Hello!
I have had non-stop health rubbish going on since August, this blog is specifically about the past month! Pain, pain, and more pain!
As people living with M.E. know, pain is exhausting. With that in mind, I typed basic info into Chat GPT and it has created a case study that explains everything that has been going on for the past month. I’ve been posting on social media about it quite a bit and I know many of you have questions and/or are going through similar. I just don’t have the energy to go over (and over and over) this claptrap. I’m sharing because I think transparency is key to effective advocacy. This blog identifies a problem with GP services right now and how it impacts individual patients. I don’t just represent people with M.E with my advocacy, I go through this nonsense myself as a person with multiple chronic illnesses and a complicated medical history!
Case Study: Managing Complex Pain in a 48-Year-Old Woman with Multiple Medical Conditions
Patient Profile
A 48-year-old woman with a history of multiple chronic conditions, including Myalgic Encephalomyelitis (M.E.), Fibromyalgia, Hypermobility Syndrome, and Osgood-Schlatter Disease and Chondromalacia Patellae.
Medical Background
The patient had previously managed her Fibromyalgia symptoms with Gabapentin (recommended by Rheumatology and prescribed by GP), but after experiencing a reduction in pain a year ago, she successfully weaned herself off the medication. At that time, her pain was tolerable, and she felt that discontinuing the drug was appropriate. Recently, however, her Fibromyalgia symptoms worsened, prompting her to contact her GP for a repeat prescription of Gabapentin. Unfortunately, she discovered that Gabapentin was no longer listed in her repeat prescriptions, and she was instead referred for physiotherapy.
Acute Pain Episode
Approximately a month after her contact with the GP, the patient experienced a new pain episode when she trapped a nerve in her back on the left side. Due to an altered gait, she developed significant pain in the opposite knee the following day. This pain was intense, and she resorted to paracetamol and ibuprofen, as well as heat and ice packs for relief. After the weekend, when the pain persisted, the patient used the GP’s e-consult system to request stronger pain relief.
Walk-In Centre Visit
The GP surgery advised her to visit the local walk-in centre for further investigation. The patient was diagnosed with tendonitis and was instructed to return to her GP for stronger pain relief. The GP practice subsequently prescribed Co-Codamol for pain management.
Worsening Symptoms and Complications
Five days later, the knee pain persisted, and a painful lump the size of a golf ball appeared suddenly on the outer upper side of her knee. The lump was compressing a nerve, leading to excruciating pain radiating down her lower leg, knee, and thigh. Any movement was agonising, and the patient was unable to move. She contacted friends with medical knowledge who suspected bursitis, and a quick internet search suggested ice and anti-inflammatory medication as treatments. However, these measures did not alleviate the intense neuropathic pain.
In desperation, the patient remembered that she had Gabapentin tablets prescribed for her dog’s spinal issues. She took two tablets, and within an hour, her pain was under control. Having these tablets available allowed her to manage the pain over the weekend.
Request for Gabapentin Prescription
On Monday, the patient contacted her GP surgery once more to request a repeat prescription for Gabapentin. She spent 15 minutes trying to reach a receptionist, and upon answering, she was asked if she was registered with the Anima system. After confirming, she was told that a query would be submitted on her behalf, and someone would call her later that day.
Realising she hadn’t had an opportunity to explain the issue, the patient logged into the Anima system herself and submitted an e-consult form. Three hours later, she was asked to submit photos of both knees for comparison. After doing so, she received a message stating that Amitriptyline would be prescribed and that she should “trial” it.
Response from GP Surgery
The patient was concerned about the proposed prescription of Amitriptyline, as she had historically experienced sensitivities to this medication. She sent a follow-up query to the practice, explaining that Gabapentin had been prescribed to her in the past by both Rheumatology and her GP and had been effective in managing her neuropathic pain. She also noted that her current condition, including her Fibromyalgia and knee/nerve issue, would benefit from Gabapentin.
Within ten minutes, the surgery responded, stating that a telehealth appointment would be scheduled in 3-4 weeks. In the meantime, the patient no longer had access to Gabapentin (since the medication had been for her dog and there weren’t many left), leaving her without any medication for her neuropathic pain.
Key Issues and Challenges
- The patient’s difficulty in obtaining appropriate pain management was exacerbated by the GP practice’s refusal to prescribe Gabapentin despite it being part of her previous treatment regimen.
- The delay in addressing the patient’s pain was compounded by a lack of communication and follow-through from the GP practice.
- The alternative medication, Amitriptyline, was not a viable option for the patient due to her known sensitivities to the drug.
- Despite being actively involved in her healthcare and attempting to communicate her needs, the patient faced significant barriers in receiving appropriate and timely pain relief.
Conclusion
This case highlights the complexities of managing chronic pain in patients with multiple underlying health conditions. It also underscores the importance of clear communication and continuity of care between healthcare providers and patients. The patient’s experience reveals the challenges faced when navigating healthcare systems, especially when medications are withdrawn or altered without adequate alternatives or explanations. Furthermore, the case demonstrates the need for personalised treatment plans that take into account the patient’s medical history, previous treatments, and sensitivities.
**Maggie’s drugs** To confirm, Maggie’s Gabapentin use is approved by her vet. They are exactly the same drug as humans take. Fortunately, she had a strip of tablets left (reorder done today), she has enough tablets to last until her new batch are ready for collection (I have not deprived her of medication/caused her pain). Taking her medication will not become a habit of mine! But desperate times call for desperate measures! Sooooo much pain!
My Hypermobility Syndrome worsened at the exact same time that my Fibro flared – both were mentioned in e-consult submissions to the GP. I believe both were impacted by the COVID19 infection I had in August. My left shoulder has never been particularly impacted by Hypermobility Syndrome (my right shoulder has always been bad) but now feels very loose and painful. The Physio concentrated on this rather than the Fibro pain when I saw him last week – we are ‘strengthening’ the muscles around this area.
I feel ‘stuck’. I have no way of getting hold of a drug that I know works well for me right at a time when I need it the most. My Fibro pain is mostly impacting my hands, arms, upper back and neck and is becoming unbearable without appropriate medications. I’m at that point of being sick of being in unnecessary amounts of pain and am feeling sorry for myself. If this is also where you are right now, I see you, I ‘get it’.
Love Sally
and Foggy (OBVIOUSLY) xx