This is an outline of “my” average symptom severity increases and decreased based on the time of day. As you can imagine, all sorts of misconceptions can be made by physicians based on what time of the day they have seen me in the past. Appointments in the early morning typically resulted in psychiatric referral for impatient care. Appointments held around 12pm to 3pm typically resulted in me being ignored and treated as though it was all in my head and I was perfectly fine and ready for full-time employment. Appointments later in the evening typically resulted in treating me somewhere between a hypochondriac and mentally ill resulting in a psychological referral.

Appointments at night were typically emergency room visits with seizure-like episodes and psychotic-like emotional episodes which again would typically lead to psychiatric referral for impatient care. It wasn’t until I attended a 3-week chronic pain management program that I was properly diagnosed, because they were able to monitor me at all times of the day and see the full range of symptom severity fluctuations. Considering that most of my doctor’s appointments were held during times I was the most alert, my condition was largely ignored until it became an emergency issue either due to seizure-like episodes or physically violent episodes. Symptom severity also fluctuates throughout the week, months, and years.

When centralized pain is reported by a patient, I implore physicians to consider the full range of symptom severity fluctuations before considering diagnosis and referral.

12AM-11PM: Incoherent, Non-verbal, Reduced coordination, High risk of accidental injury, Emotional control deficit, Pain, exhaustion, and muscle weakness is severe, Symptom escalation in 5 minutes (how long the condition can be aggravated until emotional control deficit and /or full body paralysis-like or seizure-like episodes).

12PM-3PM: Coherent with attention deficit, verbal with poor recall, Lacking in very fine motor skills, Mild risk of accidental injury, Emotional control if not experiencing severe pain and exhaustion, Pain, drowsiness, and muscle weakness is moderate, symptom escalation 15-30 minutes.

3PM-10PM: Semi-coherent, Reduced verbal communication with poor recall, Lacking fine motor skills, Moderate risk of accidental injury, Reduced emotional control, Pain, drowsiness, and muscle weakness is moderate-severe, Symptom escalation in 15 minutes.

10PM-12AM: Incoherent, Non-verbal, Reduced coordination, High risk of accidental injury, Emotional control deficit, Pain, exhaustion, and muscle weakness is severe, Symptom escalation in 5 minutes.