an uncertain state of affairsPosted: 02/05/2013
my daughter is back in school for a second visit – we are aiming for an hour today. she was in worse pain when she woke this morning. by the time we left the house, dosed up on paracetamol and ibuprofen, she was in brighter spirits and clearly looking forward to seeing her friends again.
the morning encapsulates for me the uncertainty that exists at the heart of the diagnosis. is the fact the she’s in more pain this morning – the day she is due in school – a coincidence, or evidence of some deep-seated anxiety that she may not be aware of? we know that anxiety triggers pain, but how is it possible to differentiate between co-incidence and causality in the absence of an anxious child?
perhaps it is not helpful/useful to think too closely about this. but I can tell you, it is a question that drives me quietly mad.
Functional abdominal pain, (FAP), is sometimes described as a wastebasket diagnosis. the diagnosis is great at telling you what is is not, but thereafter the detail is as grey and muddy as an abdominal ultrasound scan.
i remain deeply dissatisfied with the level of care offered to my daughter after she was discharged from hospital in February. ‘team’ management has meant in practice that no one person has taken charge of her care beyond diagnosis. advice on medication, and a prescription for amitriptyline, came from a paediatrician at another hospital. we have had to push and push to get any guidance on pain management. most recently, my daughter’s care has been bounced back to our family doctor, who admits she is no specialist in abdominal pain.
we can argue over the extent to which FAP is a wastebasket diagnosis – in many ways that is by the by. what our experience shows, unequivocally, is that this is the basket into which a child with FAP often gets thrown.