The multidisciplinary team undertook a detailed assessment and allowed the patient to tell her story of living with pain and other symptoms. The team were able to explore her beliefs of what pain, weakness and shaking symptoms meant to her and her goals and expectations of the pain service. She told the clinical psychologist she had a difficult adolescence; her father had been abusive to her mother, and they had separated when she was 13. The family experienced financial difficulty and her mother remarried soon after her father left. Her stepfather had issues with alcohol and often hit out when he was angry. She left home when she was 16 but returned to live with her mother when her stepfather left when she was 19. She got pregnant at the age of 20 and her mother helped care for her baby whilst she went back to college. She lost her job when the local newspaper she worked for closed when she was 30. Her pain made finding alternative work difficult. She described feelings of embarrassment when her arm shook uncontrollably. She felt her painkillers did not work but probably added to her exhaustion. She was fed up with the pain and weakness controlling her life and the unpredictable nature of her symptoms made her afraid to go out. She felt lonely, frightened and had become isolated from her friends.
When formulating a differential diagnosis, the team considered other widespread pain conditions such as fibromyalgia and considered a neurological diagnosis for her symptoms. Over the years, she had been investigated extensively. She had had at least two MRI scans of her spine previously and other investigations including nerve conduction studies, CT brain and CSF sampling. She had seen a neurologist several times who examined her and excluded serious neurological pathology. He had suggested a diagnosis of Functional Neurological Disorder (FND).
