Q:  Body Pain & Bipolar Disorder

What about the Pain? I was first diagnosed with Hypothyroidism, Migraines, PTSD, OCD Anxiety Disorder, and then years later with Bipolar and Sleep Apnea and Severe Allergies. Now a Ruematologist is telling me I cant have Fibromyalgia (even tho I have 18 of the 18 tender points) and all the symptoms and PAIN, because I have a Mental Disorder. Can this be correct? She says the whole body pain is cause by the Bipolar and the Sleep Apnea (not enough oxygen getting to my tissues and muscles ect...when I sleep). I have Chronic Pain all the time. Marijuana in small amounts is the only thing that really calms me down, takes most of the pain away and gives me energy to do things. And why dont I ever see information about PAIN Management in Bipolar sites? Am I the only one with such intense PAIN?


Dear Ms. H' -- 
It may feel sometimes that you're the only one with such intense pain, when you're looking around and not seeing it emphasized in discussion of bipolar disorder.   I can tell you that in my practice alone, there are others with intense pain problems as well; and the fatigue of Chronic Fatigue syndrome; and often the sleep problems of both -- and that sometimes these appear to be completely independent of bipolar disorder (the latter stops cycling, for example, yet these symptoms remain).  Obviously there are people out there with CFS and Fibromyalgia who don't have bipolar disorder, so we know they're not that directly related.  

Therefore, you could have anything from several completely unrelated conditions; to conditions which share some common provocation or source (e.g. immune system changes, which I just heard today are being elegantly and diligently studied by Dr. Charles Raison at Emory University, and his colleagues; to conditions which are actually directly related to each other or somehow part of each other.  The last of these explanations is the one your doctor seemed to be operating on.  That's maybe an understandable shorthand but shouldn't be taken too literally; we just don't know enough to know how to regard these relationships.  That's what Dr. Raison is working on, in part. 

Of course, it would be nice if all this analysis led to something that would help with the pain.  Dr. Raison did mention that in his view antidepressants that affect norepinephrine are more likely to help with pain, and so would emphasize Effexor and Wellbutrin over Paxil and Prozac, for example.  Of course in your case you have to watch out for the bipolar part, though.  Some of the mood stabilizers have also been used in pain clinics, and I've had some luck with them in patients with your mix of symptoms:  carbamazepine and lamotrigine (see more on these from their links on my list of mood stabilizers).  Good luck with your search for understanding and pain relief, a hard combination sometimes. 

Dr. Phelps
 

Published April, 2004