Patients with a mental health condition might have a hard time accessing opioids for pain relief, while patients with unexplained pain are often referred to psychiatric care, which does little to alleviate their symptoms. Finding treatment can be frustrating and humiliating.
Four years ago, Dez Nelson’s pain management clinic demanded that she complete a visit with a psychologist. Nelson was surprised, since she had no history of mental illness, but she didn’t feel that she could push back on the request.
“Of course I said okay — I didn’t want to lose my treatment,” Nelson told The Fix. “I was not happy about it, but I did it.”
Nelson, 38, went to the appointment and had a mixed experience with the psychologist. She hasn’t been back since and the pain clinic hasn’t asked her to visit a psychologist again. Still, Nelson said that the experience highlighted — yet again — the discrimination pain patients face.
“It was a condition of my continued care,” she said. “It seemed like they’re bringing it up in a beneficial light, as part of a multi-pronged approach to pain care. But I don’t think [mental health treatment] should be forced on a patient who doesn’t think they need it.”
Chronic pain and mental illness are among the most stigmatized conditions in modern medicine. The conditions frequently intersect and change the way that patients are cared for and treated. Patients who have a mental illness might have a hard time accessing opioids for pain relief, while patients with unexplained pain are often referred to psychiatric care, which does little to alleviate their physical symptoms. At the same time, research suggests there is a strong connection between mental health and pain: depression can cause painful physical symptoms, while living with chronic pain can cause people to become depressed.
All of this makes treating chronic pain and mental illness complex and frustrating for doctors and patients alike.
A Mental Health Diagnosis Affects the Way Your Doctor Treats You
Elizabeth* is a professor in her mid-thirties who had undiagnosed Lyme disease for eight years. Her Lyme contributed to the development of an autoimmune disease that has led to widespread inflammatory and nerve pain throughout her body. Elizabeth also has bipolar disorder. Despite the fact that she has been stable on medication for a decade, her mental health diagnosis complicates her pain treatment.
“Doctors’ demeanor changes when I tell them my medications. When I say I have bipolar disorder, it’s a whole different ballpark. To them that’s clearly a risk factor and red flag for drug abuse,” Elizabeth said.
Opioids are one of the few treatments Elizabeth has found that works to alleviate her pain. But she also takes benzodiazepines on an as-needed basis to control her anxiety (usually once a week). Even though Elizabeth is well aware of the risk of combining the two medications and knows better than to take the two pills together, doctors refuse to prescribe both. They don’t seem to trust her not to abuse them.
“I could tell them that I wouldn’t take them together. But that’s not a valid choice,” Elizabeth said.
While doctors were extremely cautious about this drug interaction, they didn’t focus on another drug-related risk: medications that are used to treat nerve pain can cause adverse reactions in patients with bipolar disorder. No one warned Elizabeth of this danger, and she ended up being hospitalized for psychosis after a long stretch of stability.
“The doctors didn’t talk about it because it’s just a side effect, not a liability concern,” she said.
On the flip-side, Elizabeth has experienced psychiatric providers who were skeptical of her pain diagnosis.
“They wrote in my chart that I had a delusion that I had Lyme disease,” she said…
Find out more about the complications of treating pain in patients with mental illness, the dangers of confusing one’s body with one’s psyche, and the “time bomb” of untreated pain in the original article Should Your Mental Health Determine How Your Pain Is Treated? at The Fix.