Pain lessons from my terrifying persistent stomach distress
I’ve had some amount of varying persistent pain for more than 25 years. In general, I’m pretty sensitive but I’ve learned to cope and do the things I love with varying amounts of modifications through the years.
Like many people with persistent pain I have other sensitivities. The big one, as my family will attest to, is my misophonia. I hate the sound of people chewing, breathing, slurping, sighing…ughhhhh. I’ve excused myself from countless dinner tables through the years. When I lecture, if someone whips out a carrot I’m heading to the other side of the room. Goddamn rabbits.
But then the end of August rolled around. I had a new pain. New pains aren’t cool. If I don’t understand them I get worried. It just started with a seemingly innocuous stomach ache. And since I’ve always had a sensitive gut this wasn’t unusual. I thought I had too much beer. But, It was higher up and not my usual location. Nothing made it worse and nothing made it better. After it being sore for 3 weeks I thought I should get it looked at.
I saw my doc, he asked about triggers, recommended I have less beer, eat well, sleep well and we started an antacid medication. The first lesson here was that I was essentially diagnosed with Non-specific stomach pain. This is funny because many in my field hate the term “non-specific low back pain” and I’ve had people say to me that no doctor would ever say “Hey, you have non-specific stomach pain”. Yet, this was essentially my diagnosis. I didn’t have a diagnosis but we just tried a therapy. More on non-specific low back pain here
6 weeks later, no change.
And now I am worried. I catastrophize. I ruminate. I lie awake at 3 am and convince myself my kids will be better off without me. I’m not kidding. The mind goes there. I called my insurance broker and increased my life insurance.
My M.D got me an abdominal Ultrasound and it found nothing. Phew, but that wasn’t enough to allay my fears. I wanted to know how sensitive that test was. I’m sure it misses lots of things that are really serious. What could it be missing? We tried a new medication - no change. It is now 7 weeks of constant, low to mid level stomach pain. My googling is freaking me out. My catastrophizing is 10 out of 10. My pain and fear is getting worse. The doctor asked if I had black stool. No, I said and thought that’s good thing. I then had black stool the bloody next day.
At 9-10 weeks of pain I got a gastroscope done. The specialist said she saw nothing. THANK GOODNESS. That was what I needed to hear. In my follow up I made her specifically tell me that there was nothing sinister. No serious pathology. She absolutely confirmed this. This was a massive relief. I started to walk out and she stopped me because she wanted to discuss treating it. I didn’t really care. I can cope with stomach pain as long as I know what it isn’t. My stomach hurts but I’m safe. I still didn’t have a diagnosis, she was willing to try some other meds but to help with the symptoms but it was never the symptoms that really bothered me. The symptoms weren’t awesome but they weren’t the primary issue.
And guess what happened almost immediately after that last session with the specialist?
!My stomach pain went from 6/10 to ZERO within 3 days. I’m not kidding. I stopped the medication - felt fine.
So, what the hell happened?
What I think happened here was that I had some unknown stomach sensitivity. Indigestion, acid reflux, who knows? I didn’t fit any of the textbook symptoms except for the pain. I had a “spark” of discomfort but my traits of catastrophizing and worrying and fear fanned that tiny flame into something unmanageable. I don’t think this was merely the “brain” increasing what I felt/perceived but it was also my nervous/endocrine/immune system influencing the physical function of my stomach. It was a brain, nervous system, tissue interaction. It was all real. It really was a perfect example of how pain is multifactorial and a bloody complex interaction.
Take home points:
1. Non specific diagnoses are acceptable: Having a more specific diagnosis would not have changed management unless it was something serious and sinister. We need a specific diagnosis when there is something that needs specifically treating. That didn’t exist here.
2. Pain is the interplay between what ever is happening physically and how we respond or cope with that. My poor coping and personality traits (catastrophize, ruminate, fear, anxiety) magnified what I felt and probably increased the physical duress. This is what we do as humans.
I actually have had some stomach pain for the past two weeks. I had a good 3 months before that. I can cope with this. I will reflect on my diet, try to find and modify triggers, sleep better (my sleep has sucked for the past 4 weeks), exercise and manage my Covid stress. In other words, get and stay healthy. Pretty much the same process I would recommend for anyone in pain. I’m off to eat a burrito now.