As you likely know if you read my posts here regularly, I am no longer taking any real mood-stabilizers for my bipolar disorder. It isn’t an anti-medication stance, it’s actually just a place I ultimately came to through very little choice of my own (you can read a bit more about it here).
Now, being Bipolar I with psychotic features, unmedicated is a pretty daunting place to be, and I’m learning all the angles I need to cover. Some I already knew and had accounted for: exercise, sleep, stress, and situations I knew were very high on the potential trigger list. Others I knew, but didn’t really think about planning for, because they just didn’t come to mind when thinking of the day-to-day and what I needed to be vigilant about.
One major issue I’m suddenly finding myself scrambling to deal with is being in pain. More specifically, being in a great deal of pain for a prolonged period of time, without too many resources to treat it. Right now I am traveling, having a visit with family back in my hometown of Pittsburgh, PA. In a rather unfortunate pre-trip packing incident, I turned my back in exactly the wrong way. It hurt at the time (this would have been Monday last), but not too incredibly. After several hours on a plane, as well as lugging a 48 pound suitcase around — getting it in and out of the car, carrying it up the stairs both to the room and in the room — I was in a fairly severe state of pain. Tuesday night on a hotel mattress ensured that by Wednesday, I was eating Vicodin, muscle relaxers, and prescription anti-inflammatories in greater quantities than the really delicious chocolate thumbprint cookies I can only get on these trips.
Chocolate thumbprint cookies of deliciously addicting evil.
Fortunately for me, I was able to get my doctor on the phone and am now taking a steroid that is very rapidly mitigating the pain. Which is great for two reasons. The first, obviously, is that I’m not in such intense pain that three prescription medications can only take the edge off. The second is the way being in pain, particularly severe pain lasting for days (or longer), completely messes up my moods and my thinking.
I get irritable. I become easily stressed. I slip into a depressive state, and often begin to think things like I am worthless, a burden to the people in my life, and I have no value whatsoever. I never become suicidal, but I do still believe most everyone I love would be better off if they had never met me, even when I am told things directly to the contrary.
Now, I know that pain can affect the moods of those who have no mental illness at all. Just within the past day, my poor mom has done something to cause her back to become most painful (we’re a fine family for back issues), and she and I talked about this very thing. But when you have any kind of affective disorder (bipolar or depression, or anything that’s in their extended family, like cyclothymia), being in pain seems to pose a much more severe, long-term risk, a risk to overall mood stability.
I have experienced these same issues when I get truly epic migraines. Dealing with a migraine for a day or so is certainly no picnic, but I can handle it, and very rarely do I feel any effect on my moods or perceptions. But when I get one that lasts for three days, sometimes a week. . . I learned the hard way that when I’m unsure whether I should take my prescription opiates or try to ride it out with an over-the-counter NSAID, it’s better to choose the former and risk a bit of over-medicating. But then, I’m lucky, and I have never had issues with addiction or dependence in the 18 years I have been taking Vicodin for my migraines.
I have read numerous studies on how those with a firm bipolar diagnosis are much more likely to have migraines as well. I have also read studies linking fibromyalgia with depression, and not specifically in a “being in constant pain and having a lifelong physical illness makes you depressed” way, either — though that certainly doesn’t help depression. And premenstrual dysphoric disorder (PMDD) can bring on horrible “menstrual migraines” for those who don’t already deal with these types of headaches all month long.
I guess my purpose in writing this piece is twofold. First, it’s a bit of a “lesson learned, need to be vigilant about this as well if I want to maintain relative stability” post, and maybe it may even cause a few of you, my loves, to realize that pain has destabilized you in the past, and that it’s vital to make sure you think carefully about “toughing it out” if it has. Of course, I know not all cases are straightforward, sometimes medications for pain interact with other medications, sometimes you can’t take anything because of past issues with substance abuse, and sometimes (too often) all the options for treating ongoing pain have been exhausted — with limited success, or no success at all.
My second aim is to get your own input and experiences. Do you also find that pain can cause or exacerbate a mood state? Do you find it can distort your perceptions as well? What strategies have you developed for managing, mitigating, or ultimately preventing pain that others might find helpful?
Any way you slice it, the psychological and somatic aspects of our health are too intimately linked to be treated as though they existed as two separate, discrete problems. The whole individual needs to be treated, whether you are dealing with an uncooperative back or a badly malfunctioning brain.
And on that note, this particular individual needs to take her a.m. dose of Medrol (the magic steroid) — along with her gabapentin and clonazepam, of course! 😉
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I don’t have any input for you, just wanted to tell you, as I am beginning a battle of accepting ‘brain’ issues, your post made me feel not so alone. Thank you.
Deanna, that battle can be a very hard one, and I applaud you for taking whatever steps you have in your start. I’m very happy I could make you feel less alone, because you are anything but alone. There are so many of us here (at Canvas), so many of us in the greater blogging community, and so many of us just walking around this world. I hope you can find more and more support on your journey, and feel less and less alone in your fight.
To be honest, I’ve suffered with chronic pain in my back and pelvic region for so long, that I don’t really think about what it does to my moods. I have dysfunctional sacroiliac joints along with arthritis in those joints plus spine, a d degenerative discs. While our back pain may have different causes, I sure know how you feel!
I suppose, when I sit back and look at it, I DO get depressed and irritable. Usually when I have a flare-up of the arthritis. Which is happening more now that we are heading into winter in my part of the world.
What do I do about it? I walk. Not only does it relieve the pain by keeping the joints moving – it helps improve my mood. A walk along a beautiful beach allows me to clear my mind and just be. A wonderful way to practice mindfulness. So, there are two forces at work on my mood. Pain relief and relaxation. I suppose relaxation also helps with pain relief. So it’s all good!
🙂
Ooh, I am so incredibly sorry you have to deal with that! I know a young man who just had surgery on his sacroiliac joints, and he says it has made huge improvements for him already. And, as you say, I’ve had migraines for almost all of my life, so I never really considered any pain-mood correlation there. I’d always go a little out of my mind when they hung on for days, but it was just part of the migraine for me. It wasn’t until I started having ongoing issues with sciatica and other back pain that I realized it was something more.
It’s good that you know how you react to that kind of pain, and even better that you have strategies for coping with it. I love that your approach helps all of you — your body and your mind — I think that was one thing that this post really brought up in me. I mean, I already knew that the holistic approach was best, but this really brought it into focus, as did your thoughtful sharing of your coping techniques.
Thank you, and I wish you all the best with this — though it sounds like you already have a good handle on it!
‘Life gives you lemons, make lemonade’
What a cliché, but true. We can’t change these things, as much as we might want to. So we have to make the most of what we’ve got. Finding what works for us to improve both body and mind can be hard, but it isn’t impossible. As I found out. 🙂
I am so glad I was able to help you. That is the beauty of the Internet, of technology, of blogging. It allows people with the same struggles to come together and share ideas. What works for one may not work for another, but often ideas can be modified to suit the individual. 🙂
Be well. 🙂
Boy, you’ve really hit on a hot topic for me personally and relationally. I grew up with a mother desperately addicted to anything she could get her hands on to “relieve her pain” (mental and physical). After having self-medicating my Bipolar with drugs and alcohol and then heavy doses of psycho-tropics, I am now on very low doses of mood stabilizers and almost never take anything else stronger than a regular strength Tylenol (though I have chronic back pain).
I’ll resist telling others what they should do specifically, but I will say more broadly I firmly believe that our desire to relieve short-term pain (physically and mentally) in the present winds up causing exponentially more long-term pain in the future.
Thanks for such a thoughtful post.
Tony, I absolutely agree that every person is different, and they need to assess what is best for them on a personal level. I understand completely, with the background you have shared, why you are making the best decision for you when choose not to take anything strong for your chronic pain. And may I also take this moment to applaud you for getting past the self-medicating — that is extremely difficult, and you should be so proud of yourself.
My situation happened kind of in reverse of yours, in that (as I mentioned) I have been so fortunate as to not have any issues with addiction. I’ve had the same doctor for 18 years prescribing a narcotic to me, and we are both firmly agreed that if I were going to develop any kind of addiction or dependence, it would have happened long ago. Having said that, I am still incredibly mindful of what I take, as I lost a family member to addiction to the very same drug I take. So I think I ended up in a place where I was “over-correcting” in the other direction — not taking stronger medication for my pain when (for me) it really was the right choice. And now especially, when my mental state can be so easily jarred, I feel (again, for me personally) that I do more long-term damage to myself — months of destabilization — by not treating the more short-term pain.
I am very glad you brought your voice into this discussion, because I did try to make clear that there are so many cases where treating pain the way I am learning to is not the best course of action.
I take gabapentin too, which helps my joint pain and neck pain I’ve always seemed to have. I feel it helps with anxiety and bipolar as well. Hope your feeling better soon!
Nicole, thank you! Gabapentin has definitely been proven to have neuralgic benefits, though I take a very low dose. It’s very interesting, because it actually failed the clinicals for treating bipolar, but there is lots of anecdotal evidence (like your story, and for a while, mine) showing it does really well in certain people to help manage bipolar. I mostly take it because I found when I titrated off of it completely, I had so many horrible migraines, all of the time.
And though it’s taken me a while, I want to say thank you once again! I am very happy to report my back is in perfect working order — the steroid seemed to be exactly what it needed!
Really happy to hear your back is doing well again. God bless!!
While I was reading your post, I couldn’t help but think about your trigger list. How did you figure out that exercise is a potential trigger for you? Have you ever found yoga to help with your pain or maybe accupuncture?
Hi Dawn! I guess I should have made that one a little more clear. For me, exercising really helps me to remain stable, it’s failing to do it regularly that sometimes triggers or exacerbates mood issues. Yoga is wonderful, because even if it may not be able to target a specific injury, it does help me to stay loose, flexible, and prevents the muscular tension that can lead to injury for me. Plus, the soothing benefits for calming the mind are wonderful both for my bipolar and my anxiety!
Being in pain (back, arthritis) always affects my mood negatively, mainly because I’m limited as to what I can do. I’m fortunate that doesn’t happen too often, or last too long. As you say, it’s the whole person that needs to be looked at and treated……I would think it odd if pain didn’t affect one’s mood.
Janet, you’re absolutely right, and that’s a lot of what my mom and I discussed. Even when you are completely mentally healthy, it’s still really difficult to deal with all of the limitations pain places on you. I honestly have no idea why I never really thought much about it before now, possibly because I did not have such prolonged stability, so it was difficult to isolate what was triggering what as far as my moods. But I feel so strongly that we need more to be treating the person as a whole — just as no man is an island, neither are any of the body’s systems!
Physical discomfort has a major effect on my mood – it’s mostly anxiety related where, for example, a sugar rush feels like the very beginnings of a panic attack.
But I also get the general pain as depression stuff – a former psychiatrist was very interested in my day-to-day pain, even prescribing a fibromyalgia med to supplement the antidepressant. I do notice the the level of body pain affects my mood. I often play the game, “are these aches and pains the flu or am I getting depressed?”
The best remedy I’ve found for the mood/pain connection is exercise.
My experience…..pain exacerbates my mental illness and mental illness crises exacerbates my pain. Sometimes it seems like an endless merry-go-round. I have been working on being mindful when I have an increase in my pain level and try to remove the suffering (read catastrophizing about the rest of my life in pain) from the actual physical pain and try to “be” with it. When my mental illness symptoms are triggered, I try to be very kind to my physical body and allow myself to just stay in bed if that is what my body feels it wants to do. The optimist inside me tries as many natural, holistic, alternative strategies that I can get my hands on in an effort to enjoy my life. Relaxation cd’s, self hypnosis, guided imagery, EFT/tapping, watching a great comedic movie, ice, warm baths, walking barefoot through my nature path….all of these work some of the time. The other times…..there is morphine.
Thanks for this post….I really relate to it. Keep on going.
I totally agree with you (as I suspect you will have guessed) that on-going pain and our mental illnesses can have an enormous impact on each other. I say each other because with fibromyalgia I know that my fibro affects my mood dramatically, especially when the pain goes on and on, but interestingly my mood (and for that matter my other mental health issues) also affect my fibro. Sometimes there is no winning, and a lack of access to adequate meds doesn’t help, but it is good to be aware of the interaction.
Yes, my perceptions get screwed, and like you I begin to de-value my existence. That’s where it gets scary for me. I think it’s something that health professionals really have to take note of.
My final thought is that my fear of what my physical illness might do to my mental illness, is much more significant than the reverse. I don’t at all welcome my physical pain, but if I had to choose I would take that over the mental anguish and out-of-control mental illness any day. I accept that others may disagree.
I ruptured five disks in a period of three years while working 120 hours a week as a resident and taking various antidepressants which didn’t work, of course, because I am bipolar. When I finally couldn’t work because I couldn’t stand up and was crying all the time, they put me on six months of disability in which I was supposed to get it together. The steroids made me manic, and the narcotics made me depressed. Luckily I met my Chi Gong master and in two weeks I was off all meds and walking without the two arm canes I had had to use before, and weaning off the full torso molded plastic brace they had made me wear 23 3/4 hours a day (fifteen minutes off for a shower). Chi Gong, combined with swimming (single pointed focus meditation, weightlessness) got me back on track and healthier than I had ever been. Chi Gong treatment combined with Chi Gong movement. Sending you loads of good juju for a complete recovery, body and mind.
I broke a bone in my foot about 20 months ago and didn’t realise (I just thought I’d sprained my ankle). I walked around on it for a week, not taking painkillers because asprin/paracetamol didn’t touch the pain and the stronger painkillers I had came with the warning of “don’t drive or operate heavy machinery” and I was needing to use my car to get to work. By the end of the week, I was demented with the pain to the point of snapping at everyone and randomly bursting into tears all over the place. So while I only have very, very, very mild depression and no issues with pain the rest of the time, that week has given me a minor insight into what it’s like for someone with a more severe condition. Being in pain is exhausting physically, and people understand that (providing they can see an injury that’s caused the pain), but being physically exhausted quickly becomes mental exhaustion when the pain prevents things like sleep and rest and it seems like that’s when the spiral begins.
(I ended up going to my doctors’ surgery, saw one of the nurses, who sent me to the local hospital where I was x-rayed to find I had fractured my cuboid, and was given crutches to keep the weight off to allow the tendons etc a chance to heal as well as the bone itself. Five days of being on crutches allowed enough healing to happen so that by the sixth day, it was then completely pain-free providing I didn’t walk too far. I do still get some twinges now and again, but they’re nothing by comparison to what I put up with before.)
Wow, I am so grateful to have come across this post.
I admit that pain can take my mood all over and my esteem too. I feel guilty for the small buffer I have against specific discomforts – like extreme hungry, and I think this partially has to do with the fact the drugs in my blood stream are not countered with nutrition so I get jittery, anxious, achy, headachey, just so many ways that I don’t like to admit to because I just assumed I was being a baby. The other day as I was having a panic attack, I tried to talk my self down before it escalated. They come out of nowhere and frustrate me. But other specific pain can be made worse by the anticipation or subconscious triggering nature if you have had trauma.
Its so debilitating sometimes. When things are rough, I need to be close enough to run home at any moment, so I can close the door and without any apology just take care of myself. Now I tell myself to stop being ashamed for needing to have this space, even if I think no one else understands what it is like.
Its embarrassing for me to think what seems like PAIN can be trivial discomfort to other people, or they are able to “push through.” How I can be so weak?
I didn’t always feel this way. And I realize I DON’T always feel that way. There are times when I have more reserve against discomfort and pain, which could be partially connected to mood. When I have low mood, you bet it is much harder to tolerate pain. Its hard to get through it without catastrophic thinking. For you it doesn’t ever become suicidal. But for me, there is at least the ideation of ending the pain by being dead or not existing.
There have been really good suggestions here. Self care including rest (as mentioned, being tired increases pain), massage, rest, Yoga, Yoga Nidra specifically (following a script), nutrition, social supports, swimming, nature – these are all great for me. But sometimes I just can beat it. The mood is abysmal.
If I am able to garner some inspiration, I find my mood does fuel creativity. Writing and painting. It seems to create one perspective (albeit a negative or distorted one), that if you feel safe, is powerful to explore. To accept fully that state of darkness and depth is in itself a sort of mindfulness activity. This is rare. Sometimes it takes help, but resolving or working through the bad parts instead of cutting off from it, I do it because I hope one day I’ll just be able to cope. That I will mentally be resilient to letting my mood destabilize, but instead practice tolerating.
I have had a headache for three days now and two days ago started feeling like a worthless hunk of human flesh. Not suicidal, but definitely think it’s a better idea to stay in bed than inflict myself on the world and the world in me. Having just come off a hypomania that lasted longer than usual, I assumed it was that typical up then down and the headache had nothing to do with it. Now I think they are probably interrelated. And the riding out a migraine thing with ibuprofen. It nice to know I’m not the only one trying to be stoic.
Be kind to yourself. I found a webinar on the internet targeted at practicing family physicians and what to watch out for with Bipolar I patients. Did you know that bipolar patients suffer from higher incidences of psychopathology not related to bipolar, neurotoxicity, diabetes, obesity, etc. Basically there is a subsyndromal presentation that can delay diagnosis of the underlying or cocurrent bipolar. Bipolar ptients are even less likely to respond to treatment of metabolic syndrome! And as we know, the later we are diagnosed, the more vulnerable we are to the cyclicity and increased amplitude of manic and depressive phases. jmlindy422, be kind to yourself. Take extra care to support the fact you have a heavier load right now.
AH, here it is: http://www.medscape.org/viewarticle/781133_transcript
I like the conclusion: Bipolar disorder exists above and below the neck.
In order to maintain stability and exist in a functional range of experience, we have to address comorbidities as soon as possible. Best wishes.
Hi Denise, just a quick note for you and other readers. The article you’ve linked to can’t be viewed unless you have a Medscape account. It’s free to create one, it only takes a minute, and I strongly encourage it — if for no other reason than to have access to their Drug Interaction Checker, which I use before I pop any new pill, and which saved my life (literally) by finding an interaction that three very good doctors and two pharmacies did not have anywhere in their databases. But I did want to note the need for an account here, so if anyone clicked the link they would be a little more prepared!
With a permanent injury to my back AND to my neck I can sympathise with your pain even if I can’t empathise (being not you, of course). Physiotherapy saved my career a few years ago by sorting out my neck and giving me exercises to at least keep it at bay for much of the time. However, my neck has been a nightmare for the last two weeks and even the exercises are barely working right now. If my back goes as well I’m done for!
I can’t speak for your emotional state, for one reason or another. But I’m sorry you’ve been feeling pretty crap. Truly, very.
Why can’t you take any medication for Bipolar?
I understand what you mean about living in pain. I suffered with migraines since I was 13 (I’m 52 now). None of the OTC meds helped, and for many years nothing else was available, and even when meds came out, turned out I couldn’t take them–they made me so sick and I still had the headache. I also suffer from pain caused by my ms. For many years I just suffered, finally I learned to meditate and that was the first relief. It is difficult to live in chronic pain. Everything is more difficult and it’s easy to get depressed. I wish you all the best in your journey. I hope you find good ways to cope. I’ve been working at this for years. Sometimes I am successful, sometimes I’m not. Wishing you success.