Understanding Chronic Pain

Bipolarity

[From Chapter 13 of Understanding Chronic Pain]

The bipolar patient experiences times of wellness and emotional equilibrium alternating with intervals of depression and others of manic hyperactivity. With these swings in mood and behavior, the entire neural axis reconfigures and exhibits almost unbelievable effects. Some bipolars suffer tremors, even dyskinesia, during depressive interludes with total disappearance of these during mania. A change in dominant handedness may occur: left-handed when depressed, right-handed when manic! In a notable case reported many years ago, a bipolar patient was conversant only in the Gaelic language when he was depressed. During mania, he became fluent only in the English language! In another case, even more remarkable, a brain-damaged, hemiplegic, and aphasic patient experienced the restoration of speech and movement during manic intervals. If bipolar disease can do these things, what can it not do?

Henry was a mechanic. He retired on account of chronic back pain incurred in an automobile accident in which he suffered a compression fracture and a ruptured lumbar disc. He came to surgery, and his spine was fused. Vertebral alignment was stabilized, but Henry remained painful and unable to work. Most of the time his discomfort was tolerable and responsive to low-grade analgesics, but occasionally he experienced sudden sieges of excruciating pain. A reasonably effective treatment form evolved.

During the attacks his orthopedist would admit him to the hospital and treat him with intravenous opiates and muscle relaxants. After a few days—the sieges were all rather brief—Henry would settle down, go home, and resume with only modest inconvenience his sedentary life. This pattern extended over more than a decade with a hospital admission once or twice a year. Henry's orthopedist, a very wise man, recognized this as a very unusual behavior. Chronic pain due to an injured back is certainly well-known to orthopedists, but the intermittency of Henry's attacks was very queer.

You can read the rest in Dr. Cochran's book, Understanding Chronic Pain

Last Updated: Nov 19, 08:27 AM

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