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.
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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