Suggest treatment for fatigue and neck pain in a child
Patient: my 12 yr old daughter Alexis has had severe back pain, leg pain, neck pain, fatigue, shortness of breath and generally just feeling unwell for 2 months. All blood tests came back normal except for 2 Lyme titers which came back positive. However the dr feels this is a false positive and wants to run another test in 3 months. He doesn t want to start her on antibiotics. Doctor: Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice.  There are so many complaints that Alexis's illness is complex medical condition.  I am assuming that musculoskeletal, cardiac, lung, endocrine, and anemia have been ruled out.    I would like to know whether she has had a tick bite.  Does she worry a lot?  Has she missed any time from school in the past few months?   I wish to give you information about a condition known as Somatic Symptom Disorder(SSD).  It causes one or more bodily symptoms, including pain, nausea, dizziness, fainting, and abdominal pain.  The symptoms may or may not have a physical cause. For the patient, they cause excessive levels of distress.  The distress from pain or other problems are real, whether or not a physical explanation can be found.  The distress from symptoms significantly affects daily functioning.  Doctors need to perform many tests to rule out other possible causes before making the diagnosis of SSD.  Some doctors feel that while the tests are being obtained the child ought to be evaluated simultaneously for SSD.  In SSD the brain-body message system is not functioning properly: you may have such a strong emotion, e.g. anger. that your brain is overwhelmed and it sends signals so that you experience the emotion in your body as abdominal pain rather than as a feeling in your mind.  As time goes by and if there is no diagnosis, you might consider asking if a developmental and behavioral pediatrician would be a good choice for children with complicated medical problems.    I hope I have been able to give you some additional thoughts to help your daughter.Please return if we can assist you further. Arnold Zedd, MD, FAAP