Is there a role for medication in the treatment of functional conditions?

If having a functional condition means that there is nothing wrong with your body, then how can medication have a role to play in your treatment? It is important to say that medication here is not used to treat any disease but can relieve functional symptoms in numerous ways.

Below I will describe the stories of three of my patients where medication played a central role in their treatment.

Hans

Hans was suicidal with his pain when I first met him. He was convinced his teeth were the cause and had persuaded his dentist to pull six of them out even though they were healthy. But his pain persisted night and day. Two things were immediately obvious: the pain was very real and severe, and his jaw muscles were the cause: his relentless bruxism (jaw clenching or grinding) was putting enormous pressure on his teeth, leading to pain,

I gave Hans a simple relaxation treatment, and that night was the first night without pain in months. However, his habit of bruxism was lifelong and it was hard to break the habit, so he underwent a series of Botox injections to his jaw muscles. The muscle relaxation caused by the Botox has allowed Hans to enjoy sustained relief, while we address the underlying traumas that may have contributed to the bruxism.

Botox is a brilliant therapy for those with unrelenting symptoms due to muscle tension. Headaches, choking, voice disturbance, eye tics, bladder problems, the list is endless. In experienced hands, it is safe and effective.

Carla

Carla is a survivor of sexual assault and had experienced pelvic pain for years. All her medical investigations were normal, but she was convinced there was something terribly wrong. Of course, there was: her functional symptoms were worse than if she did have a physical problem like an infection. It took a while to persuade her to take amitriptyline as she worked with her pelvic physiotherapist and her trauma counsellor to finally overcome the pain. Pain specialists discovered that using low doses of this antidepressant drug works to raise the pain threshold and allow the body to stop the vicious cycle of pain, tension, more pain.

A great circuit breaker, amitriptyline helps to enable the pain centres in the brain to stop their dreadful message.

Felix

Tremor is a common problem with many causes, including functional. Musicians like Felix find their performance anxiety causes a tremor bad enough to affect their playing. Propranolol is a drug that blocks the surge of adrenaline which can happen with anxiety. Small doses can help to steady the nerves and the hands.

The role of medication in functional conditions

These three drugs have their specific roles in the treatment of different functional conditions. It is necessary to have a good understanding of what is happening in your body to produce the symptoms before you can accept a trial of such medication. I go into this in some detail in my book. For now, it is helpful to recognise that your functional symptoms are not a conscious, deliberate bodily response, so you cannot expect to override them consciously. For some deeply entrenched symptoms, even extensive therapy is simply not enough to break the cycle. Medication can be safely used to facilitate the journey to recovery, or at least alleviate the symptoms.

The three drugs I have mentioned are not addictive and can be used by many without risk. (Of course, there are important exceptions so only try them under medical supervision). But many drugs can do more harm than good, especially if taken long term. Opiates, strong painkillers, are particularly counterproductive and can cause death if misused. They are best avoided for long term pain.

I hope by reading this and the previous posts, you are seeing that there is a vast range of treatments for functional conditions and often a number of different therapies, including medication, can help you to recover.

I will write more about pain in the next post. It is one of the most common functional symptoms; it is frequently undertreated; and there are ways to control it beyond medication.

Wishing you functional wellness.