AB219. SOH21AS098. Case report: a patient presenting with pain and the practice of binding in Ireland

Abstract: Binding is the practice of compressing breast tissue to give an appearance of a flat chest. This is important for many patients including transgender, non-binary, masculine-presenting assigned female at birth and gender non-conforming patients. We report a case of a 17-year-old masculine-presenting assigned female at birth patient. She presented to a pain clinic with new complaints of bilateral chest wall pain. There was a background history of Ehlers-Danlos Syndrome (EDS) Type III and Pain Amplification Syndrome (PAS). On examination tenderness at their costochondral region, lateral ribs bilaterally and costovertebral joints was appreciated. The majority of the pain has now resolved after changes in binding practice however patients with EDS may take prolonged time periods to recover from injury and clinical examination assessing progress may be obscured secondary to PAS. This case demonstrates binding can cause pain and may have long term health implications. Pain may have been intensified due to EDS and PAS. A key aspect was the non-judgmental, open communication style by the pain specialist enabling the patient to interact in honest dialogue with their doctor. These points are in keeping with current literature such as the Binding Health Project Survey. The decision to augment binding methods was made by the patient with support from the pain MDT ultimately alleviating symptoms. This case demonstrated a delicate balance of prioritising health needs and treating pain whilst simultaneously respecting gender expression and patient autonomy.

Keywords: Anaesthesia; binding; chest binding; LGBTIQ+; pain; transgender health