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).
You can find Natasha Tracy on Facebook or Google+ or @Natasha_Tracy on Twitter or at Bipolar Burble, her blog.
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 2023, April 1 from https://www.healthyplace.com/blogs/breakingbipolar/2016/02/treating-physical-pain-in-bipolar-neuropathic-pain
Author: Natasha Tracy
There are definitely cases of Lyrica and gabapentin causing hypomania plus.
They need to be very carefully monitored.
Thank you for your comment. I'm not aware of these cases. If you could point to a source, that would be great.
-- Natasha Tracy
Hello! there are so many people that have nerve pain that can last for many years before they actually find physical reason ( there could be numerous different medical reasons). I don’t understand how it is that your doctor just automatically knew there wasn’t a medical reason for your pain as appears to it being related to your psychological disorder. Could you elaborate on that?
I suppose he was just making his best, educated guess based on clinical experience. You're right, there are many reasons for pain.
- Natasha Tracy
I'm bipolar and I also really have terrible physical pain, I just had a hip replacement done a mo. ago, I've had a neck fusion with a metal cage , I have had lumbar Sugury and both hands operated on for Carpol Tunnel, I am trying to find a knew pain Dr. That can also treat my bipolar. I'm only 48 yrs old, can you help me?
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
Natasha is right but you really need to try to have the doctors work as a team. So they can try balancing the conditions. I’m still trying to find my doctors. But try you may have more luck.
Addendum- I feel strongly Norco 10 TID is actually pretty low end. Tired of FIGHTING
Having worked with patients what have you told them to do. Be strong, trust in your self. Fighting is really the only way that we have and as you know health eating, exercise (mind if the body can’t, like mine).
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.
61 y/o former Psych ER RN w severe lumbar pain and thoracic spasms. Unable to tolerate Steroids due to Mania. My goal , since I am formally disabled w/ R LE weakness after bilateral PE between my two surgeries is COMFORT. I self detoxed just to show my new pain mgmt group (Fentanyl 50 MCG q 72 hrs, w Norco 2 tabs/ day. Took Oxycontin 20 po BID 5 yes fine until exacerbation w L3 bulge wasn't covering. On Bupenorphone, but nowhere near covered. Don't want patch(want to swim). My Physiatrist moved to Haiti. Frustrated, as Norco TID would be perfect alone. In SF Bay Area. Any suggestions???
I see a pvt psych MD weekly- on Depakote 500 TID. No inpt. Visits/ SI, but feeling demoralized.
I think that the medicines listed above might work well, but vitamins/supplements might work too. I wasn't really a huge believer in natural medicine until recently. I have bipolar disorder and have quite extreme knots all over my body. It used to be so bad that I couldn't move and I'd cry due to pain. I'm taking turmeric and magnesium tablets, and for the first time in 6 years, I'm not in pain anymore - it's been about a year now. I think it's worthwhile trying natural medicine as well, as these tablets listed above have quite significant side-effects.
Good for you! While I would need more than just magnesium and tutmeric, I swear by magnesium, preferably citrate or another that's absorbable, and epsom salt soaking helps yhe body to get more magnesium.
In place of prescription opioids I use various Kratom strains, a different one each time and cycle again once I used them in sequence.
How is fibromyalgia pain related to Bipolar pain? My wife has been diagnosed with fibromyalgia for years, but I am certain she is bipolar. Her pains are severe and inexplicable and everywhere. We have been married 55 years and had a beautiful life together living out of the country for 20 years having adventures.. I find that sometimes just talking and messaging her comely I can ease some of the pain. She cries everyday and is chronically depressed. When she has a good day, it is so beautiful as she is a really special person.
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
Hang onto her. It sounds like you two have had a great life together. I have had that with my spouse for 36 years too.
Show her how much you love her. Bipolar is a hard, lonely, disease the pain ruins our lives.
Just be there for her and love each other. Its nice to hear you understand her illness and are trying to learn more ways to help her. My husband doesn't understand anything and wont learn anything. Bipolar is lonely and painful enough without the guilt we feel from being disabled by the pain and chaos..
Im desperate. Im in excruciating pain and have real diagnosed physical problems with joints all over but doesn't explain the pain i am experiencing in just about every atom of my wretched body. Ive gone from a muscular size 10 -12 to a size 6 in a couple of months. I am not getting anywhere with Dr's to the point where I can't face another appointment with one ever again. Im also medication sensitive, so the steroids the gp prescribed followed by the opiods then amatriptaline caused major hypermania episodes with all the associated problems. They promptly stopped all treatment saying medicine doesn't have all the answers. Im now £8000 in debt, unable to work and then my little girl of 9yrs old died in my arms and my life has fallen apart. I want to die so badly but a coward for one and have my 2 boys to try to look after on my own. Professionals have given up on me and so have I.
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 recently started having infamation pain in the joints (showders, arms and neck and i got Biofreeze which heled a lot from the first day.
I have peripheral neuropathy and always thought it was from my diabetes. I am bipolar and it really flared up after a long period of debilitating depression.
I could not agree more. I am a 59 year old with a long history of Bipolar and get pain and fatigue usually accompanying the depressions but sometimes preceding them. All over the body, joints,limbs etc. Nothing shows up on blood tests etc. A mystery to my General Practitioner(physician). But rather the physical symptoms of bipolar depression. I have always had a severe course.
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.
i have bi-polar disorder even though right now it seems that I AM bi-polar. I have always been a spectator of life, feeling like a monster, shattered, broken, and now, in a lot of neuropathic pain. I was prescribed gabapentin. I think it makes me cry.
Elavil makes me cry and get very depressed
My first bipolar symptom, even before the depression, was chronic, debilitating, physical pain. I was told I was experiencing a somatic disorder of types because it was idiopathic, I was in my very early twenties. I was about to give up when my doctor got my to try Lyrica (now I use the generic) and it helped so much. Unfortunately not enough though. I was sent to a pain specialist who ended putting me on buprenorphine patch eventually, but she got me sectioned after I told her Tramadol was making me suicidal. Then I got my bipolar diagnosis, and got put on Depakote and Nabilone. So now I'm on Lyrica (for pain- also an anticonvulsant) Depakote (anticonvulsant for mood stabilizing) BuTrans (semi synthetic opioid for pain and mood) and Nabilone (synthetic cannabinoid for pain, mood, and to stimulate hunger). So far this combination has done wonders for me, but it took me years to get this far. I still have my bad days, the flare ups where I end up losing all the spoons I collected on my good days (check out 'spoon theory').