Understanding Chronic Pain

Chronic Fatigue

[From Chapter 14 of Understanding Chronic Pain]

Sexual assault can certainly be an event of catastrophic consequence. It is, however, perhaps too easy and too convenient to ascribe diseases such as chronic pain and chronic fatigue to unfortunate sexual encounters. We have to keep it in perspective. Is it reasonable to relate the remarkable development of her illness to a single unsuccessful sexual assault? As is often the case in patients with chronic pain (and chronic fatigue), there is more going on than meets the eye. It wasn't just the assault that made Darlene ill. It was the harassment complaint that followed. It became public in short order. Lines were drawn, and Darlene found some new friends, but she lost a lot of old ones. Management circled the wagons, and Darlene became a pariah. The violated became the violator. In the end, after several months of negotiations and confrontations, her boss was reprimanded. Darlene was given a financial settlement and advised to relocate to another city.

I thanked Darlene for sharing her story with me. She was to continue her Prozac and Norpace. I advised her to check back periodically. I had a suspicion, which I did not share with her, that her recovery represented more of a spontaneous remission than a pharmacologic effect.

She returned a couple of months later. Her career was going nicely, but her sleeplessness was becoming more of a problem. I inquired if she had ever taken the drug Klonopin. She had not. It worked pretty well at first (most of the drugs work pretty well at first, sustaining their benefit is another matter). She began to experience sedation from the drug, and her depression worsened. I told her to discard the Klonopin and to increase the Prozac dosage. A few weeks later she awoke feeling very unwell and nauseated. She dressed and went out to her car and then collapsed. A neighbor found her and brought her to my office. She was drenched with sweat, unsteady on her feet, and disoriented. Her blood pressure was eighty over fifty, and her pulse forty beats per minute.

You can read the rest in Dr. Cochran's book, Understanding Chronic Pain

Last Updated: Nov 19, 08:29 AM

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