What came first?

You've probably heard the question, "What came first, the chicken or the egg?"  Well another comparison for people with chronic pain is, "What came first, the pain or the depression?"  We talked about this in the pain management rehab this week.  For some they thought the pain came first, for others, including myself, I thought the depression came first. 

I have had a history of depression since I was a child.  Of course, back then, I don't think it was ever something that was openly discussed.  I remember when I was a teenager I ran away from home (for a whole day) and then my mom said maybe I needed to go to a counselor.  I proceeded to tell her I wasn't going to a f''n shrink and went to my room.  Hind sight is 20/20 though and that is exactly what I needed along with some anti-depressant meds. I got severly depressed in my late 20's when my husband (at the time) left me for someone else.  Our son was only 6 months old when I was asked for a divorce.  I tried everything to keep the marriage together, but after another six months he was gone.  The depression and stress was so significant I couldn't swallow.  I lost a lot of weight and looked anorexic.  My mom and dad came and brought me and my son to their house for a week.  I took off work.  I did go to my doctor and got some anti-depressant meds and went to counseling.

The counselor used a method known as "Cognitive Therapy".  It's basically recognizing your inner thoughts and learning to change them.  So, for instance, an overly negative person thinks negative thoughts most of the time and discounts any positive experiences or compliments. This is what I did.  The cognitive therapy was very helpful and I was able to basically rewire my self-talk.  They talked specifically about cognitive therapy in rehab as a means to help cope with chronic pain and depression.  I can see that this would be useful because I have noticed that I have a lot of guilty thoughts and feelings because of my chronic pain.  These lead to depression and the cycle begins. 

We also talked about medications for depression and pain.  I take 90mg of Cymbalta in the morning and 30mg of Nortryptaline at bedtime.  When I first started taking Cymbalta it was like turning my pain switch off, but that was several years ago and it's not as effective any more.  My pain doc says I'm taking as much as recommened so I might talk with him next visit about adding Welbutrin.  My sister takes that and is happy with the pain reducing effects it has.  It's crazy.  I never thought I would know as much as I do about pharmaceuticals.  They are a blessing though.  I can't image what it would be like without them.

So "What came first, pain or depression?"  I think it's as complicated as the chicken or the egg.  No straight forward black or white answer, just an understanding that they co-exist and both need to be treated.