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Dr. Andrew Rynne

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Exp 50 years

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Suggested immobilization for broken arm. Having severe pain. What cure should be done?

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Dr. Sudhir

Internal Medicine Specialist

Practicing since :2000

Answered : 1417 Questions

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Posted on Mon, 7 Jan 2013 in Bones, Muscles and Joints
Question: My closest friend, a 61 year old woman broke her arm 11 months ago in a fall. She wanted the doctor to operate and put a pin in it but instead they recommended immobilization. It took longer to hear than normal due to her taking a drug for osteoporosis but it has now healed. However she complains of blinding pain. Her husband has had to quit work to look after her as she is completely unable to do anything. She cries constantly from the pain. She is extremely angry that she did not get the "right treatment" at the time. I can not stand to call or visit her any more because she lays on the couch and cries from the pain alternating with ranting that her husband and doctor made the wrong decision (in her mind) in immobilizing the arm. Is there any possibility that this is physical or is she suffering from a mental illness.
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Answered by Dr. Sudhir 21 minutes later
Hello,

I guess it's more of misunderstanding on part of your friend.Generally doctors consider many factors before suggesting treatment and patient might not be aware of the facts.So a good discussion with her doctor can help her understand why particular treatment was selected. Results of treatment are not always predictable and treatment selection is always done in good faith.This would be first step.

Second step is to investigate her for the pain.A broken healed fracture should not cause so much pain.There might be other injury associated with this which might cause so much pain.Injuries which need to be ruled out are pinched/injured nerve, torn ligament or tendon etc. A healed fracture should not cause debilitating pain.

I know it would be difficult for her to understand as she is in severe pain but this things can help her.And in such cases generally there are both physical and mental elements involved.With good discussions, support, understanding and treatments she should feel better.

For time being doctor can put her on higher painkillers.

Hope this answers your question.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Sudhir 20 hours later
Thank you I found your answer very comprehensive and understanding.

The question I now have is what could be the reason why she is prevented from taking any painkillers.

As far as I or anyone else knows she is not taking anything at all for the pain.

The only reason I can imagine that she can not take painkillers is that she has liver damage.

She told me that she could not take any pain killer because it interfered with healing. I understand that one does not take noninflammatories immediately after a broken bone and maybe when the bone was healing slowly someone got the idea that not taking painkillers might speed the process. ... but it is now healed.

She now is telling other people she is allergic to opiates but I know she has taken Tylenol three all her life and she has never told me she was allergic to opiates.

I imagine it is possible to develop an allergy or a low level allergy to become worse but there must be something else that would help.

I am feeling particularly guilty because her husband has complained that I am abandoning her after years of friendship and also I received a phone call l from other friends saying she feels abandoned by me. In turn I am being told that her husband looks terrible due to the pressure of caring for her.

I am not squeamish about ill people because i am an estates planning lawyer and visit dying and ill people constantly. But I have not experienced anything like this before where a person is alternately crying and ranting for 11 months.

I considered having a psychologist visit her with me, but the psychologists advice to me was that my withdrawal was self protective and perhaps necessary to my mental health when faced with an intractable problem i don;t understand.
doctor
Answered by Dr. Sudhir 5 hours later
Thanks for follow up question.

Common causes of not taking painkillers are allergy, compromised liver/kidney function or side effects. But still there are medications that can be taken in these cases. So her doctor after evaluation and detailed history can suggest painkiller medications for her.A appropriate medications can surely help her.

In my view your friend is in self pity and attention seeking phase. She is doing it by not taking medications, complaining and exaggerating pain. Such patients always want to show their suffering and continuously complain about people close to them. A good counseling can prove helpful in her case.
I agree with your psychologist and your approach of withdrawal. I think you should keep visiting her, but keep visits short and don’t think about it when you are away. Don’t evaluate yourself by opinions of others, just give support as much as you can and don’t get stressed out.

Hope my answer helps you.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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