New Hope CE Notes, September 2005
William Gaultiere, Ph.D.

"Rejoice in suffering" the Bible teaches us repeatedly. Is this crazy? Fake? Masochistic?

Painful conditions make it hard to cope, much less live and love with a smile. You may know this from the experience of living in your own body. All of us know this from talking with people in pain who call and chat with us at New Hope.

Studies of people dealing with chronic pain, as well as our own anecdotal observations, demonstrate that some sufferers become miserable complainers others while others find a way to cope with their pain cheerfully and are generous toward others who suffer far less. What's the difference? What can we learn from the "Positive Overcomers"? And what can we offer those in pain who contact us at New Hope?

CHRONIC PHYSICAL PAIN IS A HUGE PROBLEM

For instance, consider the man who goes to his doctor and says:

"It hurts when I press here" (pressing his side) "And when I press here" (pressing the other side)

"And here" (his leg)

"And here, here and here" (his other leg, and both arms)

So the doctor examined him all over and finally discovered what was wrong... "You've got a broken finger!"

People dealing with chronic pain sometimes have trouble thinking straight. Pain makes it difficult to concentrate. For instance, I read a story from many years ago about a woman in her 80's who was quite ill. The 911 emergency number was new. She was in terrible pain and yet somehow she managed to drive herself to the hospital and stagger into the front door from the parking lot. The horrified nurse said, "Why didn't you call the 911 number and get an ambulance?" The lady said, "My phone doesn't have an eleven."

Sometimes young people suffer from unremitting pain too. A little boy was taken to the dentist because he had a painful cavity. "Now, young man," asked the dentist, "what kind of filling would you like for that tooth?"

"Chocolate, please!" replied the youngster.

Statistics. Seriously, chronic pain is an enormous problem in our society. Consider these statistics:

• 90% of all diseases may be associated with pain
• 65 million Americans (22%) suffer painful conditions at any given time
• $120 billion are spend each year because of pain

Our society is starting to pay more attention to this problem. As one example did you know that this week, September 12-18, 2005, is National Invisible Chronic Illness Awareness Week? It's this week. Really. It's sponsored by Rest Ministries, one of our New Hope referrals, which I'll tell you about later. Here's what it's about:

National Invisible Chronic Illness Awareness week is held annually in September as a designated time, worldwide, in which people who live with chronic illness, those that love them, and organizations are encouraged to educate the general public, churches, healthcare professionals and government officials about the impact of living with a chronic illness that is not visually apparent. You may have a chronic illness, but we hope this year you will join us in choosing to THRIVE, not just survive! You may have an invisible illness, but you aren't invisible!

Common examples of chronic pain. You may experience chronic pain in one form or another. There are many diverse examples. Undoubtedly, you know people struggling with this. Many of our New Hope callers and chatters experience these types of chronic pain.

• Arthritis
• Throbbing feet
• Back pain
• Headaches
• Ulcers and other stomach and GI distress
• Chronic fatigue
• Nerve conditions
• Fibromyalgia
• Pneumonia
• Multiple sclerosis
• Cancer
• Others not mentioned?

Often patients don't receive available pain relief

Joyce Biddel (New Hope telephone counselor) sent me a copy of AARP's October 2005 magazine article that covered the problem that 75% or more of patients in hospitals aren't receiving available pain relief because their doctors are afraid of being investigated and prosecuted by the Drug Enforcement Agency for illegal distribution of narcotics!

For instance, a woman named Deborah was suffering from Multiple Sclerosis. For two decades she was tolerating numb extremities, tingling sensations, and weakness that caused her foot to drag. Then she began having intense shooting pains that raced across her shoulder blades and down her limbs. For three years she sought help with the pain from a neurologist every three months, but each time he dismissed her pain by changing the subject. Finally, she lost it with the nurse and cried out, "My pain is real!"

The nurse whispered, "I shouldn't tell you this, but he doesn't want to treat your pain because the treatment that works is opioids and he's afraid to prescribe them".

Consequences of Untreated Pain

Living with chronic pain takes a heavy toll on your energy, mood, outlook, self-image, and relationships. It wears and wears and wears on you until you're exhausted. The word "exhaust" is Latin and means "to draw out your energy." Chronic pain leaves you feeling utterly depleted or used up.

The American Academy of Pain Medicine and physicians specializing in pain say that pain is not only a symptom but can become a physical disease by itself that if untreated can trigger a cascade of other health problems like a weakened immune system, obesity, sleep disorders, and suicidality.

WHAT DOES THE BIBLE SAY ABOUT CHRONIC PAIN?

A lot actually. Job suffered from chronic pain and the Bible gives 40 chapters in the book of Job to tell his story. David and the other psalmists wrote Psalms when they were in pain. Jesus and the Apostle Paul both suffered terribly. We'll come back to their stories later.

Suffering is one of the most common subjects in the Bible. And it's a good thing given the pain that God's people have suffered from over the centuries. Here are a few examples of verses applicable to chronic physical pain from my article, "Bible Verses for the Soul: Dealing with Pain," which is on my website - ChritianSoulCare.com:

The Bible is Honest: In Pain we Often Struggle to Feel God's Love

"How long, O Lord? Will you forget me forever? How long will you hide your face from me?" (Psalm 13:1).

Jesus: We all Experience Troubles and Need to Learn to Find our Peace in Him

"I have told you these things, so that in me you may have peace. In this world you will have trouble. But take heart! I have overcome the world." (John 16:33)

Jesus: God Allows Underserved Disabilities to Display His Glorious Work

"As he went along, he saw a man blind from birth. His disciples asked him, `Rabbi, who sinned, this man or his parents, that he was born blind?' 'Neither this man nor his parents sinned,' said Jesus, `but this happened so that the work of God might be displayed in his life.'" (John 9:1-3)

Jesus: God Allows Undeserved Sicknesses to Reveal His Grace

"There was given me a thorn in my flesh, a messenger of Satan, to torment me. Three times I pleaded with the Lord to take it away from me. But he said to me, `My grace is sufficient for you, for my power is made perfect in weakness.' Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me." (2 Corinthians 12:7-9)

Trials Bring Grief and the Glorious Joy of Growing Faith

"In this you greatly rejoice, though now for a little while you may have had to suffer grief in all kinds of trials. These have come so that your faith - of greater worth than gold, which perishes even though refined by fire - may be proved genuine and may result in praise, glory and honor when Jesus Christ is revealed. Though you have not seen him, you love him; and even though you do not see him now, you believe in him and are filled with an inexpressible and glorious joy, for you are receiving the goal of your faith, the salvation of your souls." (1 Peter 1:6-9)

God Comforts us in Pain so we can Comfort Others

"Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves have received from God." (2 Corinthians 1:3-4)

TREATMENT OF CHRONIC PAIN

Humor. Consider the proverb, "A cheerful heart is good medicine" (Proverbs 17:22). Indeed laughter can help us cope with pain. (It can also be an unhealthy defense mechanism used to deny pain, as in Proverbs 14:13.) Perhaps the therapy of laughter is why some people laugh when they hurt their "funny bone."

Here's a true story told by a family physician about an incident that actually happened to him back in the early days of his practice.

He said a woman brought her baby to see him, and he determined right away that the baby had an earache. He wrote a prescription for ear drops. In the directions he wrote, "Put two drops in right ear every four hours" and he abbreviated "right" as an "R." with a circle around it.

Several days passed, and the woman returned with her baby, complaining that the baby still had an earache, and his little bottom was getting really greasy with all those drops of oil.

The doctor looked at the bottle of ear drops and sure enough, the pharmacist had typed the following instructions on the label:

"Put two drops in R. ear every four hours."

Palliative care or hospice

Pain associated with a terminal illness or at the end of life requires special treatment.

Medicine

The American Academy of Pain Medicine and physicians specializing in pain argue that a more aggressive approach to treating chronic pain is needed, not only for the patient's comfort, but also to prevent the health problems that can result from chronic untreated pain. They say they are able to use pain medicine to relieve pain without fogging patient's brains or turning them into pain pill addicts if the medicine is used appropriately. Some patients do abuse pain medication and need to be treated for prescription drug addiction.

For those who are using pain medicine appropriately it needs to be taken as prescribed. Some people dealing with intense or chronic pain may wait until their pain comes back to take another dose of medicine, but this causes needless suffering. It's easier to prevent a pain episode than calm it down. Pain medicine requires a certain amount of medicine in the blood to work.

Physical Comfort

Heat relaxes muscles and thereby can reduce pain. Warm showers or baths, hot water bottles or warm washcloths can provide comfort. Massage also relaxes sore muscles and brings comfort.

Conversely, cooling the skin and muscles can soothe pain as well, especially pain that comes from inflammation or swelling.

Ask others for support

Fighting chronic pain is a battle. You feel attacked and under siege. You get exhausted need strength and help! Exodus 17:8-15 records the story of Moses leading the Israelites when they were attacked by the Amalekites. As long as Moses held his hands up to God in prayer the Israelites were overcoming their enemy, but when his arms got too tired to stay raised up to God then Israel was being defeated. Moses needed to sit down and receive the help of Aaron and Hur. Together they kept Moses' hands raised in prayer until the sun rose and Israel defeated her enemies. God's power flowed through Moses hands as long as he received help to pray.

When you're attacked by chronic pain you need help! You need someone to life your hands to God in prayer. And you need the comfort of being listened to and empathized with as you share your experience and feelings. Practical help with meals, driving, housework, and errands are often the kindnesses that are needed.

Relaxation

Stress and anxiety make it much harder to cope with pain and can actually intensify the pain. Strengthening your personal boundaries and maintaining good limits to reduce your stress are important.

De-stressing is also important. The same relaxation exercises that help with anxiety also help with pain: exercise, deep breathing, meditation, guided imagery, and so forth.

Positive Thinking

A news brief cited on Pain.com made the startling claim: "When it comes to controlling pain, positive thinking can be as powerful as a shot of morphine according to new brain imaging research at Wake Forest University Baptist Medical Center." The research study found that positive expectations decreased people's pain ratings by 28% - equal to a shot of morphine. The positive expectations significantly reduced both the subjective experience of pain and the activation of pain-related regions in the brain.

Finding New Purpose in Pain

For the joy set before him Jesus endured the excruciating pain of the cross - years of anticipation and persecution then beatings, punches, thorns piercing his brow, staggering under the weight and splinters of carrying the cross, being nailed to the cross, being naked hung up high in the cold wind, and suffocating to death, to say nothing of all the emotional pain of the betrayal, trials, and abuse. Is pain sometimes a way that we're to take up our cross and follow Jesus? As with Jesus is our cross carrying a path to joyful intimacy with God and blessings that we can pass on to others?

Of course, whenever we have an illness or are in pain we hope and pray for God's healing - whether through a miracle or medical treatment. This is natural. Besides, Jesus does heal people. But if the condition persists or the pain is chronic then what?

The Apostle Paul was in this situation and he learned to follow Jesus. He had painful problem, perhaps a disease with his eyes, and he cried out for healing in intense prayer on three separate occasions and each time the Lord said to him, "My grace is sufficient for you, for my power is made perfect in weakness" (2 Corinthians 12:9). He came to accept his pain as his "thorn in the flesh" that taught him to rely on God's grace. He did the same with many other persecutions, abuses, and hardships.

Could we accept our pain and problems as Paul did? Dare we try to find a God-honoring purpose in something that feels bad? To do this we have to grieve what we've wanted and missed out on. We have to learn to desire God's will above our own comfort and then give ourselves over to the Lord's service so that he can bring a greater good. Then we can say with Paul:

"Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves have received from God. For just as the sufferings of Christ flow over into our lives, so also through Christ our comfort overflows. If we are distressed, it is for your comfort and salvation; if we are comforted, it is for your comfort" (2 Corinthians 1:3-6a, NIV).

For years Lisa Copen has lived with chronic pain from rheumatoid arthritis and fibromyalgia. She started Rest Ministries, a Christian-based outreach to help other people deal with chronic pain. On her website, http://www.restminitries.org/ she wrote:

"As the founder of Rest Ministries, I have found a joy beyond description in being able to use my earthly weaknesses towards God's greater good. Even when I mess up, I am able to shar my struggles with all of you, and then I receive letters from you saying, 'That is exactly how I felt too and your article really helped.' When we open ourselves up to God's plan the pain becomes bearable. By using your pain for God's glory you will begin to focus on Christ and others, and the pain will become more of a tool and less of a thorn." ("Finding Purpose in the Pain.").

I talked with a woman recently who was in pain after a sudden seizure. This came out of the blue and while she was in a public restroom. She was badly bruised and cut. She lost consciousness for some time and was found wandering around. Of course, the experience was quite traumatic for her. Because of the risk of her having another seizure her driver's license was suspended. So added to her pain, upset, embarrassment, and fear of having another seizure was the inconvenience of not being able to drive to do her errands or to get her children to all of their many activities.

It'd be understandable if this woman were depressed, besieged with fear, or angry at God. Instead she was thankful to God for his care and how he was using this trauma and it's aftermath to help her to grow closer to Jesus and to her husband who was caring for her.

To have a positive attitude while in significant physical pain like Jesus, Paul, Lisa, or my friend is not easy. It requires deep trust in Jesus that's developed over time. It requires a shift in priorities. It helps us deal better with intense pain if we first learn to deal with "little" nuisances, deprivations, and pains by "rejoicing in the Lord" and relying on "the joy of the Lord as our strength." We can practice this by giving thanks in all circumstances and denying ourselves certain pleasures or comforts as we do when we fast from food for a period of time.

HOW TO RESPOND TO SOMEONE WHO IS IN PAIN

I hope you know that teaching a class to Christian counselors is very different from caring for someone in pain. I don't talk to hurting people in the way I've been teaching you. At times in psychotherapy I am able to teach important lessons in Christian living to clients, but I am very careful about this, always focusing primarily on expressing compassion and being gentle in what I say.

As a volunteer crisis counselor you have to be especially careful not to turn a conversation into a teaching time - because your training and your context are much more limited than mine. What I've been teaching you in this class is for you personally and for your understanding of a Christ-like way of dealing with chronic pain. As this kind of thinking and this way of being becomes a part of you it will have a profound influence on the "you" that you offer to hurting people - the way you listen and care and pray. This is what's important rather than you trying to teach New Hope callers and chatters what I'm trying to teach you!

Chronic pain requires special empathy

In Chronic illness the natural cycle of healing doesn't occur. With other sicknesses and diseases there is a period of illness and then recovery. The care and help that are needed are time-limited and hope-filled because the person is expected to get better. It's harder to respond to someone in pain when their condition is permanent or, even worse, degenerative.

Lisa Copen knows what it's like to be hurt by other people's insensitive reactions to her chronic illness and pain:

"I hoped that people would stop saying, 'Smile!' or 'You sure look tired today.' If I tried to explain that my illness tended to make me tired, they would respond, 'Oh, I'm tired too. I had a late night.' Is there anyway to explain that my tired is different than their tired?"

Don't say, "I understand."

Even if you're going through a similar situation let other people describe their uniqueness and then offer your empathy by communicating specifically what you're understanding.

Don't give advice. Chronic pain is a complex and emotional struggle. Advice would be like a bandage on an infected wound. Listen, care, and then go fishing for ideas from the person on what he or she needs to work on today.

Don't give what Lisa calls "God balm." Don't offer spiritual reassurance like, "God will heal you."

Don't try to fix faith struggles with Bible verses or principles. It's "spiritualizing" to say quickly and tritely things like, "God will work this for good for you." There's a place to offer Biblical truth, but you need to be hesitant and very careful with this. Remember, the wise dictum, "People don't care what you know until they know that you care." When people are having trouble trusting in God or feeling his love listen, empathize, and pray silently. God doesn't need to you polish his reputation, but he asks you to show his compassion.

Don't pray according to your agenda. Pray for what the person requests or is ready for. People in pain are seeking different things:

• Strength to cope today
• Companionship
• Regain more normal functioning
• Healing
• Sense God's presence
• Grow spiritually
• See God use them to help others in pain

REFERRALS FOR CHRONIC PAIN

There are many referrals that may be helpful to someone in pain, depending on the kind of pain they're in. You'll find them in "New Hope Referrals" on our website (http://www.newhopenow.org/) and in binders in each booth in the phone room. For instance, for those in chronic pain look under the category "Health & Medical" and you'll find these three referrals:

Pain.com: Education, support, Q&A with doctors, http://www.pain.com/.

PainNet: Articles from and referrals to specialized pain doctors, http://www.painnet.com/.

Rest Ministries: Christian organization providing information, resources, and support groups for those with chronic pain, http://www.restministries.org/.

Also, I have a three-page handout of Bible verses on "God's Relationship with and Response to Our Pain." You can receive this by e-mailing me or going to my website http://www.christiansoulcare.com/.