The Spiritual Aspects of Chronic Pain Management

Many times, in the Western medicine approach, one area is not addressed at all – the spiritual. I see the spiritual aspect of self as the glue that contains and nourishes all three of the other areas and I always ask my patients to explore this important part.

Looking at the Whole Person

I believe healing must address the whole person in order to obtain the best treatment outcomes and an effective chronic pain management plan – not to mention freedom from suffering. Part of my initial evaluation session with patients includes scoring each of the four areas of self: Bio-Psycho-Social-Spiritual. Each area is scored on a 1 to 25 point scale. If it’s low, I tell them not to worry because they can bring it up; if it seems high, I tell them not to get complacent because it can always come down.

I explain some of the important components needed in each of the four areas:

In the Biological area, for example, we look at diet/nutrition, sleep hygiene, activity pacing, stress management, eliminating or reducing nicotine, caffeine and sugar, etc., as well as having an effective medication management plan in place.
In the Psychological area, I list examples like managing self-defeating defense mechanisms (or denial), positive thinking and feeling management plans, therapy or counseling, daily balanced structure etc.
In the Social area we cover such things as letting go of enabling friends/family members, setting assertive limits and boundaries, developing a chronic pain support system, connecting and communicating with family and friends in a healthy manner, etc.
Finally, the Spiritual area is where we talk about prayer, meditation, finding peace in nature, working the steps if in a 12-Step Program, spiritual practice, religious practice, etc.

People who are willing to develop a treatment plan that includes medication management, psychological/emotional healing, social/cultural and spiritual growth have a much better chance of obtaining effective chronic pain management and freedom from suffering.

Chronic pain is often misunderstood and under-treated. One reason may be that, in addition to the biopsychosocial impact of chronic pain, a spiritual crisis frequently accompanies the condition. This is a body-mind-spirit problem that needs a multifaceted solution, including addressing the spiritual component of pain. For me, spiritual healing was an effective complementary and alternative approach that helped me to finally be able to fully make peace with my pain.

Like me, many other people have found spiritual interventions – like the traditions of prayer and meditation – to contribute to the easing of their suffering. Unfortunately, in our fast paced world and our secular treatment modality, the spiritual component of chronic pain management does not receive enough attention.

Another problem is that many people confuse religion with spirituality. Although the terms religion and spirituality are sometimes used interchangeably, they are really separate concepts. Religion is an organized faith system grounded in institutional standards, practices, and core beliefs. On the other hand, spirituality is grounded in personal beliefs and practices that can be experienced with or without a formal religion.

What is Spirituality?

Let’s look at some different definitions:

Miriam Webster Online Dictionary states: 1. something that in ecclesiastical law belongs to the church or to a cleric as such; 2. clergy; 3. sensitivity or attachment to religious values 4. the quality or state of being spiritual.
Your Dictionary.Com states: 1. spiritual character, quality, or nature; 2. religious devotion or piety; 3. the rights, jurisdiction, tithes, etc. belonging to the church or to an ecclesiastic; 4. the fact or state of being incorporeal.
Wikipedia Encyclopedia defines spirituality as: Spirituality is relating to, consisting of, or having the nature of spirit; not tangible or material. Synonyms include immaterialism, dualism, incorporeality and eternity. Spirituality is associated with religion, deities, the supernatural, and an afterlife, although the decline of organized religion in the West and the growth of secularism have brought about a wider understanding of its nature.

Spirituality Versus Religion

Over the years, I have found it important to have a discussion with my patients about how spirituality applies to effective pain management, and to develop a common understanding of the terms we will use in our work together. One concept that rings true for many people is a simple saying: “Religion prepares people for the next life while spirituality helps them live this life to their full potential.”

Many of my colleagues recommend clarifying the difference between the terms “spirituality” and “religion.” They advocate developing a broad-based definition of spirituality that encompasses religious and nonreligious perspectives.

Spirituality is a complex and multidimensional part of the human experience. It involves beliefs, perceptions, thinking, feeling, experiential and behavioral aspects. Thoughts, beliefs and perceptions include the search for meaning, purpose and truth in life and the values by which a person lives their life. The experiential and emotional aspects involve feelings of hope, love, connection, inner peace, comfort and support. The behavior aspects of spirituality involve the way a person externally demonstrates their individual spiritual beliefs and inner spiritual state.

I’ve known many people who were very religious, but lacked true spirituality. I have met many others who demonstrated powerful spiritual principals that were not in any organized religion. However, many people find spirituality through religion or through a personal relationship with the divine, while others find it through a connection to nature, through music and the arts, through a set of values and principles or a quest for scientific truth.

Moving Towards Spiritual Healing

As you learned in a previous section, chronic pain is often associated with perceived endless and meaningless suffering. Given the definition that spirituality is a basic human phenomenon that allows the creation of meaning and purpose in life, a person’s spiritual beliefs can influence their health and sense of well-being. Spiritual issues related to the suffering of chronic pain involve an interaction between emotions such as fear, guilt, anger, loss and despair. Often this suffering seems inseparable from the physical pain a person experiences and can influence the way they express their pain.

The concept of healing spiritual pain requires that we go beyond the bounds of traditional clinical treatments and be prepared to devote the time required to develop supportive and understanding relationships with trusted people who care. It is very important to include a spiritual component in a multidimensional treatment plan.

It’s difficult to fully understand or measure spirituality using the scientific method, yet convincing evidence in the medical literature supports its beneficial role in the practice of medicine. It will take many more years of study to understand exactly which aspects of spirituality hold the most benefit for health and well-being.

The world’s great wisdom traditions suggest that some of the most important aspects of spirituality lie in the sense of connection, inner strength, comfort, love and peace that individuals derive from their relationship with self, others, nature and the transcendent. I believe that, for myself and many other people, spiritual healing needs to be an important component of a multifaceted pain management plan.

One goal of spiritual healing is to improve my well-being and quality of life, rather than to cure specific diseases – or in this case, eliminate my pain. Components of spiritual healing may include visualization, prayer, meditation and positive thinking.

As chronic pain impacts your body mind and spirit, the solution must address all of these areas. For me, this took a multidisciplinary approach that was greatly assisted by including a spiritual healing practitioner on my team. My ultimate goal of effective chronic pain management is to increase my quality of life on all levels and constantly change my perception of pain.

Changing Our Perception of Pain

The Three Parts of Pain:

Biological: A signal that something is going wrong with your body
Psychological: The meaning your brain assigns to the pain signal
Social/Cultural: The approved “sick” role assigned to you by society concerning your pain

Like many people, I was one who irrationally believed that: “I should be able to stop my pain!” or “Because I keep suffering with my pain there must be something wrong with me.” A big step toward effective pain management occurred when I was able to eliminate my suffering by identifying and changing my irrational thinking and beliefs about pain, which in turn decreased my stress and overall suffering. I’ll talk more about this later.

Because of the three parts – pain, suffering and social – pain management must also have three components: physical, psychological and social support. Also, the way we sense or experience pain – its intensity and duration – will affect how well we are able to manage it. Anticipatory pain is also a major psychological factor that must be addressed.

The research on recovery from chronic pain is very clear: The people that are most likely to successfully manage their pain do so by becoming proactively involved in their own treatment process and have positive family or social support. The chances of success go up as we learn as much as possible about our pain and effective pain management. One important component helped that me succeed was developing a better understanding of anticipatory pain.

The people that are most likely to successfully manage their pain do so by becoming proactively involved in their own treatment process and have positive family or social support.-Stephen Grinstead

Coping With Anticipatory Pain

When we live with chronic pain, we hurt. Doing certain things can make us hurt worse. I came to believe that these things would always cause me to hurt. In other words, I associated those triggers with pain. I believed that every time I did those things, I’d experience pain.

Because I believed that I was going to hurt, I activated the physiological pain system just by thinking about doing something that I believed would cause me to hurt. This is called anticipatory pain. I anticipate that something will make me hurt, which in turn activates the physiological pain system. I start hurting even before I begin doing whatever it is that I mistakenly believed would cause me to hurt. All I had to do was start thinking about doing that thing…and I would be in suffering.

The Pain is Horrible, Awful, Terrible! I am Suffering!

Once the physical pain system is activated, the anticipatory pain reaction can actually make pain symptoms worse. Whenever we feel the pain, we are at risk to interpret it in a way that makes it worse. If so, we start thinking about the pain in a way that actually makes it worse. We might start telling ourselves that the pain is “awful and terrible,” and that “I can’t handle the pain.” We convince ourselves that “it’s hopeless, I’ll always hurt, and there’s nothing I can do about it.”

This dysfunctional way of thinking causes us to develop emotional reactions that further intensify or amplify our pain response. The increased perception of pain causes us to keep changing our behavior in ways that create even more unnecessary limitations and more emotional discomfort. This can make us feel trapped in a progressive cycle of disability.

We Get the Level of Pain and Dysfunction We Expect!

Our expectations – what we believe it will be like when we experience pain – affect our brain chemistry; they can either intensify or reduce the amount of physical pain that we experience. What we think about and how we manage our feelings in anticipation of experiencing pain can make the pain either more or less severe. In other words, we usually get the level of pain and dysfunction that we expect – a self-fulfilling prophecy.

The anticipation of an expected pain level can influence the degree to which we experience pain.-Stephen GrinsteadThe anticipation of an expected pain level can influence the degree to which we experience pain. When our self-talk is saying, “this is horrible, awful, terrible,” our brain tends to amplify the pain signals. When this occurs, the level of distress increases – we suffer, remaining victims to our pain.

Fortunately, we can learn how to change our anticipatory response to pain. We can lower the amount of pain that we anticipate by changing what we believe will happen when we start to hurt. We can also change our thinking – or the self-talk – and learn how to better manage our emotions.

We can learn new ways of responding to old situations that cause or intensify pain. As we come to believe that we really can do things that will make our pain sensations bearable and manageable, our brains respond by influencing special neurons that reduce the intensity of the pain. As a result, our brains become less responsive to an incoming pain signal.

There are things we can do that will make us less responsive to incoming pain signals. Both ascending (pain signals coming from the point of injury to the brain) and descending nerve pathways (signals from the brain to the point of injury) will influence or modify the effects of pain on the body. This is the reason for including biofeedback, positive self-talk, meditation, and relaxation response training as part of an effective pain management treatment plan.

Moving Beyond Anticipatory Pain

I wrote an article titled “Coping with Anticipatory Pain.” Much of that article’s content is in the previous section and has become one of the most requested articles on my site. I now believe it would be helpful to support people to not only cope with anticipatory pain, but to move beyond it.

I learned that what we expect is usually what we get, which can be both beneficial and harmful. When it comes to feeling pain and development an effective chronic pain management plan, it is crucial to more fully understand the role of anticipatory pain. It has both biological and psychological components.

Remember, on the biological side, the cascade of effects from a pain sensation occurs on many levels and involves a variety of different areas within the nervous system. As a result, a wide variety of nervous system chemicals are produced and dumped into the blood while other brain chemicals are rapidly absorbed or depleted. Pain doesn’t just hurt – it changes the most basic neurophysiologic processes in the human body.

As I mentioned earlier, the psychological side can influence the degree to which we experience our pain, especially anticipation of an expected pain level. In some cases, when our anticipatory level of pain expectation is lowered, our brain responds by influencing special neurons. This renders our brain less responsive to an incoming pain signal and our sensation of pain decreases. In any event, both ascending (pain signals coming from the point of injury to the brain) and descending nerve pathways (signals from the brain to the point of injury) will influence or modify the effects on our body.

The good news is that we can learn how to change our anticipatory pain response. We can lower the amount – or perception – of pain that we anticipate by changing what we believe will happen when we start to hurt. We can also change our thinking, or our self-talk, and learn how to better manage our emotions.

We can learn new ways of responding to old situations that used to cause or intensify our pain. As we come to believe that we really can do things that will make our pain sensations bearable and manageable, our brain responds by influencing special neurons that reduce the intensity of our pain. Our brain becomes less responsive to an incoming pain signal.

Remember the important question I asked earlier about how we can learn from our experience of pain: What is my pain trying to tell me? Unfortunately, it can sometimes be difficult – if not impossible – to pinpoint why we hurt, and as human beings, we want to know why something is happening and we want to know “right now.” Because when we’re in pain, a more important question is: What do I need to do, right now, to manage my pain in a healthier way that supports me physically, emotionally and spiritually? As I’ve mentioned several times, the answer will be different for each person.

Understanding Pain Versus Suffering

What if you can’t answer that question because your chronic pain has become unmanageable, no matter what you try? This brings us to a back to our discussion of pain versus suffering.

We can develop many mistaken beliefs when we get caught up in the chronic pain trance. Many of those beliefs are what lead us – and keep us – in suffering.-Stephen Grinstead
The psychological meaning you assign to a physical pain signal determines whether you simply feel pain (Ouch, this hurts!) or experience suffering (This pain is awful and will just keep getting worse; this is terrible and why is it happening to me!).

It is crucial to remember that, because pain and suffering are often used interchangeably, in order to avoid suffering, you need to make the distinction. We need to remind ourselves that pain is a physical sensation, a warning sign telling us that something is going on in our body and we need to listen. Suffering results when we amplify or distort this with our thinking and feeling response.

We can develop many mistaken beliefs when we get caught up in the chronic pain trance. Many of those beliefs are what lead us – and keep us – in suffering. A big step toward effective chronic pain management occurs when we can stop suffering by identifying and changing our thoughts and beliefs about our pain, which in turn can decrease our stress, uncomfortable emotions and overall suffering.

The Role of Neuroplasticity

Neuroplasticity refers to the changes that occur in the organization of our brain as a result of experience. As such, brain activity associated with a given function such as living with chronic pain can move to a different location as a consequence of normal experience or brain damage/recovery.

It has been found that this capacity for rewiring of the neuronal synapses to allow for re-development of entire regions of the brain is present in adults as well as children. Newly discovered principles of neuroplasticity are at the heart of some of the most revolutionary and groundbreaking brain research. I’m excited that we can also apply this to chronic pain management.

Constantly living in anticipatory pain actually changes our neuronetwork. In addition, learning and practicing ways to change our beliefs, thoughts, and conclusions about pain can change our neuronetwork, so eventually we can move beyond our previous anticipatory pain responses.

Pain research presented by the American Society of Anesthesiologists has emphasized the molecular transduction of painful stimuli – the sensitization processes that occur after injury and long-term phenomena such as pain memory. Neuroplasticity after surgery occurs in the central nervous system, where central sensitization occurs – where the signals are generated.

Cognitive Behavioral Restructuring for Reprogramming the Neuronetwork

As my friend and mentor Terry Gorski says, language is the key to reprogramming the neuronetwork. Mr. Gorski’s TFUAR (Thoughts, Feelings, Urges, Actions, Reactions) process is a cognitive behavioral restructuring model that I adapted for chronic pain management, and is especially useful for moving beyond anticipatory pain.

Thoughts lead to feelings: Humans have literally hundreds – if not thousands – of thoughts going through our heads every day. People living with chronic pain who have problematic perceptions and mistaken beliefs about their pain will generate negative thinking patterns.
Thoughts and Feelings work together to cause Urges: Our way of thinking causes us to feel certain feelings. These feelings, in turn, reinforce the way that we are thinking. These thoughts and feelings work together to create an urge, or impulse, to do something. An urge is a desire that may be rational or irrational. Sometimes the irrational urge is to isolate and give into our depression. At other times, we might be tempted to use inappropriate chronic pain management medication, including alcohol or other drugs, even though we know that it will hurt us, which is also called craving. Other times, we might want to use self-defeating behaviors that, at some level, we know will not be good for us and could worsen our depression and pain.
Urges plus Decisions cause Actions: We need to always remember that this decision is a choice. A choice is specific way of thinking that causes us to commit to one way of action while refusing to do anything else. The space between the urge and the action is always filled with a decision or choice. This decision may be an automatic and unconscious choice that we have learned to make without stopping to think about it, or this decision can be based upon a conscious choice that results from carefully reflecting upon the situation and the options that are available to us for dealing with it in a better way.
Actions cause Reactions from other people: Our actions affect other people and cause them to react to us. It is helpful to think about our behavior like invitations that we give to other people to treat us in certain ways. Some behaviors invite people to be nice to us and to treat us with respect. Unfortunately, many of our old automatic and unconscious behaviors invited people to react to us in a negative manner.

These old behaviors invite other people to argue and fight with us or to put us down. In every social situation, we share a part of the responsibility for what happens because we are constantly inviting people to respond to us by the actions we take and how we react to what other people do. Sometimes these reactions help us manage our pain more effectively, but at other times it leads to increased stress levels that cause us to make poor decisions.

This TUFAR process helped me to move beyond anticipatory pain so I could develop a more effective chronic pain management plan. However, this is only a first step, although a critical one, that needed to be enhanced as I moved forward in my chronic pain management journey. Remember, anticipatory response can also work for us. If we expect to have success with our chronic pain management, that is what we will tend to manifest. We can learn to make this a positive self-fulfilling prophecy and continue to move beyond anticipatory pain.

In every social situation, we share a part of the responsibility for what happens because we are constantly inviting people to respond to us by the actions we take and how we react to what other people do.-Stephen Grinstead

Epilog

Today, I am mostly at peace with my pain. I must admit that some days are much better than others. I also have times when I drop down and try to fight my pain once more. I’m so grateful for my work with others who are living with chronic pain, the research I conduct or writing I do about chronic pain. I find that I can quickly move back into a peace-centered place and put my pain in its proper place.

I hope that by sharing my patients’ experiences and my own journey with chronic pain, I can help others achieve better results. However, it does not come without a challenge: Your willingness to move into authentic action, to examine your beliefs and perceptions about pain and what really constitutes effective pain management.
Images Courtesy of iStock

Making Peace With Pain – Part IV