Desmoid tumor complicating remobilization treatment for a chronic pain syndrome

The criteria for recommending an operant conditioning program for a patient with chronic pain include definable pain behavior. A thorough investigation of all organic factors that may contribute to pain is usually made prior to such treatment. This report describes a patient with chronic pain and mild cognitive deficits related to a truck accident who insidiously developed an extra-abdominal desmoid tumor. Desmoid tumors, which may develop after trauma, are associated with incidental connective tissue anomalies. They can be initially mistaken for fibrocytic nodules because they have a distribution similar to that in fibromyalgia. This patient's painful tumor was diagnosed while he was participating in a remobilization program. Subsequent resection and irradiation adversely affected rehabilitation goals and reinforced the patient's conviction that all his complaints were organically based.