Pain and the Bipolar Spectrum
There is increasing recognition that obsessive-compulsive disorder (OCD), attention deficit disorder (ADD), narcolepsy and bipolarity and bipolar disorder are linked, commonly with chronic pain. This linkage is identified as the Bipolar Spectrum.
A 40-year-old female with painful fibromyalgia was referred to me. She also carried a diagnosis of discoid lupus (a skin rash, usually on the face) and obsessive-compulsive disorder. These diagnoses made at her age 27. She was a habitual counter, counting objects, be these stair steps, cans in the pantry, or books on the bookshelf. After child birth by C-section, she developed mood shifts and periodic flares of pain with irritability. She also described spells of high energy with creativity and happiness lasting a day or two. A diagnosis of bipolarity was at least suspected by her psychiatrist. He also made a diagnosis of attention deficit disorder (ADD) and appropriately prescribed the stimulant, Adderall. She did rather well on this program and acknowledged that the Adderall might actually be helping, not only her ADD but also her OCD and bipolar mood shifts. That is when she came to me. She described very vivid dreams with emotionality upon awakening and also sleep paralysis, awakening from a dream mute and unable to move for a few moments. These are symptons of narcolepsy, certainly a part of the bipolar spectrum. She also had a problem with migraines, very common and often treatment resistant in those within the bipolar spectrum.
I elect to prescribe the opiate, Oxycodone in addition to the Adderall and on that program her pain is vastly diminished. Her ADD and OCD symptoms have abated and her vivid drams, formerly terrifying have actually become pleasant. Her mood shifts have diminished. She has done marvelously well over the course of several months on the combination of Adderall and Oxycodone, a pair of drugs that I am increasingly using in those with the bipolar spectrum. Her migraines are much diminished and, most curiously, her discord lupus rash has cleared.
In those who suffer pain and bipolar spectrum (and perhaps several other diseases) the opiates and stimulates can be dramatically effective, either singularly or in combination.
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