May asks…

I’m wondering if any research has established a link between patients with Bipolar Disorder I or II and nervous system disorders? I’ve suffered from different types of neuralgias for years, as well as IBS and migraines. One of my doctors said she often sees these or similar co-morbidities, but she’s not sure why.

Chronic pain combined with a mood disorder does not make for a very pleasant life. I recently read somewhere that people with chronic pain tend to carry a lot of stress and tension, both physically and psychologically, much like BP sufferers do.

If that’s true, then I’m surprised that all of the “good behaviors” I’ve adopted as a BP patient haven’t done anything to calm the pain from my central neural windup – a firestorm of pain that is self-perpetuating. The recommendations are almost identical in terms of what to avoid, what one should do, and the types of mindfulness and relaxation techniques that are standard lifestyle changes following a diagnosis of bipolar or chronic pain.

I do not dare ever mention my bipolar condition outside of my home, so it’s not like I can ask a fellow pain sufferer if he or she has experienced mental illness along with his or her nervous system dysfunction. I’d love to know if anyone is studying this central nervous system cross-talk of BP and neuralgia.

Dr. Fink answers…

Bipolar disorder is, at its most basic, a neurological condition – an illness/disruption of the function of neurons, so it wouldn’t be surprising at all to find overlap with other neurologic disorders. We have little data on rates of co-morbid neurological disorder with bipolar disorder, but we do know that pain, migraines, and IBS are much more common in people with depression.

We’re beginning to learn that many psychiatric disorders, including mood disorders, are actually associated with inflammation in the brain and body caused by the body’s response to physical or emotional stress, such as infection or even sleep deprivation. When the immune system responds to infection, for example, such as a flu virus, tissues become inflamed and actually cause many (or even most) of the symptoms associated with the infection.

Inflammation can create a number of symptoms, including fever, but more generally fatigue, aches and pains, decreased appetite, and poor sleep. Other than fever, many of these symptoms are common in depression. It is now thought that inflammation is an important component of mood and anxiety disorders.

This brings us back to chronic pain, which is associated with inflammatory processes. And IBS and migraines are also increasingly thought to have inflammatory components. So it is not surprising to me that there would be frequent overlap in these conditions. And it is not surprising that so many of the treatments are similar – finding ways to reduce the inflammation and the stressors that can trigger inflammation.

That being said, the bodily processes that can trigger inflammation are not the same, so these general, anti-inflammatory treatments do not necessarily treat the underlying disorder, but they can improve well being and quality of life.

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    Last reviewed: 6 Aug 2010