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A 30-year-old woman presented with recurrent abdominal pain over several months. When an ultrasound revealed stones in the gallbladder, a diagnosis of biliary colic was made and a cholecystectomy was carried out. Within a month of the operation, the pain had recurred. Numerous investigations were conducted, which suggested spasm of the sphincter of Oddi. Various dilatation procedures did not relieve the pain, eventually leading to further exploratory surgery. By this time, the patient was consuming large quantities of benzodiazepines and codeine phosphate for the pain, which had now become chronic.

Despite referral to multiple specialists, recurrent investigations and many procedures, pain continued and a psychiatric opinion was requested. On careful review of the patient's medical history before the presentation with the abdominal pain, a clear story of recurrent symptoms in multiple body systems since adolescence was clear, as well as difficult relations with family and husband.

In retrospect, the diagnosis of somatisation disorder could be made. A case conference was organised by her general practitioner, who initiated a plan of management as specified by Bass and Benjamin²⁰ (see Box 5). Drugs were gradually withdrawn and referral to specialists ceased. The general practitioner arranged to see the woman on a weekly basis for a half-hour consultation, and no further investigation was done. Counselling and problem-solving strategies to deal with the family problems were implemented. Over one year, complaints of pain gradually diminished and the patient returned to being able to cope with home duties and her young child.

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