The Social and Physical Aspects of Chronic Pain

Christianity undeniably affirms the physical, material aspect of life, for could there possibly be a greater affirmation than the fact that God Himself became an incarnate physical, material human being? Christianity likewise affirms that we are all related to each other as children of single Creator, as our brother’s and sister’s keeper, and members of one another. To deny the physical and the social aspects of reality is to deny the very aspects of reality through which we are to be saved. Hence not only from a holistic approach to chronic pain, but also from a Christian vantage-point, the physical and the social facets of pain need to be taken seriously and given due attention as do the cognitive, emotional, and spiritual factors that all influence the overall experience. Prior to writing about the more subjective factors of thoughts and emotions, I would like to say something about the more objective contributions of how we treat our bodies and how others treat us, for if we can modify the physical and social factors relating to pain, we can also potentially alter our overall experience of chronic pain.

When we experience pain, we often focus our attention solely on the bodily area affected by the pain.  This may have the undesired effect of actually increasing our pain.  Grant and Haverkamp note in their article, “A Cognitive-Behavioral Approach to Chronic Pain Management,” “When clients view injury as the sole cause of pain, they may overlook physical factors that are still within their control and that can greatly influence the pain experience.  The first is muscle tension, one of the body’s naturally occurring protective responses to pain (Philips, 1988).  When pain becomes chronic, this beneficial tension can shift to an extreme, sustained muscular hyperactivity that actually exacerbates the pain experience (Turk & Holzman, 1986).” And this is where choice comes in: one can allow the body to tense up and exacerbate the pain or one can try to learn to relax the muscles purposefully or stretch them through exercise in order to assuage the pain.

I have a friend who required back surgery a few years ago.  One of the lower disks in his back was crushing his sciatic nerve making him unable to walk and causing him excruciating pain.  He required surgery to relieve the pain and free the nerve from the disk impingement.  After the surgery, the intensity of the pain subsided but he remained in constant discomfort.  His doctor recommended intense, long-term physical therapy so that the muscles surrounding the surgically repaired area might relax and be strengthened without the hyperactivity that led to the chronic pain.  Today, he is able to function and manage the discomfort through a regimen of diet and exercise.  I provide this example because it demonstrates what most of us think when we experience chronic pain—it’s just an isolated physical problem—and how no thought is sometimes given to the surrounding muscles and joints.  My friend’s first inclination after surgery was to protect his back at all costs and refrain from physical activity, an inclination that would have eventually led to complications and further pain. Fortunately, he trusted his physician, was obedient to his instructions, and took an active role in his recovery. Trust, obedience, and activity—the very traits necessary for healing on the spiritual level—are essential on a physical plain as well.

Of course, chronic pain affects more than one’s physiology.  Social isolation is often a by-product in those that suffer with chronic pain.  The chronic-pain sufferer is often no longer able to participate in many past, enjoyable social interactions with spouse, family, and friends and may come to believe that the condition precludes any meaningful social interaction whatsoever.  This may be an exaggeration, but it is fueled by real disappointments, faltering self-esteem, and sometimes even a loss of purpose in life. Social isolation, like physical inactivity, is a coping mechanism and attempt to protect the self, an attempt that unfortunately results in consequences that are precisely the opposite of what the sufferer intends. As human beings created in the image and likeness of God, we are essentially relational beings who are meant to interact with others, to give and receive love. Limiting this aspect of our humanity causes deep existential suffering in its own right, making the physical pain doubly painful.

Chronic pain tends to drive us to isolation and avoidance, both physically and socially. Such isolation and avoidance, however, exacerbates the experience of pain, for the physical body of the sufferer, like the social body of humanity, is a well-constructed unity intended to work in harmony.  As Saint Paul reminded the Corinthians, “For the body is not one member, but many. If the foot shall say, because I am not the hand, I am not of the body; is it therefore not of the body? And if the ear shall say, because I am not the eye, I am not of the body; is it therefore not of the body? If the whole body were an eye, where were the hearing? If the whole were hearing, where were the smelling? But now hath God set the members every one of them in the body, as it hath pleased him. And if they were all one member, where were the body. But now are they many members, yet but one body.”

This passage about the nature of the Church also says something obvious, but not to be forgotten, by those who suffer from chronic pain: the body’s organs are meant to function, the muscles are created for movement, and all in the service of the whole person. Likewise as members of the body of humanity, we are meant to interact with one another and should not cut ourselves off from others when we need them and quite surprisingly they may need us the most. To act when pain seems to be forcing us to inactivity and to be communal with others and with God when pain seems to be driving us into isolation requires nothing less than heroism, the heroism that characterized the Christian martyrs. When, however, we dare to act and to interact with others for sake of the love God and in spite of the pain, we not only receive strength from on high, but also our actions and interactions can become a precious sacrifice, a golden offering purified in the furnace of pain warmed by the flame of love.

About Father Alexios

Comments

  1. ledetasunday@yahoo.com says:

    Hello, Thanks for your posts. I had a back pain supposedly caused by sciatic nerve. I was told to have surgery after a some sessions if physical therapy but did not have faith in what I was told. I prayed to God. Then a friend suggested Bikram Yoga which help a little since it was an intensive exercise in a hot room. But it will only help for the time being. At the end, by the grace of God, I found a book written by doctor John Sarno, Healing back pain. He says majority of back pain is not caused by structural abnormality but mild oxygen deprivation to the muscles in the back. He says this condition is caused by a repressed emotion caused mainly by anger and rage, which the Church teaches we should avoid. Just knowing this fact by itself made a lot people better. I am happy to say that 90% of my pain is gone now. He says to resume all normal physical activity and shift attention from the pain to emotional issue. I urge you to read the book and recommend to your friend.

    Yonas Assefa

  2. Thank you, Yonas, for your comment. I am very glad to hear that you have found relief for your back pain through the insights from Dr. Sarno’s book about his diagnosis of tension myositis syndrome for people who, according to Dr. Sarno’s researchers, tend to be given to perfectionism and self-criticism, who have previously suffered from tension related disorders, who note clinical improvement on vacation, and who have no clear structural causes for their pain. There is an article by his group in the 2007 Journal of Alternative Therapies in Health and Medicine that involved fifty case-studies that did improve with this treatment. I suspect that as we go through the series there will be some commonalities between a CBT approach and Sarno’s approach to the problem of chronic pain. An important difference between the two approaches at present is that CBT has blinded randomized clinical trials, like those used in pharmaceutical research, that indicate the effectiveness of this approach. This doesn’t mean that other approaches don’t work. They may even work better. But until they earn the status of scientific knowledge and acceptance by the scientific community at large, they are opinions, perhaps wise, perhaps ahead of their time, but opinions, not yet scientific probabilities. For the purpose of the blog, I try to take what is the best that science can presently offer using the consensual criteria of science on the one hand, and then the sanctifying truth of Christian revelation as understood by those who have lived the faith wholeheartedly on the other. The aim is always to use the best from both worlds. Outside of those worlds, there may be other material of value, but beyond the parameters set for this blog.

    Thank you once more for alerting me to Dr. Sarno’s work and I hope people continue to receive help from it.

    Fr. Alexis

    Reference:

    Schechter, D., Smith, A., Beck, J., Roach, J., Karim, R., & Azen, S. (2007). Outcomes of a mind-body treatment program for chronic back pain with no distinct structural pathology–a case series of patients diagnosed and treated as tension myositis syndrome. Alternative Therapies in Health And Medicine, 13(5), 26-35.

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