me dealing with my dealing with my PAIN, not my pain. She referred me to a psychiatrist.

No, however,

A doctor referral to a "shrink" is not, in my opinion, necessarily bad; relating to "Somatoform Pain Disorder", or any 'chronic the pains in your "head case"', or, well, as I am referencing only one author, therein lies a [sic] rub!

ELVIRA G. ALETTA, PH.D. states:

"If you are experiencing symptoms but don’t have a diagnosis yet, here are some tips that I hope will help you get through this trying time a little easier.

Trust yourself. You are not crazy. Physicians have referred many people to me before they had a diagnosis, even doctors who don’t know what else to do for their patients.

ALL of them eventually received a medical diagnosis. That’s right. All of them."

http://psychcentral.com/blog/archives/2010/10/04/its-all-in-your-head-living-with-chronic-illness/

I'm a bit thick-skinned, trying to understand the harm done of being written-off as a "head case"...as he proudly shouts, "I've had fingers in my brain!", along with my MVD photo avatar on Twitter @dbobsnodgrass.

From 2001-2004, I was a substance abuse counselor (know everything about addiction by watching myself) at a 28-day in-house program. Having the lowest in the hierarchy of post-secondary academic degrees offered, and no office, or wall to display it - that rewarding, yet frustrating grunt work, with 12-step programs (AA/NA) has assisted me in this journey, along with an appreciation of the wonderment of life.

Unfortunately, there are "medical morons" able to "practice medicine". Their referral may be necessary, a 2ND opinion STAT! DEA and the War on Concepts...curiouser and curiouser, another great discussion!

Good Luck working with the "Dangerous Doctors", Red, as "psychobabble" has been my experience, and I tend not to CAPITALIZE psychology, as these forums somewhat (((complete))) me, including the high end of http://www.icd9data.com/2011/Volume1/290-319/default.htm

Thanking Everyone for piquing, prodding, and MOTIVATING me to contribute, as a "head case" with caring and understanding "peers". My Blessings, bob

18

Dear Bob,

What I would be curious to know, as you've run the gauntlet with this illness, so to speak, have you ever received a diagnosis of "Atypical Facial Pain"?

You see, the reason why this diagnosis for someone with pain which clearly follows the route of the Trigeminal Nerve and can be described as "crushing, burning and/or searing and throbbing" would be a case of a patient, who more than likely, suffers with "Atypical Trigeminal Neuralgia", whether or not the source of compression can be found (these are tiny structures being dealt with, and sometimes, the offending vessel, or culprit, touching the TN nerve is never found).

"Atypical Facial Pain", is a diagnosis given by many Neurologists, which is misleading. First of all, it can refer to pain anywhere in the facial area, not specific to the symptoms of Atypical Trigeminal, or Type II TN. Secondly, it implies that the pain may be sourced by something psychological, rather than clinical.

Since you've undergone multiple procedures, one which, by your account, rendered you disabled, wouldn't it be nice if doctor's were more knowledgeable about what comprises the symptoms of Atypical Trigeminal Neuralgia, and it's proper treatments, which do differ from treatments indicated for sufferers of classic Trigeminal Neuralgia, or Atypical Facial Pain.

I, for one, would like the myth disbanded that "Atypical Facial Pain" is synonymous with "Atypical Trigeminal Neuralgia" by the major research/healthcare facilities in this nation and abroad, so that future generations may not have to deal with the red tape that they have to endure, at this stage of the game, just to get the best of treatments available for their illness.

Thousands suffer needlessly because of this misconception.

I know that, given all that you've been through, with this life-changing illness, that you would probably agree with me when I say that any true ATN or TN patient, those who clearly have pain characteristics of pain which is consistent with the path of the 5th cranial nerve, may benefit from psychiatric counseling, but should NEVER be dismissed as a patient who has a psychosomatic illness.

Correctly diagnosis is the key to correct treatment. Certainly, I believe, that you would concur.

Your friend,

Stef



Bob Snodgrass said:

Asking this particular Discussion question, prompts me to answer -NO!

No, however, self-referral for my "head case" is 2 out of 3.

April 2007 - For a different prospective in dealing with my PAIN, (TN1 and *Toxic Epidermal Necrolysis) I referred myself and "visited" with a psychologist for five (5) "sessions". Exhausting fishing stories, he referred me to either a psychiatrist, or a pain management center. He was a pleasant man, nervous with me at first. I mentioned to him that he was picking up and mimicking my teeth-grinding at the last appointment that I scheduled.

*IVIG and Cyclosporine NO OTHER MEDICATIONS. This "." means PERIOD!

November 2008 - For a different prospective in dealing with the pain of medication failures, (adverse reactions/direct reaction) and three failed brain surgeries resulting in MY PERMANENT DISABILITIES from the treatment of Trigeminal Neuralgia, the Social Security Administration REFERRED me to a boatload of psychiatrists and psychologists. After the psych eval, (and permanent disabilities) I was referred to Dr. AUTH REQUIRED.

February 2010 - For a different prospective, after "Splotchy Tongue" I had this month-long different prospective http://en.wikipedia.org/wiki/Lorazepam#Withdrawal I referred myself to a psychologist. She was a pleasant lady, I was exhausted after five (5) "visit-sessions" of talking about our children and the Caribbean. When she suggested talking about my childhood, I felt...I felt and reminded her that I was attempting to address MY LIFE over the past three years; that of me dealing with my dealing with my PAIN, not my pain. She referred me to a psychiatrist.

No, however,

A doctor referral to a "shrink" is not, in my opinion, necessarily bad; relating to "Somatoform Pain Disorder", or any 'chronic the pains in your "head case"', or, well, as I am referencing only one author, therein lies a [sic] rub!

ELVIRA G. ALETTA, PH.D. states:

"If you are experiencing symptoms but don’t have a diagnosis yet, here are some tips that I hope will help you get through this trying time a little easier.

Trust yourself. You are not crazy. Physicians have referred many people to me before they had a diagnosis, even doctors who don’t know what else to do for their patients.

ALL of them eventually received a medical diagnosis. That’s right. All of them."

http://psychcentral.com/blog/archives/2010/10/04/its-all-in-your-he...

I'm a bit thick-skinned, trying to understand the harm done of being written-off as a "head case"...as he proudly shouts, "I've had fingers in my brain!", along with my MVD photo avatar on Twitter @dbobsnodgrass.

From 2001-2004, I was a substance abuse counselor (know everything about addiction by watching myself) at a 28-day in-house program. Having the lowest in the hierarchy of post-secondary academic degrees offered, and no office, or wall to display it - that rewarding, yet frustrating grunt work, with 12-step programs (AA/NA) has assisted me in this journey, along with an appreciation of the wonderment of life.

Unfortunately, there are "medical morons" able to "practice medicine". Their referral may be necessary, a 2ND opinion STAT! DEA and the War on Concepts...curiouser and curiouser, another great discussion!

Good Luck working with the "Dangerous Doctors", Red, as "psychobabble" has been my experience, and I tend not to CAPITALIZE psychology, as these forums somewhat (((complete))) me, including the high end of http://www.icd9data.com/2011/Volume1/290-319/default.htm

Thanking Everyone for piquing, prodding, and MOTIVATING me to contribute, as a "head case" with caring and understanding "peers". My Blessings, bob

19

Not to hijack the discussion:

No Stef, I have TN1.

I have never experienced any "crushing, burning and/or searing and throbbing". I have been so distracted by the INSTANT PAIN, (see also; anxiety, fear and/or paranoia of pain) and complications from the treatments, that I often stumble in describing.

My 2ND radiosurgery (SRS) left a brachial lesion, causing Cerebellar Ataxia, visual problems, short-term memory/concentration issues, seizures, and further demyelinating of that 5th "dude":P)! All complications resulting in my permanent (SSDI) disability, have been sorting out nicely, due to a diligence, perseverance and HUMOR, which I am so Blessed and Grateful to have received. Then there's the PAIN.

Wholeheartedly agreeing that proper diagnosis is paramount, and that "Talk To YOUR Doctor" is key...pity, NEVER dismiss! Thanks, bob

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I have a degree in Psychology and clinical practice experience. Chronic Pain can drain us of energy , affect our relationships, affect our work, and our goals, fill us with frustrations . All this may have an effect in the pain itself, making it worse. That is what co morbidity means.

Going to the therapist or psychologist is not a bad a idea, who cannot be somewhat depressed having pain every single day, having to take all these medications that have all these side effects (I am dizzy all the time).

A referral to the mental health professional is a good idea as a co-management or co-therapy of the chronic pain. Going to the therapist does not mean you are crazy or that your pain is made up in your head, It helps with he medical treatment as will make you feel better by managing all the other things that are affected by the pain.

What I don't agree is a dismissal and what I consider admitting failure indicating that "it's all in your head, go to the psychologist". Labeling it with a diagnosis on the DSM-V is plain wrong.

Thank you Richard for advocating for us.

Carolina