chicken or the egg?

     Believe it or not this perennial question actually has applicability when it comes to RA, especially as it relates to pain and depression.  At first blush you may think that it is an obvious answer.  You may think, well of course, pain is first and depression follows.  Let me be clear that I am not talking about the day to day pain associated with RA that we all deal with.  Clearly when the disease takes  hold, pain is one of the leading symptoms and it occurs, in my opinion, before depression enters the landscape.
     That said, I recently read an intriguing article on the Mayo Clinic website by Dr. Daniel Hall-Flavin in which he explores this question and discusses if there is a link between pain and depression.  Here is the link to the article and I would recommend you check it out.
http://www.mayoclinic.com/health/pain-and-depression/AN01449 

In it Dr. Hall-Flavin really gets into the way these two issues can be "married" if you will (my term not his).  He relates how pain and depression can be a viscous cycle that can really spiral out of control if not kept in check.

     The result is that pain worsens depression and likewise depression intensifies pain.  According to the article, depression can often manifest first in the form of headache or back pain for instance.  And in fact, he stated that in some cases it may be the first and only sign of depression.  
     By contrast, pain can lead to lack of sleep, stress, emotional and mood problems.  One side effect of pain that I found particularly profound and common with RA is low self esteem over time that can come from work, financial and other personal issues that can arise from unending and disabling pain.  These are all elements of depression and yet we often overlook this in our drive to control the physical elements of RA.  

    So we need to attack this from a two pronged perspective that examines and treats both issues concurrently and perhaps even with the same treatment. For example, anti-depressants can help both pain and depression because of shared chemical messengers in the brain.  Psychological counseling can be effective in treating both chronic pain and depression.  Stress reduction techniques, physical activity, meditation or guided imagry, and journaling have also proven effective. 

     It may seem like there are just too many options and that can become overwhelming when trying to sort through the various treatments which can lead to a tendency to do nothing.  That personal paralysis needs to be addressed and resolved.  When I hit that barrier I find that turning to someone I trust from my RA Support Team helps me to get through that and move forward.  

     Knowing that there are people out there that you can trust to listen, advise, assist and care is, in itself, uplifting.  Sharing your choices, talking about the dilemma of pain and depression can go a long way in helping you to sort through the many options for treatment.  
     So, in the end the question of which came first the "chicken or the egg" "pain or depression" becomes far less important than understanding and addressing the link, once again adding to our strategies for managing RA.
Nan