Joanna: "the pain is real"

The case (fictional)

Joanna is 38, grew up in Poland and has lived in Dublin for twelve years, working as a care assistant in a nursing home. Eighteen months ago she hurt her back lifting a resident. Scans show "minor wear" that her doctors say does not explain the level of pain. She has been off work for seven months, and her sick pay ends soon.

When the pain flares she rests in bed. She avoids bending, has given up swimming, and her husband now does the shopping. "If I bend, the disc will slip and I will end up in a wheelchair," she says, and she is angry that "nobody believes me". She has had three courses of physiotherapy, takes codeine every day, and is on a waiting list for a pain clinic.

Her mood is low, she sleeps badly and she says she feels like a burden to her two children. Her employer has written to invite her to a return-to-work meeting. She misses her colleagues and the residents.

She is referred to the psychologist in the pain service. She arrives saying, "I am not crazy. The pain is real."