Nocturia, Pain, and the Bipolar Spectrum
I have written about the occurence of nocturia (frequent awakenings to void) in the painful. A recent patient reminded me of the phenomenon. She was 40 or so and the mother of two. She had a birth defect that limited the motion of the left shoulder. Into her 20s it bothered but little but then after marriage and a series of miscarriages, she entered a depression and required treatment. That is when her shoulder began to hurt. The pain was tolerable although it progressively worsened sfter her two bouts with post partum depression. She began to require opiates but her doctors were reluctant to prescribe and she was reluctant to take. She was, you see, a nurse anesthetist and was fearful of being labeled a drug seeker by her peers. (A.s many of you know, shame and embarressment are often the lot of the painful).
She came to me and on history taking I discovered she was subject to vivid, threatening dreams sometime attended by a brief interval of paralysis. She also suffered daytime sleepiness and sudden drop attacks (known as cataplexy).Thus, I discovered in short order that she had narcolepsy.Previously undiagnosed but , I have learned, rather common in the painful and I have blogged on this subject. I prescribed Ritalin, appropriate for narcolepsy and often pain relieving in the painful narcoleptic. It worked beautifully. Within days her pain, depression, nightmares and all the rest abated. She also told me, exicitedly, that her many years of frequent nocturnal voidings which occurred almost hourly had suddenly arrested!
Who would suggest that ritalin given for narcolepsy would relieve nocturia? As is often the case in the treatment of chronic pain, particularily successful treatment, we see benefits that we don't expect and probably shouldn't expect. but nevertheless often do occur. As I have written many times, when the right drug kicks in EVERYTHING GETS BETTER. And that is a good part of the fun of pain management.
So, nocturia is a part of chronic pain and also, it seems, of narcolepsy. At least it went away with treatment with Ritalin
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