The initial clinic discussion included an explanation of the multifactorial causes of pain and central sensitization. He was reluctant to accept that further courses of antibiotics were unlikely to be helpful as infection did not appear to be causing his symptoms. Possible risks of antibiotics were also discussed, including the potential for them to cause or worsen pain conditions. The possibility for chronic pain to develop after an infective illness was also explored.
He declined a trial of a laxative to help with his constipation as he was worried about faecal incontinence.
Psychological support was offered but he felt this would not be useful and declined. He reluctantly agreed to attend a pain management programme if his work would give him time off.
He was able to arrange to attend and actively participated in the programme. At the end he commented that he had enjoyed the physical activities as he used to be very active before his health issues.
At his pain clinic follow-up review, he described making good progress since the programme. He had joined a wild swimming group and had been working on weight management and eating a more nutritious diet. He had also given up drinking alcohol completely. Although some of his symptoms persisted, he found them less troubling and felt they were interfering less in his day-to-day life.
