The minute I woke up I knew it was going to be one of those days. The sun was streaming into my bedroom, and its brilliance hurt my eyes. I turned on the news and the weatherman announced in an annoyingly chipper voice that we could expect yet another spectacular sunny day in SoCal. “Perfect for that long walk on the beach you’ve been wanting to take,” he said. I shut him off and scowled.
A long walk on the beach? I can barely walk my poor dog down the street, and I love her beyond measure.
If you’ve been reading this blog for the past few months, you’ll know why I’m so cranky. I’m in chronic pain from an auto accident eight months ago, when an Uber driver ran a red light and totaled my car. Until then, I’d always thought of whiplash as the dubious invention of ambulance-chasing lawyers. But the unrelenting pain in my neck and right shoulder has taught me otherwise. It’s real, it hurts like hell, and apparently it’s not going away anytime soon, despite constant attempts at treatment.
I soldiered on for the first several months, with confidence in my doctors and my own mental health. My bipolar disorder has been mostly under control for years now, and along the way I’ve learned how to use an arsenal of recovery tools to maintain a relatively even mien. So I had faith that I could surmount this challenge, too, without losing the ground I’d gained.
Oh ye, of too much faith. As the pain increased, so did my mental vulnerability. Depression came sniffing around, sensing an opening; but I didn’t feel sad, like I usually do when I’m depressed. Instead, I felt angry and agitated, like I wanted to punch the world in the face. Perhaps I was in a dreaded “mixed state”—where symptoms of mania, like restlessness and irritation, collide with symptoms of depression, like hopelessness. I wasn’t sure exactly what was happening to me; I only knew it wasn’t good.
It really disturbed me that I couldn’t pinpoint precisely what was going on with either my body or my mind. Was my pain ever going to go away, or was I permanently damaged? Was I having a bipolar episode, or were my feelings just a normal reaction to an abnormal situation? And did it even matter what I thought?
Apparently, it matters a great deal—especially when you have bipolar disorder.
According to numerous studies, the way bipolar people in chronic pain perceive their physical health is essential to their recovery. A longitudinal review of such patients found that “individuals…with more negative views of their physical wellbeing tended to have more severe mood symptoms and worse functioning across the two years of observation. These data suggest that addressing broad attitudes or thoughts about physical health are important in treating individuals with bipolar disorder as subjective perceptions seem to impact course of illness.” J Affect Disord, 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 therefore may have an increased risk of suicide. It concluded that a multidisciplinary approach is necessary to adequately manage these patients—meaning that in addition to pain management physicians, mental health professionals are an essential part of the treatment team. (Citing Acta Psychiatr Scand, 2015 Feb. 131(2):75-88.) This is especially true since antidepressants are routinely prescribed for pain; but taken without a mood stabilizer, they can significantly worsen mood lability in bipolar patients.
And yet…none of the medical doctors I’ve seen has ever asked me about my mental health, or recommended that I seek counseling to manage the difficult emotions caused by the pain. I’ve been forthcoming on intake forms about my bipolar disorder, but it never comes up in exams—unless I bring it up myself.
This is troubling, because apparently my reaction to my chronic pain is as important as the pain itself. Luckily, I have a therapist, and a psychiatrist who manages my bipolar medications, and I’ve been able to seek their help. Their empathy and guidance has been invaluable, allowing me to identify cognitive distortions that might be muddling my thinking, and showing me ways to reframe the issues I’m dealing with so they don’t seem so dire. Yet even with their help, it’s been a long eight months.
Chronic Pain Essential Reads
But how many people are so lucky or privileged? Or are even aware that their mental health needs as much tending as their physical health in the wake of a traumatic injury? When you’re suffering, it’s not easy to come up with solutions on your own—isn’t that what we go to doctors for?
It seems obvious to me that a critical aspect of treatment for chronic pain is missing: the emphasis not just on the pain, but on the brain. I’d be thrilled at this point—and very surprised—if one of my medical doctors asked me, “How are you dealing with this enormous change in your life?” And then suggested ways I could cope.
