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Danish migraineurs, who are applying for a protected job or a pension due to chronic migraine, are now at risk of being referred to psychiatric treatment, and are denied their migraine medicine as part of this treatment.

The treatment goes under the name of the TERM model.  One hospital department has established themselves as the national center for this particular treatment, and runs teaching courses for General Practitioners (GPs) in how to identify and treat patients who suffer from bodily distress syndrome, even though they have an established diagnosis of migraine (or other pains).

We bring an account of the principles, as a warning to migraineurs, so they may be better equipped, mentally, if they are being forced into the treatment programme by their local administration, as part of the terms for receiving a welfare benefits while in the process of being assessed for a protected job. The TERM treatment may be practised by the GP or in a psychatric setting.

The teaching programme for GPs has a number of recommendations for physicians who treat patients with diseases that are difficult to treat. When a doctor may give up finding a treatment that can alleviate or reduce the number of days in pain (e.g. migraine days), the TERM model maybe the way forward, is the message to the GP.

  1. advice to doctors comes from the teaching material, which is published by the Research Unit for Functional Disorders, Psychosomatics and Clinical Psychiatry, Aarhus University Research Unit for General Practice, Aarhus University, for training of non-psychiatric physicians.

Your Danish doctor may have been trained in this! Read the text before you accept that you have a functional disorder.

Migraine is a recognized diagnosis

Migrænikerforbundet is pleased that migraine is an internationally recognized diagnosis. Especially the Danish doctors have done a great job to get migraines recognized internationally as a physiological disease.

We fear, however, that there may be migraineurs with chronic migraine, which is difficult to treat, who will be offered treatment according to the TERM-model. The short version is, that treatment according to  the TERM-model will convince the migraineur that migraine is a mental illness, and the pain is imaginary.

Functional disorders is not a recognized diagnosis

Functional disorders (as the symptoms are called in the TERM model) or BDS (Bodily Distress Syndrome) is not a recognized disease - ie. doctors may not use the concept as a diagnosis. Nevertheless  a great many citizens in the social system are treated for functional disorders in the form of the TERM model (ie. a treatment model which is still in research stage). The idea is that diseases such as fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome and many others are just something we imagine. 

So physicians who treat functional disorders treat a disease which is not generally accepted. Part of the treatment is to remove all medication, including the medication for the migraine. They also do not tell patients that they are in fact part of an experiment to show that treatment works. The experiment is run without comparison to people being given sham treatment, so it is far from the normal standard for clinical trials.

The teaching materials for Danish GP's is so far only published in Danish. It includes 62 pages of text. We have not translated this material. 

Migrænikerforbundets comments to the 21 specific recommendations (page 50 ff) to doctors are given below. The comments are subjective (and somewhat critical) interpretations of the recommendations to doctors, but we hope you will get the gist of the treatment.

1. Let the patient believe you accept his symptoms. Do a series of tests. You will not find anything.

Tell the patient that it is not what he says that is important, but what you find that is essential for treatment. You're the expert.

2. Tell the patient that there are many side effects from his medication and that he takes far too much for his migraines, or whatever he thinks he has.

If the patient is unhappy about abandonning the painkillers, you may explain that the patient has become dependent on medication and therefore has to get out of the medicine to get better.

Talk to the patient as if he is an obstinate child.

3. Tell the patient that he has a disease called 'functional disorder'.  The mere fact that his illness gets a new name will make it easier to treat the patient later.

4. Let the patient believe that you accept his symptoms as real. It makes it easier to collaborate later.

5. Pretend to be honest and direct. That is, use sentences like "I can hear you find it difficult to accept what I say".

6. Let plenty of time pass. The patient is probably on welfare, and ideally should continue with it for a long time - it reduces the resistance to treatment and is cheaper for the municipality.

7. Time helps you to make the patient happy with the situation and he will agree that he is has a functional disorder, and no actual pain.

  1. If the patient does not think your treatment works, you may explain that it is wrong to focus on the pains (or the fatigue, or whatever it is that bothers the patient).

9. Give a diagnosis of depression or anxiety, if necessary. Both can include a lot of symptoms, also found in the diseases grouped under 'functional disorders'. That is, among others, pain, fatigue, palpitations and headache.

10 - 13. Give the patient antidepressants or anti-anxiety medication.

There are no clinical trials that have shown that these medicines have an effect on migraines, headaches, fatigue or any other symptoms, patients come with. But they make the patient tired, so he does not  complain too much.

14. Preferably prescribe several different types of medication for mental disorders simultaneously.

Remember to use drugs of types that can be measured in the blood, as the patients tend to drop the medicine. You must have evidence that the patients adhere to your treatment.

15. Remember it is the clinician who runs this process! Do not let the patient talk to you too often! You run the risk that he will drop out of treatment if you allow him to talk to you too often!

16. If your patient breaks an arm or a leg, he obviously needs some sick leave. But do not be persuaded to grant a sick leave, if there is no such physical causes for it.

17. Persuade the patient to avoid contact with other physicians. Maybe they do not agree with you!

18. Make sure you have a vacation replacement, who will continue your treatment. If an outside physician gets access to the patient, the treatment may be changed!

19. Ensure that the patient's family agrees with you (the doctor), and support your suggestions and conclusions.

20. Patients are so stubbornly demaning, that you probably need supervision (mental support) from a colleague.

21. If everything else fails, you can try psychiatric treatment. But psychiatrists do not always agree with our treatment, so it's an uncertain road forward.

 

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