How Physically Painful can Anxiety(GAD) actually be?

[neurolorurodoc]

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Ok, I listed a Hx of a patient on the urology forum. It is about a patient with severe unexplained progressive urinary(urethral pain). Out of lack of other tests the urologist suspects that anxiety has to do with all the pain, can pain from anxiety manifest itself in UTI, urethral and progressive pain after ejaculation. I mean the pain seems so urological, is progressive, pain is very real. Is this common that pyschotropic drugs are prescribed eventhough patient is intelligent/graduate school educated, doesnt present any pyschiatric symptoms or history. In what ways and body systems have you guys seen anxiety manifest pain? The patient is convinced it is due to an STD due to the promixity and correlation of when the pain started to occur and the time of having unprotected sex with his exgf.

I am really interested of what the professional pysc people think of this...

Thanks.

 

[strangeglove]

Ok, I listed a Hx of a patient on the urology forum. It is about a patient with severe unexplained progressive urinary(urethral pain). Out of lack of other tests the urologist suspects that anxiety has to do with all the pain, can pain from anxiety manifest itself in UTI, urethral and progressive pain after ejaculation. I mean the pain seems so urological, is progressive, pain is very real. Is this common that pyschotropic drugs are prescribed eventhough patient is intelligent/graduate school educated, doesnt present any pyschiatric symptoms or history. In what ways and body systems have you guys seen anxiety manifest pain? The patient is convinced it is due to an STD due to the promixity and correlation of when the pain started to occur and the time of having unprotected sex with his exgf.

I am really interested of what the professional pysc people think of this...

Thanks.

Consider pain disorder, which is pain out of proportion to a medical cause, often the manifestation of an underlying psychiatric process, but not necessarily anxiety.

 

[neurolorurodoc]

Consider pain disorder, which is pain out of proportion to a medical cause, often the manifestation of an underlying psychiatric process, but not necessarily anxiety.

So is this that the patient interprets the pain out of proportion or does the pysch disorder make the pain extremely higher in proportion to what others sense or feel?

 

[masterofmonkeys]

the mind has huge power over the body, but as far as I know, your brain cannot put bacteria in your urine...

Pain after ejaculation though, if he's on an SSRI, that could be the culprit.

Since the pain started after he started having unprotected sex with his exgf, might be worth figuring out how that's affecting him psychologically.

'Pain out of proportion' could have multiple causes. It might be an objectively nasty thing that exam simply can't see. The patient may feel the pain more strongly due to underlying psychopathology. Or the pain could not be that bad, but he's overstating it, attention-seeking or whatever.

 

[whopper]

The sensation of pain is partly based the person's psychological interpretation. Although I haven't seen any studies showing anxiety increasing pain, from personal experience it makes sense. Anticipating & worrying about the pain can make it worse.

However from your description--that'd be a first I've heard of such a thing if there's an anxiety disorder component to it. It seems too specific to be pinned down to anxiety. I'd still investigate a non-psychiatric cause.

Dyspareunia is a specific psychiatric disorder where pain is experienced during intercourse in the genital organs, but it cannot be due to a medical condition.

In pretty much any psychiatric disorder, medical causes have to be ruled out. That'd be the first thing to do here.

If you are concerned there maybe an underlying psychiatric basis to this, after all the medical causes are ruled out, I'd get a psychiatrist to work with you on this case. Heck, if there is a psyche component, you could publish this thing.

Is this common that pyschotropic drugs are prescribed eventhough patient is intelligent/graduate school educated, doesnt present any pyschiatric symptoms or history

Intelligence & education does not rule out a psychiatric disorder. Of course someone could be psychotropically medicated in that demogrphic.

However if they don't have any psychiatric symptoms--it could be they are medicated and the medication is working--therefore no symptoms. If they have no history, but are on psyche meds, then its either poor history & the person needs the psyche meds, or the person may have been put on psychiatric meds without needing them. I see that from time to time though its rare. Last one I saw, the PCP convinced the patient she had Alzhiemers...and she had no symptoms whatsoever of memory problems, no dementia workup, and that doc put her on Seroquel--claiming its a treatment to treat Alzhiemer's. The white coat can be a good thing, but it can also make patients believe doctors too much.

 

[nancysinatra]

the mind has huge power over the body, but as far as I know, your brain cannot put bacteria in your urine...

Oh yes it can--if it is Munchausen's. (Ok, that requires hands as well as brains.)

Though he doesn't seem to have a UTI, from the history.

 

[masterofmonkeys]

from the original post:

"can pain from anxiety manifest itself in UTI, urethral and progressive pain after ejaculation"

 

[nancysinatra]

from the original post:

"can pain from anxiety manifest itself in UTI, urethral and progressive pain after ejaculation"

You're right! Sorry about that. I got the idea that the patient did not have a UTI from the urology forum, where it says "urine test normal." It's a bit confusing as to whether he ever really had a UTI or not.

 

[masterofmonkeys]

the whole story is confusing. This isn't directed at the original poster but in general whenever someone pulls a studentdoctor curbside psych consult, I scream in frustration because we often don't get enough history--medical and psych--or what meds they're taking.