Case studies

Pain control 1

Liz Whelen, University of Chester

‘Lily’ is 24 and works in hospitality. She gets a small wage supplemented by tips and is on a zero-hours contract. Therefore, to pay her bills she must work as many shifts as she can get. Lily is also trying to study alongside her job, but her boss is not very sympathetic about this, and she sometimes thinks that she is offered shifts that clash with her lectures deliberately. Lily is finding this increasingly stressful and thinks it might be time to look for another job, but has not had any luck so far finding one.

In her spare time, Lily goes to the gym, which is her way of dealing with stress. Recently she has been suffering from some pain in her right arm after going to the gym and first thing in the morning, which wears off after a while. She has tried over-the-counter medication, but this is not really helping so she made an appointment to see her doctor. Her doctor carried out a full examination and sent her for x-rays but cannot find any sign of anything that might be causing her pain so has just told her to monitor the situation and see if any exercises or machinery at the gym are triggering the problem.

The pain has not gone away, and she thinks it is, in fact, getting worse. It is also affecting her work as she cannot carry as much as usual. Lily has taken to taking lots of pain medication to help her cope and be able to work but is now suffering from stomach pains due to the medication. She has tried skipping the gym to help as well but is really missing the stress release.

Pain Control 2 (adherence issues)

Liz Whelen, University of Chester

‘Susie’ is 42-year-old divorced woman with three children, aged 14, 12 and 6. She works nearly full-time and has to juggle parenthood alongside most of the child care as her ex-husband lives 300 miles away, and so doesn’t spend much time with their children. She was very active as a child and teenager, and played lots of sports, both while at school and university and after she started work. When she had children, she had less time for exercise, so she eventually stopped doing regular exercise.

When her husband left her for a younger woman, she decided that she needed to overhaul herself.  So she joined a gym and a running club. She admits she may have overdone the number of classes and amount of exercise she did at first after so many years without much exercise, so she wasn’t surprised when she started to feel pain in her knees and hips. She self-medicated for a while, thinking her body just needed to get used to the increase in exercise, but she started to experience stomach pains when using over-the-counter medicines. So she visited her GP to get other medication that wouldn’t have this effect. Surprisingly to her, he referred her for a series of tests, leading to a diagnosis of rheumatoid arthritis (RA). Susie was shocked by this diagnosis and the consequent changes she needs to make to her life.

She has been placed on appropriate medication, which she doesn’t think is working as she is still in pain. She is also suffering a number of side effects (nausea, headaches and loss of appetite), and so doesn’t always take her medication. Her specialist has suggested taking steroids in the short term to help manage her pain, but she worries about what side effects that may cause.

Discussion questions

1.   How could psychological approaches be used to help Lily/Susie deal better with her pain?

2.   How might you help Susie adhere to her pain medication?