14A. Pelvic Pain and Headache in an Adolescent Female: A Case of Self-determination and Healthful Recovery

A 16-year-old previously healthy white female presented to our office with complaints of a 1-year history of chronic severe pelvic pain, leg pain, and severe daily headaches that were adversely affecting her school performance. Her leg and pelvic pain caused weakness and discomfort to the point that she used a walker or a wheelchair when she had to ambulate distances longer than 20 feet. She had been disenrolled from school where she had been an honor student. She had seen several specialists in areas including gynecology, neurology, pain management, and pelvic floor physical therapy. Extensive laboratory workup, including testing for Lyme disease, was negative. Exploratory laparoscopy did not elucidate any significant pelvic pathology. Medical management with appropriate doses of non-steroidal antiinflammatory medication, amitriptyline, lyrica, oral contraceptives, and Depo-Provera did not provide any significant relief. Through a series of visits to our office, it was determined that she was incredibly motivated to return to school but was having significant difficulty managing her advanced school work due to severe headaches and trouble with concentration. She denied any specific triggering factor for her symptoms and did not have a mood disorder. With behavior-modification recommendations, she worked independently on increasing her daily activities and has been able to rehabilitate to the point that she no longer uses a walker or a wheelchair to move around. This case demonstrates the potential that a therapeutic relationship can have for facilitating patient recovery. The importance of open communication with the patient and family, addressing their concerns, and seeking a source and treatment regimen outside of a paradigm of a psychosocial trauma were highlighted by this process.