Pain is not unfamiliar to people with bipolar disorder. The psychological pain that comes with depression and dysphoria can be debilitating. Like most people, those with bipolar disorder also experience physical pain. Stubbed toes, sore muscles and broken ankles, bipolar disorder patients are not exempt from these just because they frequently experience emotional pain. By contrast, people with bipolar disorder are more likely than the general population to experience certain types of chronic, physical pain.
Physical pain by itself is often a symptom of anxiety and depression. Muscle aches, chest pain, gastrointestinal cramping and other types of pain can be symptoms of bipolar disorder. They can also coincide with bouts of extreme fatigue. Aside from the emotional trauma of depression, these symptoms can only add to the burden, especially since they may not go away with traditional pain treatment methods.
Chronic pain feeds depression and depression can feed chronic pain. There are three specific types of chronic pain that appear more often in people with bipolar disorder:
Fibromyalgia occurs in approximately 5% of the population and is characterized by chronic, musculoskeletal pain. Patients often experience dull muscle aches all over the body. It can interfere with sleep and can be accompanied by memory and mood issues. One reason mood issues may be prevalent in fibromyalgia is because 25% of people with fibromyalgia also have concurrent bipolar disorder.
Treating fibromyalgia when a patient also has bipolar disorder is complicated. Fibromyalgia is often treated with selective serotonin reuptake inhibitors (SSRIs). These drugs help calm what is thought to be overactive neurotransmitters that signal pain. The problem is that these drugs can also induce manic symptoms in people with bipolar disorder. Other treatment options include anti-seizure medications gabapentin and pregabalin. Gabapentin is frequently used as a mood stabilizer in bipolar disorder.
Both osteoarthritis and rheumatoid arthritis carry a risk of subsequent bipolar disorder. Both osteoarthritis and rheumatoid arthritis result in severe swelling, stiffness and in some cases bone loss or bone spurs. Rheumatoid arthritis is an autoimmune disease that can also affect parts of the body other than joints including eyes, lungs, heart, kidneys, nerves and bone marrow. It occurs in about 1% of the world population. Osteoarthritis occurs in 14% of people 25 and over and 34% of people over 65.
Studies have shown that people with rheumatoid arthritis are more than twice as likely to have concurrent bipolar disorder than the general population. People with RA are also more likely to have bipolar II, rather than bipolar I. One study showed that those with osteoarthritis were three times as likely to have bipolar disorder.
It’s possible that the inflammation that occurs in arthritis exacerbates bipolar disorder. Inflammation can cause increases in serotonin and dopamine, which in turn can trigger mood episodes or psychosis in bipolar disorder. Physical changes in the brain can also occur in the area most associated with bipolar disorder, the prefrontal cortex.
Migraines are severe headaches that typically occur on one side of the head. They can be accompanied by dizziness, nausea, vomiting and visual changes such as seeing flashes of light. People are often sensitive to light and sound. Migraines are often preceded by symptoms like neck stiffness, congestion, constipation and mood changes including depression and euphoria. About 16% of the general population suffers from migraines.
When looking at bipolar disorder patients, 25% also suffer from migraines. Those with both bipolar disorder and migraines often have rapid cycling, comorbid panic disorder and drug-resistant symptoms. People in this possible subtype are also more likely to have bipolar II. Medications such as valproate (Depakote) have been shown to treat both mood and migraines. However, bipolar disorder must be considered the primary illness and treated before considering treatment for migraine.
Chronic pain is difficult to deal with even when a person is otherwise healthy. Adding pain to a debilitating illness like bipolar disorder can make people even more volatile. Treating chronic pain can also lead to drug dependence, which is problematic since bipolar disorder patients are already seven times more likely to have problems with substance abuse. Pain also often leads to isolation and depression, again exacerbating symptoms.
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