The case Karin presents is an excellent one and there is lot going on; a lot to unpack. So many things point to so many mind-body conditions! You have to feel for this person who has worked so hard for so long, despite so many challenges, from childhood on.
It’s true that she has had back injuries and surgery, but I know that all injuries heal and scars don’t cause pain. It seems that her neurological exam is normal in terms of muscle strength, sensation and reflexes. And the MRI doesn’t appear to show any significant problem from surgery, such as a screw in the wrong place.
Obviously, the widespread nature of her pain suggests MBS. But it’s important to explore the back pain specifically if we want to know for certain that it’s also MBS; and more importantly that she can be certain of that. To do that, I would make a careful assessment of the FIT criteria and use provocative testing.
We will discuss these in the class, and of course, they are described in the OvidDx mobile app and in my book, Unlearn Your Pain.
If you’d like to test those with this patient, it would be useful for all of us to know what the results of that investigation.
Best, Howard