Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Orthopedic Referrals

This is a frequent occurrence: an injured worker receives immediate and exceptional care, repeat MRIs funded physical therapies over_and over_and over. Complaints continue in the absence of any hard findings. They may not be malingering, and they seem like they are being genuine.

This is called _somatization_ (so-mutt-is-a-shun). This is seen when a patients complaints do not correspond with the objective findings, and the complaints continue even when the patient is reassured that there are no positive findings.

This emerges from the patient over-interpreting essentially normal bodily responses or excessively dwelling and monitoring mild-to-moderate discomfort.

A patient told me that he needed a lumbar fusion (no positive findings) although he is able to stand, lift, bend, stoop, and ambulate without observed difficulty. He *believes* that he has a surgical lesion despite reassurance that no further care is indicated.

This focusing upon one_s body arises out of anxiety and depression associated with the *fear* that _something is wrong and they can_t find it._

Since the patient is at home, often watching television, gaining weight, insufficiently tired to promote effective sleep, then up at night bored and worried_the focusing upon remote, obscure and modest bodily complaints becomes an obsession.

This problem needs to be directly confronted. It will not resolve with yet another opinion or diagnostic study. Rather than being appreciated, you will be accused of _not understanding._

Have the surgeon collaborate with a psychologist in your area so that a clear picture of somatization can be determined. Then efforts must be extended to engage the patient in behaviors (YMCA, volunteer work, etc) that reduce his/her incessant focusing upon bodily functions.

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