i have a client ive been seeing for awhile recently diagnosed with BPD. she supposedly has had head trauma in the past. havent gotten details on that, doesn't like to talk about it. she has very little meniscus in her knees, has had back surgery, has a PT background so knows her physiology quite well. probably too well. like the whole know too much kind of thing. anyway, which comes first - the pain or the BPD? or is there any way to tell? am i treating a phantom pain or true pain? and as i'm treating the pain, she has no response to pressure/stimulation. so there's this combination of too many drugs/desensitization/needing attention/trying to prove herself to me that she can withstand the pressure. it's as infuriating to me as it is challenging. maybe this is just a vent post. i guess i need to research more about pain/BPD to figure out how to work with her best. how typical is pain and BPD? the connection? not necessarily a pain disorder, but BPD specific. thanks
Pain is usually associated with Depression. People with Bipolar D/O have Depression as well as Mania. It is the Depression that hurts. People with Bipolar D/O usually feel pretty good during the manic phases. Depression is associated with lower levels of nuerotransmitters such as Serotonin. Norephinepidrine, Dopamine and probably GABA contribute in some way. Low levels of Serotonin are known to cause muscle and joint pain. Cymbalta is a new antidepressant used to treat Depression related pain. I don't know anybody using it, so I don't know much about it. As far a "Phantom Pain" it is my opinion that all pain is real, no matter where it originates. The fact that she may not feel any pressure could be the Lortab she is addicted to after her multiple surgeries. (Sorry for my cynicism about the Lortab).
They've got my ex on Zyprexa right now, and I'm afraid these past 6 months are the most stable that I've ever seen her.
Zyprexa is magic. That annoying little side effect of triggering diabetes in a percentage of patients just won't go away though. In my opinion, worth the risk if you are treating serious BiPolar. Plus, there is the added bonus of getting your share of the class action lawsuit once it pays out.
the thing that's most bewildering to me is the lack of sensation, i swear i just had 170 lbs shoved into her ischial tuberosity and she was asking for more. maybe eight years of constant fight-or-flight will do that?
Maybe the pressure releives the pain? Maybe the pressure is so bad without the pain, that the pressure, while still hurting, is less than the other pain. (Maj - please read this sentence and puncuate correctly.) Maybe she just has the hots for you or is into S&M.
Ouch. I take a chance and peek out from under the pedestal....... and you poke me in the eye. Note to self - wear safety glasses next time you log in ......
I'm guessing that this person was diagnosed with bipolar disorder because of the changes in personality, hair trigger temper, and increased propensity to become easily agitated that normally occur following a head injury. Somewhat subsiding over years and years.
