Brief Answer:
Consultation

Detailed Answer:
Thanks for your question.

I've read what you wrote, including some of your past premium questions, very carefully. Let me give you my thoughts.

I think from a purely medical standpoint, your workup is actually thorough and reassuring. CT, MRI, and blood testing were essentially negative, which rules out a life-threatening problem. You ask if a spinal tap is something you need to rule out a virus -- I think this is unnecessary, as an infection would not have gone on this long without presenting itself with more serious symptoms such as high fever (>101) and loss of consciousness, and infection does not cause tenderness on the back of the head. Another thought is an EEG to assess for seizures as rarely they can present this way, although I think that too is unlikely. This tells me there is a functional problem here, which namely is pain.

To deal with pain, nerve blocks are an interesting idea, and I would recommend you try them again even though you are unsure if they worked. If nerve blocks continue to fail, this point to the fact that your pain may be more psychosomatic in origin. It is clear that you are suffering from anxiety and depression which can heighten pain receptors around the body and make otherwise mild pain unbearable in some cases. This issue has also caused major weight loss which is a threat to your health. In my opinion, you should be on an antidepressant that also has anti-pain effects, as improving your depression I believe is key to getting your pain under control.

A great antidepressant for this purpose is Cymbalta, but you had GI side effects. Other equally good medicines are Effexor and Pristiq. If you were my patient, I would give you a trial of Effexor for a few weeks and see how you respond to it. This is a good medicine to address depression and improve pain and I think you deserve that.

My name is Dr. Sheppe, and I am an XXXXXXX psychiatrist working in New York City. For a personalized comprehensive evaluation, treatment recommendations, or individual therapy, ask me at HealthCareMagic at this private link: tinyurl.com/DrSheppeAnswers

---

Brief Answer:
Follow-up

Detailed Answer:
Allow the Effexor some time to work. It can take up to 6 weeks to see significant effect. Continue seeing your counselor. The MRI and CT suggest nothing life-threatening is going on here. Patience is key -- continue talking with your counselor about ways to deal with the stress, anxiety, and pain while the medicines are kicking in.

If your fever is less than 101, it is not considered a real fever. The body naturally fluctuates even as high as 101 without infection as a necessity. If you are having headache in your sinuses this could well be a nasal virus, but this will resolve within a couple weeks and is not life-threatening. Try to exercise patience as viruses resolve on their own with time. Again, tenderness in the back of the head is not a sign of meningitis or intracranial infection, but rather indicative of musculoskeletal pain.

I do not think you're making up this pain at all. Your pain is very real. We just have to figure out what is most likely potentiating this pain. Depression alters pain receptors in such a way as to cause real worsening pain, and I think that is a major contributor here, as your scans and other symptoms are not consistent with intracranial pathology.

Listen, you're going through a tough time. I feel for you. But I think your doctor has it right with the Effexor. Give it some time to work, and if you do have a virus, give that some time to resolve on its own. For continuing individual therapy, ask me at HealthCareMagic at this private link: XXXX

---