Borderline Personality Disorder Common in Pain Patients

Borderline Personality Disorder Common in Chronic Pain Patients – MedScape – by Fran Lowry – Mar 2020

A significant proportion of patients who suffer from chronic pain also have features of borderline personality disorder (BPD), new research shows.

I really don’t know what to think about this because our healthcare system is so strongly biased against chronic pain patients and opioids that I don’t trust most of the research on it these days.

I can’t help but notice that it only says that pain patients “have features of” the disorder, but not that they have it. This is a sly way to make it sound like we all have BPD.

Unfortunately, those of us who don’t have a straight forward diagnosable and curable disease require more time and effort from our “healthcare providers”  than many other patients, and this makes us a “burden” to the average over-scheduled metric-managed doctor.

Even maintenance pain management is an ongoing chore to balance different pharmaceuticals (opioid and non-opioid medications) to maximize functionality while limiting side effects and tolerance.

Worse, because our pain can rarely be cured, all the doctor’s work can’t save us, and this inability to “fix” our health issue leaves them (and us) frustrated.

Results of a systematic literature review showed 23% of patients with chronic noncancer pain (CNCP) had some features of BPD, including difficulty maintaining relationships as well as affect and mood instability.

“The fact that one fourth of individuals with CNCP could have co-occurring BPD underscores the need for improved access to good psychological care,” lead investigator Fei Cao, MD, PhD, University of Missouri at Kansas City, told Medscape Medical News.

Treatment Resistance

Cao noted that a “significant number” of CNCP patients have at least some resistance to any type of pain treatment and speculated that BPD may increase treatment-resistant chronic pain.

The phrase “patients have at least some resistance to any type of pain treatment” grammatically means that pain patients are the ones putting up resistance. What they “meant to say” is that our pain is resistant to treatment, not we ourselves.

Careless grammar always seems to favor the wrong interpretation of scientific articles. I suspect it’s because the reviewer fundamentally believes pain patients aren’t “really sick” and that if we’d just stop “catastrophizing” we’d be fine.

Initially an anesthesiologist and pain medicine specialist, Cao later became a psychiatrist after recognizing the importance of addressing the underlying psychological needs of patients with chronic pain.

He noted that there is a strong psychological component to chronic pain and that many patients with chronic pain have suffered psychological trauma.

Indeed, the medical system has subjected many of us to trauma when our desperate cries for help with our pain fell on the deaf ears of doctors who believed all the anti-opioid PROPaganda (to which this study will undoubtedly be added).

The implication is that it’s our “psychological trauma” that brings about our pain.

To gain a better understanding of the prevalence of BPD in patients suffering from chronic pain and potentially provide some unexploited targets for chronic pain management, the investigators analyzed data from 11 studies published between 1994 and 2019.

They found the prevalence of BPD among CNCP patients was 23.3%.

Pain types included

  • chronic headache (11.3%),
  • arthritis (27.5%), and
  • chronic spinal cord pain (24.3%).

Screen for BPD

The study findings, he added, indicate a need to screen for BPD in patients with chronic pain.

Interventions that are effective in the treatment of BPD and CNCP include

  • cognitive behavioral therapy,
  • dialectical behavior therapy,
  • antidepressants, and
  • anticonvulsants.

And below is another article about the same abstract, which continues implicating patients’ mental problems, specifically BPD, in their own pain:

Prevalence of Borderline Personality Complicates Pain Management – Pain Medicine Newsby Kenneth Bender – May 2020

My next post will address the referenced abstract itself – and it’s a doozy…

10 thoughts on “Borderline Personality Disorder Common in Pain Patients

  1. JACKIE

    Are they serious? I am genuinely disgusted that this was even a research topic with legs. A (temporary) overlap in traits between people with pain and people diagnosed with borderline personality disorder (IF that diagnosis was even accurately made), is merely that — a likely fleeting, overlap in some traits. Correlating the conditions, to me, is akin to saying: “all people who come to the hospital with black eyes and share bruising and swelling around the eye, must have been the victims of domestic violence”; when, in fact, many of those people obtained black eyes while boxing, or while bike riding, or while doing voluntary, recreational activities (this is just an example — it is not at ALL intended to minimize domestic violence —it was just an analogy I thought of).

    My point is, this is by far the most dangerous type of “research” and ridiculousness I have seen as yet in this anti-pain patient era! BPD is NO joke. Many will agree, there is no real viable treatment for personality disorders. I believe many mental health specialists / physicians are taught as much, and a result, (non-psychiatric) physicians may simply write off a patient known to have a personality disorder, especially BPD.

    Again, I am appalled.

    Liked by 1 person

    Reply
    1. canarensis

      Ditto on the appalled. Will they never run out of imaginative ways to “prove” that our pain isn’t real? *sigh*….I fear not.

      And guesswork with a heapin’ helpin’ of propaganda. This should go down in history as the Age of Propaganda.

      Liked by 1 person

      Reply
  2. leejcaroll

    Borderline Personality Disorder is often both overdiagnosed (sometimes by practitioners who don’t like their patient) and underdiagnosed (sometimes by clinicians who “don’t believe in” the BPD diagnosis). https://www.psychologytoday.com/us/blog/i-hate-you-dont-leave-me/201312/sometimes-i-act-crazy-is-it-borderline-or-bipolar
    To me, and I a not a shrink or medical person it seems ot be a catch all diagnosis when there may be nothing to diagnosis but they need to put a name to it.

    Liked by 1 person

    Reply
  3. canarensis

    “…including difficulty maintaining relationships as well as affect and mood instability.”*
    Oh good grief. What percentage of the general population have these “features,” especially the first one?!? And I would think a much higher percentage of people in extremely high-stress, debilitating, constant pain are of COURSE going to have mood instability.

    And since their recommended “interventions” for BPD are exactly what everyone is recommending instead of opioids, except for acupuncture, what, exactly, is the benefit of labelling CPPs with yet another psycho dx (other than reducing them even further from the possibility of their pain being taken seriously)? Again, I had to look up Dialectical behavioral therapy (sounds like something from a Philosophy 101 class): one definition was “a type of cognitive behavioral therapy.” Again with the redundancy.

    I knew a person with full-blown, true BPD; at first the person seemed charming & fun, & was certainly highly intelligent. No one knew about the BPD. However, after a very few months it was absolutely impossible to deny the fact the the person was, to use psychiatric jargon, utterly crackers. And tremendously effective at destroying the life of my oldest & best friend…with whom I’d fixed up the wacko in the first place. My first & last act of match-making.

    *I had to look up ‘affect instability’ & various articles showed that (A) “affect instability” didn’t seem to exist, tho “affective instability” did. It was defined as the tendency to experience rapid and intense mood swings that are difficult to control,** so (B) as far as I can tell it’s the same thing as mood instability. So that statement is redundant but it makes it look like we have 3 “features” instead of only 2. (how many “features” does it take to actually diagnose BPD? Surely a lot more than 2 (3), especially when those 2 are basically found in a huge percentage of the whole population. But when you’re trying to prove CPPs are crazy, malingering, people whose pain is merely the figment of psychiatric problems, the more symptoms & diagnoses you can stamp on their foreheads, the merrier. Unless I totally boobed the reading.

    **does this mean that every teenager on the planet has BPD?

    Liked by 1 person

    Reply
      1. canarensis

        I sent the link to my former pain therapist (now retired) & he was roundly PO’d.

        Seems like anything anyone says about pain patients is published far & wide, as long as it’s negative. I expect before too long to read that we eat babies & torture puppies….oh wait…they already say we injure pets to get drugs.

        Liked by 1 person

        Reply
        1. Zyp Czyk Post author

          What a terrible shame that this guy retired – he seems to “get it”. Any doctor these days has to risk a raid from the DEA to practice effective pain mgmt for those of us who need opioids.

          Liked by 1 person

          Reply
          1. canarensis

            It was a horrible blow when he retired, to me & a lot of other patients. But at least I (& others) had the support of an outstanding therapist for many years, & he was a terrific advocate for us while he practiced, being part of several pain organizations & speaking at numerous meetings….& he spoke out often when the axes started to fall. We needed & need more like that.

            Liked by 1 person

            Reply

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