What's The Deal With Somatoform Pain?

[Chava]

I've done lots of testing for pain stuff and I do have some structural issues and abnormalities that supposedly wouldn't be creating the pain, but the pain is sometimes seemingly out of proportion to whatever the docs have been able to figure out. Not that I've done every test possible but I'm sick of all of them. The pain also makes me feel immobilized, powerless, like a piece of shit, and like I want to die. I can do some physical therapy to help with some of the more organic stuff but I don't want to neglect the complex mix of other stuff involved.

My company's new insurance won't pay for my Somatic Experiencing therapy...not too surprisingly, the pain got unbearable some time after learning I have to arbitrarily quit therapy in a few months. It's real pain, really bad pressure and spasms and my muscle relaxants are barely working anymore.

In spite of no clear diagnosis, just some sort of structural things that should have been relieved by past physical therapy, I feel like I really need some major physical pain disorder so I don't feel so powerless and left with this pain all to myself. That sounds messed up. But it's like I need an explanation for it now. If I can't see my trauma therapist I will NOT just go back to talk therapy and starting all over on a dead-end (all that is covered in my network) and feel like I can't cope with the pain unless I can tell myself it's all totally physical and there is no emotional or other meaning to it and no connection to stress (that's bullshit but I can buy into my own half-truths when I feel like it's better than nothing). Sorry my sentences are rambling.

I just need to have help. So if it's physical therapy and/or a pain psychologist and no more trauma work, I'll take that as at least some way to deal with the pain so I don't kill myself.

I can't do talky therapy...tried on and off for a decade...think my worst traumas are from too young and the blocks within myself are too thick...I just stare at the floor in talk therapy...one therapist nudged getting me on anti-psychotics because she didn't know how to deal with this and I ended up sleeping all day and then on some super fast track to alcohol rehab....it was all a disaster, maybe because I'm not psychotic (current somatic therapist can work with my far-away and mute place somewhat, doesn't seem ill-equipped to work with me, or at least helps me feel reassured... and she's actually able to get me to talk and stay a bit more connected).

Part of me thinks there is stuff I obviously haven't resolved but I had some medical distractions through the fall and now am totally distracted by the pain, the thought of just ending therapy, and finding any new direction so I don't feel so powerless. I wonder if I could stick with it if I could relax again and work towards my original goals. I was making some progress but now it feels like I've opened some ancient wound, only to be tossed into the world with no support for healing. My body hurts a lot. I'm not physically supporting myself like an adult at all, or in any good proportion to the demands of my life. It's all been shrunken to surviving pain every day.

I feel like my title is mismatched to this post, sorry. But basically I'm trying to tell myself there is no psychological basis to my pain because no specialist in my network will be able to help with that problem. That makes me feel too powerless and everything is unbearable. Is it possible to have pain related to depression that is of an intensity requiring opiates?? (small doses, but otc and steroid injections do NOTHING for me). Has anyone had luck with body memories, somatoform stuff, or chronic pain through just talk therapy or on their own (I'm not willing to do talk therapy again so have no idea why or what I am asking). F*cking damn it. :banghead:

At least I've recognized that the feeling of wanting to die is connected to feeling powerless. I don't want to die. The idea of killing myself if things don't work out better is some form of false power. I just don't want to feel trapped forever.

p.s. "somatoform"...way too many vowels for me to manage

 

[Deleted member 28986]

Whether it is or is not somatoform pain (hey, you taught me a new word!), stress does make pain worse. Stress spreads your endorphins even thinner than they already are and increases your perception of pain.

I might have a relatable issue: a couple structural abnormalities that doctors think should be relatively painless, but very real pain in the affected areas. Maybe if I were under less chronic stress, I would experience less pain. However, I am convinced that the pain is primarily of a physical nature. My neck, back, and shoulders are what's screwed up on me. Things that make the pain better for me are:

• Regular exercise (weight lifting targeted toward the painful areas, under the guidance of a physical therapist or personal trainer)
• Good posture (it's incredible how tough this is; again, ask a PT)
• Diet with appropriate caloric intake (ask a PT)
• Self-massage of trigger points (the book The Trigger Point Therapy Workbook is very helpful to me)
• Meds

Over the past couple months my stress levels have been a roller coaster, and there is some correlation with my pain levels.

My baseline pain level (often about a [3]) are such that I can cope without meds completely, but about 7.5mg hydrocodone would probably cut a [3] in half. However, I am saving my few remaining hydrocodone for a rainy day. Or more specifically a [4] or [5] pain day, which is a LOT worse than a [3], if you know what I mean.

I too am unfazed by OTC pain meds with some exception: Tylenol + caffeine is okay for a headache, and Bengay is a surprisingly big help. Steroid injections are a complete joke.

I occasionally take carisoprodol (the only muscle relaxant that works for me), and I just started gabapentin a few days ago, which also is supposed to have an anti-anxiety affect. I don't feel a significant anti-pain or anti-anxiety effect yet, but it's supposed to take a couple weeks to start working. I am pleased that I'm not having side effects, because every. single. other. psychotropic. med. gives me horrible side effects.

I want to try ultra-low-dose (ULD) naltrexone as used for treating pain, but if you're on daily opiates, I don't think that's recommended. ULD naltrexone is off-label for treating pain, and even though the substance is not controlled and has minimal side effects, my doctor is wary of it.

Anyway. I don't know your whole story but chronic pain really, really sucks and I feel for you. Hugs.

 

[Chava]

Thank you ? I'm not sure what you are asking..... ???

 

[sun seeker]

Has anyone had luck with body memories, somatoform stuff, or chronic pain through just talk therapy or on their own (I'm not willing to do talk therapy again so have no idea why or what I am asking).

Sorry this continues to be so hard for you. In answer to your question, I do know someone who gets severe pain related to occluded memories, who swears once she remembers the trauma so it becomes conscious, the pain goes away. I don't think there is any specific process involved.

 

[gone]

Not sure if this is relevant or not, but since I've been doing EMDR therapy for about 14mos now, some of my pain has basically gone away. In fact a surgery I was scheduled to have (and NEEDED), I would not even consider having now because the pain has fallen to manageable levels without meds.

Sorry to hear you're suffering this much. I really hope you can find some relief soon. Pain sucks. Undiagnosed pain sucks the most by an order of magnitude.

 

[Deleted member 28986]

@Chava I don't think I meant to ask much of anything. I just wanted to share my experience. I see I was long winded.

The point I guess I didn't make was that, even though your pain is getting worse with stress, it doesn't mean your pain is "all in your head." My own unprofessional opinion is that there could be a significant physical element to your pain, and I don't think you should give up hope.

In my own journey, I've found that sometimes I need to take a break from seeking pain relief. That is, the act of going to doctors and getting my hopes up for a particular treatment only to have them shattered is tiring. It sounds like you've been dealing with doctors for a while. Maybe it's time to take a break from pain doctors for a few months? Maybe; maybe not.

I apologize if my prior message was incoherent. Hugs.

 

[Chava]

@The One Who Knocks , sorry that little question was geared towards some sort of spammer post that I see has been deleted. It wasn't directed at you. Sorry for the confusion. Thanks

 

[shimmerz]

current somatic therapist can work with my far-away and mute place somewhat, doesn't seem ill-equipped to work with me, or at least helps me feel reassured... and she's actually able to get me to talk and stay a bit more connected).

Fascinating. How does she do this, do you know? When I mute up it can last for days and nobody can get to me. I can write during these times though so doctors get f*d up about that.

the pain got unbearable some time after learning

Have you researched @Chava? I am not sure what other issues you have besides the pain (I know you go mute) but I will just throw this out there. Maybe you have looked at it already, idk.

Wiki
A 2007 review stated that conversion disorder and dissociative disorders are statistically associated, share features such as a history of abuse and high suggestibility, and likely have common underlying causes. It recommended that DSM should follow ICD-10 and reclassify conversion disorder from a somatoform disorder to a dissociative disorder

 

[Chava]

Fascinating. How does she do this, do you know? When I mute up it can last for days and nobody can get to me.

I'm not totally sure and I maybe don't mute to the same extent you do...but it's something that got worse in past therapy (before I was sent to hospital because therapist felt she couldn't help me). I think the somatic focus has been easier on that part of myself, gentler, and also we've done a lot of work keeping still connected to present and my adult or communicative self. sometimes it takes a while, but I can nod at let my therapist know I hear her...so it's like I'm staying connected and aware. I don't become hopelessly unreachable I suppose, which scares me. I used to wonder a bit about conversion-type stuff by it would never be diagnosed at the clinics in my area. They are slightly terrible and only equipped to handle anxiety disorders. Before my current therapist, I had a therapist who wanted to frame my body stuff as anxiety...like I was overly-sensitive to pain (sometimes yes, but it's NOT anxiety like that). If a paxil or Prozac could fix me, great. But no, they make me more out of touch.

Anyway, my therapist works with it all as complex trauma, which makes sense. I won't start therapy over somewhere else, in the clinic I researched my way out of (to get somatic therapy) and be made to feel more hopelessly f#cked up, disembodied, and needing more medications. But I ordered a better brace for my back. I feel like I'm not giving up on myself, but left to my own devices I might identifying with the pain too much, if that makes any sense. It's sort of taken over "me" lately and it feels very shitty. But even a better brace can remind me I'm trying, and also alleviate some of the pressure and fatigue which makes me feel like such a loser at work.

 

[darrenS]

I have experienced a reduction in pain when using talk therapy , and yes i do think some pain is connected to both our trauma and other issues. I have physical reasons for my pain but have always believed they have a somatic basis - i was always the family protector (family of 7 kids) and believe my lower back issues come about from carrying everyone psychologically. My shoulder pain is from the stored energy of wanting to hit out - im not violent at all but certainly have visions of paying some abusers back. The more attention you pay to your pain the worse it will become, it may sound crazy but if its going to be there forever , youd better create some form of friendship with it.

I too have complex ptsd and have found that with certain issues being dealt with that it does reduce your pain (can increase it too) , there is a connection as im sure you know between pain and ptsd - i do believe in a somatic connection

I am also aware that any emotional upsets that involve anger will tense me up and create more pain

I too have days where i think f*** it , ive had enough this is not living , this is not even existing - i do understand , i do have those days , not so much now as ive been dealing with it for years , but it wasnt that long ago , that any mention of a drs appt or changes in treatment would guarantee to throw me in a tailspin, ive been thrown out of a drs office , ive been taking off heavy meds without warning, ive had the third degree. Ive walked out of an appt seriously suicidal because of the attitude i faced - ive pretty much had every shitty interaction you could think of and the reaction to go with it.

And now i approach things carefully , i am lucky to have a great Dr, but at the same time , when im in pain , i try not to give it too much attention (i know it sounds near impossible), if i can move or do something , then i do it , if i cant move and the pain is around 8 , then i make sure i take enough drugs to both kill the pain and zone me out a bit. If your pain is intermittent or gets trigger going from say 3-8 - then what i do is take a stronger dose of meds and continue this for 2 days - i hit it hard and fast and then taper off - i have found that if its pain that comes on sudden , then its best to hit it hard at first, otherwise it can take a couple of weeks to get it down to manageable levels. I have also found whilst in heavy pain that yes i flashback, and get triggered a lot easier , i also like you start feeling despair and hopelessness and thats the hardest of all - i do my best to keep that under control as it is what makes it far worse.

So to manage my pain long term - i accept it and strangely try and find something good in it
If i can move , i do ...its important to do anything other than think about it
Medicate it appropriately - severe pain requires a severe response and the quicker it is down to a level of control the better
Concentrate on all times on what you can do...not what you cant do
Just talking about the pain in therapy helps, i at one stage used therapy just for that , pain as you know is horrible in so many aspects and just talking about and letting someone know who can listen is a major release , i found the more i explored and released it , the more strategies i was able to develop, the less it got me down. Its a very very lonely experience .
If you ever feel the need to vent and just talk about the pain- feel free to reach out and i do mean that -

 

[Em C.]

I have severe Somatoform (I've nearly died) so if you want to talk about it, PM me. It is hard to get through but it is possible :)

 

[Chava]

Thank you @Em C. and @darrenS . I don't feel like I'm "thinking" about the pain as much as feeling it too horridly 100% of the time (same difference I suppose). It's a nasty distraction and I feel like it's trapping me badly. There is stuff to work on there but in a weird way I think I also have to feel in ways how I am not actually trapped....like not disregarding the pain, but knowing I am not trapped. I sent my therapist a note with maybe a different idea for our next appointment in case I'm too tired or chicken to bring it up when I get there. I want to acknowledge the pain but also try moving to a different space or further out into the space, something different...some way to remind myself I am not stuck and/or helpless.

Doing okay with minimal meds today, so reminding myself that not every day is horrid. Went for a walk and that was very good.