Written by Phil Monroe Saturday, 09 March 2013 00:00

Have you been to a medical practice recently to deal with an injury or sickness? If so, I’m guessing you were asked to rate your current pain level on a scale of 1 to 10. Pain assessment and management is a growing part of today’s health care services. This is helpful since many have pain as their primary presenting problem. There are a number of syndromes and disorders that cluster around pain as the presenting problem: Chronic Fatigue, Fibromyalgia, Irritable Bowel Syndrome, Rheumatoid Arthritis, Osteoarthritis, back pain, etc. Depending on which research study you read, some 9-17% of the population struggles with some form of chronic pain.

Common Pain Presentation?

While these various forms of pain are quite different, there are some commonalities. Chronic and diffuse pain sufferers frequently experience some form of inflammation, fatigue, sleep disruption, negative mood, and poor memory (it is hard to pay attention to new information when you are weighed down by pain). These symptoms develop into vicious cycles. If you don’t get restorative sleep, you experience more fatigue, you are more prone to negative thought patterns, your pain levels go up, memory goes down…and thus you don’t sleep well the next night, and so on. Researchers describe this vicious cycle in terms of “allostatic load”–the deleterious effects of chronic stress hormones without restorative sleep.

Is It Just In My Head?

When pain is diffuse AND there is a lack of visible evidence for the pain (a big red spot, a swollen limb, etc.), chronic pain sufferers and their families struggle to understand whether or not the pain is real. In addition, family and sufferers wonder just how much can be expected of the person in pain. Thus, it encourages more “I should be able to…” thinking in all parties. As a result, pain sufferers tend either to do too much (creating more pain) or withdraw even further (creating more emotional distress).

As with all physiological problems, mood, perceptions, focus, and stress levels impact severity of the problem. While chronic pain is not just a mental state, how we respond to chronic pain may help alleviate or elevate the pain sensation we experience. Ironically, many pain sufferers resist counseling because they fear that others will believe that their symptoms are all in their head. Those who refuse to acknowledge the psychological factors in pain sensation and management miss out on important means to cope with the pain and to lower pain perceptions.

Chronic pain sufferers must accept the need to adjust their lifestyle to accommodate more rest. They must fight to get the best restorative sleep possible. Sleep may even be more important than pharmaceutical interventions (and I am not knocking medical treatments nor saying that just getting sleep will solve the problem).

Faith and Pain?

One of the biggest challenges for believing pain sufferers is the matter of hope and faith. When we suffer problems, we often expect and hope they will go away. When they do not get better it is easy to slide into despair. Despair usually is the result of things not going the way we hoped or expected. Part of living with chronic pain requires grieving what is lost. Without good grief, it is hard to accept–even enjoy–what strength and health we do have. Without hope, we may lose what self-efficacy we once had. We may stop doing the basic care-taking activities within our grasp. Interestingly, one of the clearest signs of this struggle is the massive dropouts in pain management research. Frequently, dropouts number about 50% in these studies. This means that before a study gets too far along many are dropping out because they assume the new treatment won’t work.

Faith is not that things will go my way right now but that God is in control, cares/protects me, and is working for my ultimate redemption–even when the opposite seems to be true. Faith is acting in a manner consistent with said assumptions even while grieving over real losses. Such faith enables us to be mindful of our thoughts so that we do not practice into beliefs counter to what we have come to know as true.

A Realistic Picture of Suffering Well

The chronic pain sufferer who grieves well

• asks God for relief
• stays in community with others
• seeks relief through human means yet has an attitude of waiting on the Lord, and
• explores and confront hidden sin in self that the pain may reveal

Grieving well does not mean coming to a place where the pain were nothing. That would be living in a false world. Rather, the faithful Christian notes God’s presence in distress and rejoices when they find 5% improvement—even as they cry out for greater relief and healing.

Phil Monroe is Professor of Counseling & Psychologyand Director of the Masters of Arts in Counseling Program at Biblical. He also directs Biblical’s new trauma recovery project. You can find his personal blog at www.wisecounsel.wordpress.com.