Treating Physical Pain in Bipolar – Neuropathic Pain
Physical pain in bipolar disorder is one of the hardest bipolar symptoms to treat (and, of course, not everyone experiences this). The physical pain in bipolar disorder is known as neuropathic pain. Neuropathic pain is commonly associated with spinal cord injuries or amputation but can occur in psychiatric disorders and in other illnesses as well. This neuropathic pain, physical pain in bipolar disorder, can be debilitating but there are options for treatment.
Physical Pain, Neuropathic Pain, in Bipolar Disorder
Yesterday, I was at my psychiatrist’s appointment and I was complaining about an all-over pain that I have that has no cause. It occurs every day and sometimes is so bad that moving makes me want to cry. (Not to mention the fact that even water from a shower is painful.)
He called this “pain syndrome.” And yes, that’s sure what it feels like to me. It feels like a syndrome defined by pain, pain, pain and pretty much nothing else.
He readily admitted that neuropathic pain in bipolar disorder (typically bipolar depression) is very difficult to treat. If you’re in remission, it may go away, but I am not that lucky. I was, honestly, expecting him to say that nothing could be done. I’ve had this pain for so long that I just assumed I must always have it. Surprisingly, this is not what he said.
Treatment of Neuropathic Pain
The treatment of neuropathic pain in bipolar disorder hasn’t really been studied, maybe because it’s rare or maybe because it’s unrecognized, I don’t know. But treating neuropathic pain in other conditions has been studied.
According to this Medscape article, the first-line medication treatments for neuropathic pain are:
- Tricyclic antidepressants – these are the older antidepressants like amitriptyline (Elavil). Antidepressants are, obviously, a good choice for someone experiencing neuropathic pain due to depression but may not be suitable for someone with bipolar disorder due to the possibility of mixed mood or mania/hypomania induction.
- Other antidepressants with evidence in treating neuropathic pain include venlafaxine (Effexor) and duloxetine (Cymbalta). Duloxetine actually has Food and Drug Administration (FDA) approved indications for treating several pain disorders. Again, these may not be appropriate for a person with bipolar disorder.
- Gabapentin (Neurontin) – this is an anticonvulsant that is not typically used to treat bipolar disorder but may be; and like other anticonvulsants, it may be mood stabilizing and gabapentin is not known to cause mixed moods or hypomania/mania.
- Pregabalin (Lyrica) – this is another anticonvulsant which has the advantages stated above but is prohibitively expensive for many. Pregabalin also has FDA approved indications for pain disorders.
- Topical lidocaine (Lidopen) – this is an antidysrhythmic (used to treat heart rhythm irregularities) that is expensive and treats only localized pain.
- Opioid analgesics – these are the pain drugs like morphine, oxycodone (OxyContin) and tramadol (Ultram) which can be used but have limited supporting evidence and are, obviously, rife for misuse and addiction. These are not a good choice for anyone with a background of addiction, obviously.
Combinations of medications can also be used to treat neuropathic pain due to, as this study on drug combinations states,
The most commonly studied drug classes in the context of neuropathic pain-antidepressants, anticonvulsants, and opioids-have only limited efficacy and frequent dose-limiting adverse effects . . .
So even if the above fails for you, a combination of medications may be effective.
The Good and the Bad of Treating Physical, Bipolar Pain
There is good news and bad news about treating physical, bipolar pain. The bad news is that treatment isn’t terribly successful for many (but people with bipolar disorder are used to this thanks to all the other medications that only work for some or partway).
The good news is that physical, bipolar pain can be treated and that a drug like gabapentin (suitable for many with bipolar disorder) may work to treat neuropathic pain in bipolar disorder. Like I said, this hasn’t been studied, but if you’re suffering from debilitating, physical pain associated with bipolar disorder, it’s still good news. It’s good news that just because we have a psychiatric illness doesn’t mean we have to live in physical pain (along with psychiatric pain) forever.
And don’t assume (like I did) that a doctor can’t help you with a bipolar symptom that seems impossible to treat. Talk to him or her about it anyway as he or she may surprise you.
Of course, I’m not a doctor so you should always take a look at the source (linked above) and discuss anything that interests you with your doctor. Because remember, drugs are only indicated for some people some of the time but, luckily, there are many options so there will likely be one to suit you (to at least try, anyway).
Image of the brain by Allan Ajifo [CC BY 2.0], via Wikimedia Commons.
Tracy, N. (2016, February 25). Treating Physical Pain in Bipolar – Neuropathic Pain, HealthyPlace. Retrieved on 2019, August 23 from https://www.healthyplace.com/blogs/breakingbipolar/2016/02/treating-physical-pain-in-bipolar-neuropathic-pain
Author: Natasha Tracy
In all likelihood, you will need two doctors. Psychiatrists don't generally treat pain and pain doctors don't generally treat mental illness. (They're just different specialties.)
- Natasha Tracy
I love quantum physics. I take a theory (either one of my own or anther) and run it through my mind to try to distract myself from the pain. It doesn’t work all the time but if it helps sometimes it’s worth a try.
I see a pvt psych MD weekly- on Depakote 500 TID. No inpt. Visits/ SI, but feeling demoralized.
In place of prescription opioids I use various Kratom strains, a different one each time and cycle again once I used them in sequence.
I believe there is a relationship between fibromyalgia and bipolar, but this doesn't necessarily mean your wife has bipolar. Pain, itself, can certainly make a person depressed (and just depression isn't bipolar). The best thing to do is to see a doctor and get a formal diagnosis, if necessary.
- Natasha Tracy
I'm so sorry to hear about your issues with pain. I know what that's like and I know how horrible it is.
Please know that just because one doctor gave up on your doesn't mean that all of them will. I have had doctors give up on me, only to find another and get well. Please don't give up. Life doesn't have to be this way. Reach out to another doctor -- maybe a specialist. I know you don't want to, but that is the path to feeling better.
- Natasha Tracy
I have bipolar with server depression and lots of body manifestations, lost my job after 32years.
NO PERSON CAN SAY THEY KNOW WHAT ITS LIKE OR WHAT YOU ARE GOING THROUGH.
You are who you are. Everything effects everybody differently.
You sound like a person of strong inner self you know what not to do. That’s good so you help keep those two boys safe from a life of wounding why. You also have a lot of COURAGE that helps a lot. I have to FIGHT with all my heart and soul and all the courage I can muster. Sometimes it feels like it’s not enough. But some how there always seem to be a little bit more. Especially when you look your loved ones in the eye. You have to find the courage heart soul courage to Try and keep the beasts (for me bipolar,depression and the pain my body goes through) at bay. Winston Churchill called his the black dog. No matter what you call it it’s a hard job.
I wanted to be a police officer and in that job as in many, all anyone can do is FIGHT THE GOOD FIGHT. That to me means keeping family, friends and most important yourself to stay healthy take your meds go to doctors and therapy when you can, love them and let them know it. Also when you can tell your boys what is happening you never know it might save them. These beasts research is finding genetics can pass it down. Letting them know what’s going on may allow them to deal or ask for help.
This is is a medical condition just like cancer or heart conditions. Not a lot of people see it that way. We have to let people who care about us let them in and try to explain what’s going on. I think that takes real courage and it sounds like you have it.
I myself have a very bad tendency to keep the beasts out of sight from everyone. Trust them if they don’t understand, well at least they can lend a friendly ear. Talk to strangers in therapy seems easier then the ones closest to you. If those boys have the courage you have, you will be all right as long as you keep fighting for them.
Please don’t get me wrong. I don’t want you telling everyone you meet, but start letting your loved ones and the really good friends in a little at a time. Dumping it all at once on someone could scare them Just a little at a time.
I take over the counter medicines such as paracetamol & exercise (even though it is the last thing I want to do) seems to help.
Thank you for identifying the physical pain as Bipolar is often mistakenly seen only as a mental illness.