Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Is depression/anxiety a symptom of AS?

I think chronic pain can definitely cause depression, and for example, years of insecurity over a diagnosis, etc, can cause anxiety (or worrying how you appear to people when you're limping/on a cane etc) but in my case, depression and anxiety both run in the family strongly (as in, in everyone, in every generation, for at least a hundred years on my dad's side) and AS/autoimmune stuff is only MY generation, so in our case I don't think either is responsible for causing the other, y'know? Even the HEALTHY people in our family have depression/anxiety.

I have a serious love affair with Cymbalta 60 and 1200mg Neurontin. They both help my pain, AND keep me from being a complete screaming, hair-tearing shut-in. (I know what I'm talking about . . . I WAS a hear-tearing screaming shut-in one winter. I almost killed myself. I weighed 102 pounds (size zero pants fell off me) and woke up screaming every day.) Well, I think the boyfriend I had at the time contributed a LOT . . . but the combination of Neurontin and leaving him was pretty much the best thing I ever did. (Up until deciding to marry Cody and have his midgets, of course. heehee)
-Bridget

I like that chart too, Kat, a good way to gain a different perspective

Glad to see that muscle tension is included part of the cycle, as something that could be considered both a result AND a cause

As you may recall, this has been my focus lately, reading books like "Explain Pain" that talk about these things feeding each other

One thing that it talks about, that isn't reflected in that chart, is that it may take more than just breaking the cycle to get an improvement. They cite evidence that with frequent usage, over the years the neural pathways carrying pain actually physically get stronger and more efficient at carrying the pain messages!

(similar to the way lifting weights, yoga, etc exercise increases our muscle strength)

So that leads to a logical conclusion, that it will take time with different neural activity, before having expectations that the pathways will begin to physically change to reflect the new patterns

I really like some of the analogies in the book. One was that the mind is like an orchestra, it is capable of learning many, many melodies, but if we just play the same tune over and over again, it only gets good at that one!

So a great thing if we can teach it some new songs now and then, so that it doesn't just reinforce the same well-worn pathways...

Hey Erica,

I am in agreement with others that state AS (living with long term pain) and depression can go hand in hand. I battled severe depression with my AS several years ago.

Seen many posts over the years regarding depression. Wish it did not go hand in hand with AS... but I think it is inevitable at times for some of us and dealing with chronic pain.

Tim

Well, everyone has confirmed my suspicion that AS and depression/anxiety go hand in hand. My first experience with it was in my 20's for a few days, then the periods increased in length until finally in my late 30's it became chronic. I don't fit into the depressive personality type, which leads me to believe that there really is no type ~ that depression/anxiety is a physical ailment. Curiouser and curiouser.

Thank GOD for antidepressants, swimming pools, and KickAS!

Yes, Dow, that's the kind of thing we talk about. The pain cycle can begin at any point and can be broken at any point; however, it might have to be re-broken repeatedly until it gets easier.

We talk about and teach a combination of lifestyle changes (diet/exercise), meds, relaxation and meditation techniques, among other things, to help break the cycle. Although it doesn't work on the neural pathways, I can see where the two techniques could work together.

Warm hugs,

Hi Erica,
I found this link at the Cleveland Clinic website today. I thought you might want to see it too.
Chronic Illness and Depression

I'm coming around to picturing it not so much as breaking or halting the pain signals, but not being super efficient at delivering them. Which for some of us, with chronic pain, delivered day in and day out for years, may have very well developed.

When thinking of pain messages as a body alert system, to let you know that you stepped on a nail so that you can do something about it, it makes sense that the the neural system would want to be very good at telling us that there is a problem, and put everything else on hold so that you can fix that foot!

So my thinking now is that you don't want to ignore the pain, and you don't necessarily always want to interrupt the pain signal because the body is doing its best to let you know there is a problem, and may just keep trying different ways to deliver the message, construct new pathways when one is blocked, etc

But maybe what we CAN do, is recognize that the panic state that we may go into after receiving the pain messages, can be increasing the problem, as the brain reacts and subconsciously sends orders all around the body, increasing adrenaline levels, tightening muscles to get them ready to run from the monster that attacked our foot, etc and there's your pain cycle or loop

So ultimately, I'm thinking acceptance-

a neutral response to pain that neither ignores it, so that it tries harder, or an overreaction that increases it

Definitely a paradox!

Hey Dow, I think I know what you are talking about.

For a long time, days over years, the pain would too easily get to a point where it was simply not possible to ignore on any level and had such a force that it would send serious alert messages that only made matters much worse. Sometimes I had to 'go into the pain' in order to find moments, well not to relax, but to survive through it, until a pain med or something would kick in. Sometimes pain can reach such a pitch that it's hard to believe you aren't dying. I used to think that toughing through was the only way, but as I get older, I try not to ever let myself get to that point. It is harder to bring pain back from that fever-pitch and way more effective to try and manage it before it gets out of control.

So prevention is key for me, and anything that helps to calm or quiet things before that stage are all strategies worth employing.

AS pain signals should be interrupted whenever and however humanly possible!
mig

Ah yes, Grasshopper, the panic state does influence the pain levels. Hence the importance of relaxation techniques in dealing with the stress.

Some pain signals are necessary. For instance, had I listened to the one in my shin after I stubbed my foot on the bed subsequent to kicking the dog out of the room the other night, I would have realized that I was probably bleeding all over the sheet. Instead, I ignored it because all I wanted to do was sleep and I woke up to a very bruised, slightly swollen and blood smeared shin.

Then there are the ones that radiate through my shoulders all day. Those are the ones that, while I cannot necessarily ignore them, I do accept that they are there; thereby making them easier to ignore!! I think. Regardless, these are the neural pathways that need retraining.

Warm hugs,

Most honorable Ms Migster, you have been through so much, I can not say that even at my worst, I have experienced that much pain!

I'd say that understanding this thing about how fear and possibly panic can contribute to our problems is worth investigating for anyone with chronic pain

Pain like AS of course, doesn't originate from something simple like stepping on a nail, something that you could just be alerted to, remove the nail, problem fixed, pain will go away

So I'm thinking, let's just say the AS or another pain source is a 7 on the Pain-O-Meter, but are we adding another 2 points because of a muscle tightness and panic reaction to it?

And could that 2 points cause the neural dirt road to become a neural superhighway,
spiralling (note I did not say Snowball ) into a worse and worse condition?



Been thinking about it like this, not just from my readings in the book, but from my discussions with my PT, who specializes in pelvic floor problems. A lot of the women she treats are not only dealing with their physical pain, but their fear as well. Pelvic floor issues may be gynecological in nature, sexual dysfunction, things that are so personal, and some of her patients are afraid to even bring up with their husbands, for fear that it could lead to the end of their relationship. So while she does all the physical therapy that she can for them, she also has found that just as important, is looking and considering what role stress and fear may be playing