Mystery Diagnosis

Blee O'Myacin, BSN, RN · Sep 6, 2007

I am a new grad and was curious on other nurses opinions about psychological pain. I had a patient yesterday that had abdominal pain. He appeared to truely have pain, and was unable to hold down food. According to him and the family it had been going on for about a year. The patient was around 21. Every test imaginable had been done, but everything had come out negative. I started talking to him and he revealed some outside stressers in his life and began to cry. I could tell that he was having some emotional issues. I just listened and let him talk and cry. He said thank you for talking to him, and seemed to feel better then he had all day.
I really believe he was experiencing pain, but I don't think there was anything physiologically wrong with him (I know I am not a doctor). What are your opinions on this issue? I have seen it a couple times before, usually with younger patients. Do you think there is a point when you can suggest to the pt or family for psychological counseling if all of the tests continue to come back negative?

Perhaps he's feeling discouraged and depressed because of his pain and the fact that the tests are coming back negative is in some ways worse than a diagnosis. Especially when people around him are starting to suggest psych meds.

My brother had this. Turns out a HIDA scan found a mildly inflammed gallbladder. All other tests were negative. He opted for the surgery at age 29 and they removed a horribly scarred gb that was filled with stones. (The CT didn't pick the stones up either - weird - I read ther reports and talked to the doctors myself too).

I'm not saying that this man's pain is not psychogenic, but sometimes the docs really do have to look for zebras if they hear hoofbeats.

I know this didn't answer your question, and it sounds like you did not judge this young man for not having a concrete physical reason for his pain - and that is one of the best things you could have done for him.

Take care,

Blee

EmmaG, RN · Sep 6, 2007

I don't like to jump on the "it's all in their head" bandwagon. (not saying you are)

I had strange, unexplained symptoms for several years which escalated over time. Primarily abdominal, but also systemic. I had vague but persistent pain, inability to eat more than a few bites without feeling uncomfortably full, fevers, swelling,

and other symptoms ranging from annoying to nearly debilitating. For over two years, all tests and exams were negative. I seriously started doubting myself, wondering if I really was imagining things (although there were plenty of objective symptoms quite obvious to my doc).

Turns out I had cancer. I'm ok now (in that respect anyway), but the residual effects of going so long so sick remain.

EmmaG, RN · Sep 6, 2007

Perhaps he's feeling discouraged and depressed because of his pain and the fact that the tests are coming back negative is in some ways worse than a diagnosis. Especially when people around him are starting to suggest psych meds.
Blee

Bingo.

EmmaG, RN · Sep 6, 2007

My brother also went through a similar trial. He started having difficulty breathing, irregular heartbeat, and chest pains. Repeated visits to ER and his docs revealed nothing abnormal. Since this began during the time our mother was dying of cancer, his symptoms were attributed to stress and he was prescribed anti-anxiety medications. Which DID help to a point, because his symptoms surely did cause a great deal of anxiety.

He ended up having a thoracotomy and left lower lobectomy, due to a (benign) cyst-like tumor. I can't for the life of me remember what it's called, but it's present from birth and usually remains 'dormant' (for lack of a better word) until the person is in their 30's, when it can grow quite large and begin to cause problems.

woody62, RN · Sep 6, 2007

Perhaps he's feeling discouraged and depressed because of his pain and the fact that the tests are coming back negative is in some ways worse than a diagnosis. Especially when people around him are starting to suggest psych meds.
My brother had this. Turns out a HIDA scan found a mildly inflammed gallbladder. All other tests were negative. He opted for the surgery at age 29 and they removed a horribly scarred gb that was filled with stones. (The CT didn't pick the stones up either - weird - I read ther reports and talked to the doctors myself too).
I'm not saying that this man's pain is not psychogenic, but sometimes the docs really do have to look for zebras if they hear hoofbeats.
I know this didn't answer your question, and it sounds like you did not judge this young man for not having a concrete physical reason for his pain - and that is one of the best things you could have done for him.
Take care,
Blee

When I was twenty three years old, I began experiencing severe left flank pain. So severe it drove me to the ER several times. I had C & S of my urine done. An IVP, a cycstogram. All came back negative. The ER physician thought it was all in my head, except that I usually ran a temperature of 100 to 101 degrees F. My PCP finally decided to admit me and have me undergo several inpatient test. They could find nothing wrong but the surgeon was convinced that I had something wrong in my small intestine. He scheduled me for an exploratory lap. He found a badly scarred gall bladder with numerous stones and gravel. I have never doubted a patient with they complain of atypical pain. I just urge the doctor to look around a tad bit harder.

Woody:balloons:

GingerSue · Sep 6, 2007

topic is reminding me of a schoolmate who went to

a doctor because of unusual symptoms, was told

by the doctor that he was making it up to get out

of writing exams,

then it was discovered, by a different doctor, that

schoolmate had a brain tumor

and for this he had surgery,etc

and some concerns about the first doctor

CRNI-ICU20 · Sep 6, 2007

pain is the body's way of saying, "something's wrong".

I don't ever doubt that pain is real....even if it is emotionally rooted or exacerbated....

It is statistical that the average rheumatoidal/fibro patient will see at least 11 different health care providers before being correctly diagnosed and have RELIEF of their pain. It is more common than not to have those self same doctors prescribe anti-depressants, narcotics, and refer to psychiatric services rather than admit they don't know what is wrong.....

We are "fearfully and wonderfully made"....which makes us all very complex and individualistic people....we are not always cookie-cutter diagnosed and treated....my gall bladder is not the same as your gall bladder, ya know?

It makes me so sad when people are dismissed who are in pain...

their bodies are telling them, it is just that those who are PAID to find the source often DO NOT LISTEN!! Kudos to you for listening to your patient....you are a blessing to our profession.

crni

Altra, BSN, RN · Sep 6, 2007

I don't ever doubt that pain is real....even if it is emotionally rooted or exacerbated....

Wise words.

I think there are some chronic conditions, including unexplained abd pain, that have a psych component but it's a chicken & egg question to decide which came first. Did low-grade psych issues contribute to sympathomimetic s/s ... or did frequent pain, fear about recurring pain, and possible limiting of activities and social withdrawal produce subsequent psych s/s?

amanda0019 · Sep 6, 2007

Thank you for all of the feed back. I have noticed that many nurses believe patients are drug seeking when they ask for pain meds around the clock. I do live in Las Vegas so it is a common problem, but if someone tells me there in pain I am going to believe them. There are definitely easier ways to obtain narcotics without going to the hospital.

It will be interesting to find out what is wrong with my pt. I hope they discovered the problem on my days off. He went for a HIDA scan yesterday and a small bowel series. We will see what the docs come up with.

I love allnurses.com. There is a lot of wonderful advice and info. on this site. :lol2: