Pain and Eating Disorders

Monday, January 23, 2017

300300p27278EDNmainMedical Monday Winston 114Pain is one of those things that no one can really describe, but you know it when you feel it and unfortunately, pain can be a big part of having an eating disorder. Those who restrict or avoid food sometimes do so because of the pain they associate with eating. Others develop pain due to the complications of chronic vomiting in bulimia nervosa or once they begin eating again after chronic starvation in anorexia nervosa. Some people have pain that is unrelated to their eating disorder altogether. In many cases, whether the pain causes the eating disorder, or the eating disorder causes the pain, it can be virtually impossible to tease out which came first. In all cases, at ACUTE, pain is taken very seriously.

For those who purge, the acid that comes out of your stomach can cause painful erosions in the mouth or esophagus (the tube that goes from your mouth to your stomach). For those who binge, frequent overeating well past the point of being full can cause extreme pain and discomfort. This also means that you are at an increased risk of developing chronic pain in general. In fact, at least one study shows that those with problems related to binging or purging tend to report high levels of widespread pain and have longer hospitalizations. If you struggle with Avoidant Restrictive Food Intake Disorder, or ARFID, you may feel that the reason you can’t eat enough food is because of chronic abdominal pain, constipation, heartburn, nausea, or diarrhea when you eat. Other painful complications associated with eating disorders include gastroparesis – when your stomach doesn’t empty fast enough— and Irritable Bowel Syndrome. Strangely, there is some evidence that people with bulimia or anorexia nervosa may have a decreased overall pain sensation (that is, an increased pain threshold), but that doesn’t mean that pain is nonexistent!

There are three main types of pain: somatic, visceral, and neuropathic. Somatic pain basically means pain that feels sharp and is very obvious—you can feel it in your muscles, like when you get punched or cut. Visceral pain is pain that aches, cramps, distends, or feels dull. Both types of pain can be well treated with medications like acetaminophen (Tylenol) or NSAIDs (like ibuprofen or Aleve), although they tend to work better on visceral pain. Although effective, Opioid medications like “oxy,” (oxycodone, Oxycontin), Vicodin, or Percocet are usually best avoided for many reasons – they are extremely addictive, you end up needing more and more of them to get the same amount of relief, and they cause nausea and constipation, both of which can worsen pain.

The third kind of pain is called “neuropathic” pain, which means pain that can feel like electric shocks, burning, bruising, crawling, or itching. This pain is much harder to treat. Fortunately, there are medications that can help with this kind of pain as well. Gabapentin (Neurontin) is a good pain medication that is also good for anxiety. It has few side effects other than causing some sleepiness. A class of medications called the SNRIs (Serotonin Norepinephrine Reuptake Inhibitors, such as duloxetine [Cymbalta] and venlafaxine [Effexor]) can also be used to help with pain and treat anxiety or depression. At ACUTE, if pain is still severe, other medications may be considered after extensive thought and deliberation.

Of course, medications don’t fix everything and a lot of pain has a strong psychiatric component that does best with medication in combination with therapy. At ACUTE, providers are skilled at providing support and teaching coping techniques to help with the real physical and psychological pain of recovering from an eating disorder. Although sometimes there is no “cure” for pain, there is still hope—treatments do exist. At ACUTE, we are willing to work with you to improve all aspects of your medical and mental life.

Helena Winston, MD

If you or a loved one is suffering from an eating disorder, do not delay seeking treatment. We at the ACUTE Center for Eating Disorders are here to help. For more information or to take a confidential assessment, please contact our admissions team at acuteinfo@dhha.org or by calling our admissions line at 1-877-ACUTE-4-U.