When I woke up, I knew it was going to be one of those days. The sun was pouring into my bedroom, its brightness hurt my eyes. I turned on the news and the weather forecast said in a boring voice that we could expect another glorious sunny day in SoCal. “Perfect for a long walk on the beach you want to go to,” he said. I muted him and scowled.
A long walk on the beach? I can barely walk my poor dog down the street and I love him so much.
If you’ve been reading this blog for the past few months, you know why I’m such a jerk. i entered chronic pain eight months ago from a car accident where an Uber driver ran a red light and stopped my car. Until now, I always thought the whip was a dubious invention of ambulance-chasing lawyers. But the constant pain in my neck and right shoulder taught me otherwise. The truth is, it hurts like hell, and it doesn’t seem like it’s going away anytime soon, despite constant attempts at treatment.
I soldiered on for the first few months trust my doctors and my own mental health. my bipolar disorder has been under control for years, and along the way I’ve learned how to use an arsenal of recovery tools to keep things relatively flat. Thus, I was confident that I could overcome this challenge without losing the ground I had gained.
Oh, you have too much faith. As the pain increased, so did my mental weakness. Depression smelled the surroundings, felt the opening; but I wasn’t upset like I usually am when I’m depressed. Instead, I felt angry and excited, like I wanted to punch the world in the face. Perhaps I was in the dreaded “mixed state” – here are the symptoms maniasuch as restlessness and irritability, clash with depressive symptoms such as hopelessness. I wasn’t sure what was happening to me; I just knew it wasn’t good.
It really bothered me that I couldn’t pinpoint what was going on with my body or mind. Will my pain go away or am I permanently damaged? Am I having a bipolar episode or are my feelings just a normal reaction to an abnormal situation? And does it matter what I think?
Apparently, this is important, especially if you have bipolar disorder.
According to many studies, how bipolar people with chronic pain perceive their physical health is critical to their recovery. A longitudinal study of these patients found that “people with more negative views of their physical well-being had more mood symptoms and worse functioning over a two-year follow-up. These data suggest that addressing thoughts about physical health is important in the treatment of people with bipolar disorder, as subjective perceptions influence the course of the illness.” J affective disorder, 2015 Sep 30;189:203–206.
Similarly, the Southern Pain Center found that patients with bipolar disorder and chronic pain often respond poorly to treatment and may therefore be at increased risk for the disease. commit suicide. It is concluded that a multidisciplinary approach is necessary for the proper management of these patients, i.e. in addition to pain management Doctors, mental health professionals are an important part of the treatment team. (Citation Acta Psychiatr Scand2015 Feb 131(2):75-88. antidepressants regularly prescribed for pain; however, when taken without a mood stabilizer, they can significantly worsen mood in bipolar patients.
And yet…none of the doctors I saw asked me about my mental health or recommended that I seek counseling to manage the difficult emotions caused by the pain. I’ve had admission forms about my bipolar disorder, but it never comes up on exams – unless I bring it up myself.
This is troubling because the way I deal with my chronic pain is just as important as the pain itself. Fortunately, I have a therapist and a psychiatrist who manage my bipolar meds and I was able to ask them for help. Their empathy and guidance have been invaluable, allowing me to identify cognitive distortions that may be clouding my thinking and showing me ways to reframe the problems I’m dealing with so they don’t seem so daunting. Even with their help, eight long months have passed.
Essential Readings on Chronic Pain
But how many people are so lucky or privileged? Or even know that their mental health needs to be taken care of just like their physical health traumatic injury? When you’re struggling, it’s not easy to find solutions on your own—isn’t that what we turn to doctors for?
It seems clear to me that an important aspect of chronic pain treatment is missing: an emphasis on the brain, not just the pain. If one of my doctors asked me, “How are you feeling about this huge change in your life?”, I would be very excited and very surprised. And then suggested ways I could cope.
