By Don Topp, Hope Church member
I want to begin by telling you the story of “Job,” a fictional patient who combines various patients seen over the past year or more; his name is chosen not by accident. Job is a 35-year-old, married, male who has been trying to manage widespread chronic pain for the past year or more. He is on temporary disability from his blue-collar manufacturing job. He is taking fairly high doses of an opioid medication (7.5-325 mg) four times per day (but he acknowledges he takes up to 6 per day); this means he is taking somewhere between 30 and 45 mg per day of narcotic medication per day. In addition, he is taking 300 mg, three times per day, of another medication that is supposed to be effective for his type of pain. Despite taking these medications, his pain is worsening. There does not appear to be any particular rhyme or reason for his pain, and his primary care physician, who has referred him, has diagnosed him with fibromyalgia. Job ranks his pain at 8 on a 10-point scale, and says he’s consistent most days at this level of intensity. Some days are worse, and only occasionally do symptoms lessen to maybe a 6 on that scale. The ones that need relief from pain and relax can navigate to this website here to get help. He reports that his marriage is tense, as his spouse does not understand or sympathize with his pain, and because he is non-functional in the household and with their three children. His children seem to wonder why he is always home and notice that he does not attend their school or community involvement activities. He reports feeling guilty, ashamed, and depressed because of this. Other extended family members and some friends nod politely; he reads a condescending look on their faces as a sign of disapproval and disappointment.
A publication of the Centers for Disease Control and Prevention, published in September 2018, estimated that 20.4 percent (50.0 million) of the US population had chronic pain, and that 8.0 percent (19.6 million) had high impact chronic pain—meaning that pain limited at least one major life activity. Chronic pain has been linked with restricted mobility, opioid dependency, anxiety, depression, and reduced quality of life. Further, it is estimated there are costs of $560 billion annually in domains of medical expenses, lost productivity, and disability claims. Chronic pain is the number one reason for disability claims. Pain affects more Americans than diabetes, heart disease, and cancer combined. These are just some of the statistics that are easily available through a cursory on-line search.
Job is a typical referral to the Mary Free Bed Pain Rehabilitation program, where I have worked as a psychologist for about the past year. This program has been in existence for more than 20 years and is one of two in the state of Michigan that follows this model of treatment: a multidisciplinary pain rehabilitation program that uses the combined work of a medical doctor, psychologist, physical therapist, occupational therapist, and nurse. The goal of the team is to reduce or eliminate reliance on medications that do not work, to increase pain coping skills, and to reduce as possible pain symptoms. It is a time-limited program that is intense and focused on these goals, occurring in a ten- to twelve-week timeframe with multiple appointments per week. There is a waiting list for program admission due to the overwhelming need.
My experiences with chronic, debilitating pain are both professional and personal (the latter I won’t get into here), but I have seen and been part of the struggles noted in the statistical paragraph above. Also, as clergy with pastoral experience, I have known many who have struggled with questions of faith and doubt that are raised by chronic pain conditions. There have been many attempts, across many years, by pastors, mystics, and theologians to find ways to think, consider, and hopefully understand the questions that are raised by these problems. Often framed by the word “theodicy,” the attempt is to find meaning to justify the existence of a good and loving God in the context of inexplicable pain, suffering, loss, or tragedy. I have a mini-library of such works, and here confess that there are no easy answers, and possibly none that are satisfying. I will turn to the namesake of the made-up patient described in the first paragraph to conduct a brief search for such meaning. Before launching into this treacherous ground, I will also confess something that is well-known by friends and colleagues in ministry and during my seminary years: I am a limited biblical scholar—but I will plunge onward anyway, knowing that others with greater skill and wisdom might well critique what is offered in the next paragraph. These thoughts are not original, but are gleaned from the text of Rabbi Kushner.
Job is a good man who is “blue-collar” in his day as farmer-rancher, and he is a person of faith. Over the course of events he loses everything, including children, farm animals, buildings, his health, and wellbeing, and his faith is heavily threatened. His “pain” is emotional, familial, religious, and physical—as he is set upon by seeping sores and manifestations of illness. He maintains that he has done nothing to deserve this state of things, and shakes his fist at the heavens while enduring the religious soliloquys of his “friends,” who insist, in differently nuanced arguments, that he must somehow be responsible for his fate. His spouse adds to this litany and suggests that he would be better off to “curse God and die.” In the end he demands that his accuser, God, appear and justify the events that have befallen him. To his likely amazement, God appears. First, God takes on the “friends,” announcing to them that “you have not spoken the truth about me, as has my servant Job.” This suggests the interpretation that when you go back and re-read everything that the friends have said about Job’s situation and God, an illuminated sign “NOT TRUE” ought to be flashing above their words. Further, when you read everything that Job has said the flashing sign reads “TRUTH.” Yet, the story is not easily ended there. God turns attention to Job and in a fit of poetry suggests that when Job can understand the amazing wonders depicted in the poem that maybe he can take a shot at being God. That is the end, unless of course you want to wrestle with the prose prologue and epilogue that Rabbi Kushner suggests were added to make the poem more palatable to the religious establishment.
As you can see from the above sequence, I have been tacking (something I learned from another friend and colleague) between matters of psychology and religion—kind of the story of my life. In my worklife the former takes precedence. Those who see me professionally as a pain psychologist come to me to find some means to increase management of pain symptoms, while reducing pain symptoms and the effects of them in the balance of their lives. The good news is that there are many things that can be done. I often say to patients that if the current me (2019) could go back to the undergraduate college me (circa mid-1970s), the former me would accuse the current me of being deluded. This accusation would be due to what we “knew” in the past in comparison to the wealth of research that has revamped what we know today. Much of this knowledge has come about as there has been progress in various scanning technologies—C-Scan, MRI, PET-scan—and the functional versions of some of these that has mapped the brain in action. This knowledge now allows us to intervene in ways that can effectively “reprogram” the brain and its “pain control systems.” The brain is the processing center of everything—pleasure, pain, movement, thought, emotion, insight. I refer the interested reader to some on-line resources (see sidebar) that can be accessed through YouTube.
As you might deduce from the prior paragraphs, the matters of chronic pain are widespread and complicated in life and the effects on people and those who love them. The effects of this problem are felt by individuals, families, businesses, and the various professionals who are trying to address the issues. However, what I have learned is that this is not a hopeless quest. Rather, there are treatments and approaches that can make real differences in the lives of the afflicted and those associated with them.
Additional Resources to Consider
Lorimer Moseley, PhD (physiotherapist, professor, University of South Australia: “Why Things Hurt” or “The Pain Revolution: 7 Discoveries to Change Your Life”
Daniel Clauw, MD (professor, University of Michigan) “Chronic Pain: Is It All in Their Head?”