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A Holistic Approach to Chronic Pain

September 3, 2013

Disclaimer Acute pain may be defined as intense pain of recent onset that usually diminishes and disappears when healing has taken place.  Acute pain is a symptom of some underlying disease or injury.  Chronic pain is that which is ongoing and defies simple causal analysis.  It may be diagnosed in general terms and defies mere biological factors or pharmaceutical therapies.  Chronic pain will be the subject of this blog series.

Medicine concentrates on the physiochemical causes of illness in which a given complaint is explained within a theoretical framework that has room for pathways of change suggesting specific therapeutic treatment. As a model, it works wonderfully when it works! But when it doesn’t, as in the case of chronic pain, other broader frameworks are necessary, frameworks that look not only to the pain in the body, but also the suffering in the soul. Saint Augustine once wrote, “For what pain or desire can the flesh feel by itself and without the soul? But when the flesh is said to desire or to suffer, it is meant, as we have explained, that the man does so, or some part of the soul which is affected by the sensation of the flesh, whether a harsh sensation causing pain, or gentle, causing pleasure. But pain in the flesh is only a discomfort of the soul arising from the flesh, and a kind of shrinking from its suffering, as the pain of the soul which is called sadness is a shrinking from those things which have happened to us in spite of ourselves. But sadness is frequently preceded by fear, which is itself in the soul, not in the flesh; while bodily pain is not preceded by any kind of fear of the flesh, which can be felt in the flesh before the pain” (City of God, Book XIV, chapter 15). There is, in other words, a difference between the sensation of pain and the soul’s perception of pain. We react to our pain in various ways, shrinking back from it, feeling fear in its presence, and those ways of reacting are wider than a purely physical model will allow for. It seems that the fathers would hardly disagree with modern day professionals who have come to the conclusion that the purely physical medical model isn’t always helpful in working with those who suffer chronic pain.  While the pain is real, there is no identifiable physiochemical cause that can be targeted that can lead to the desired, therapeutic cure.

The holistic approach, which I mentioned in the previous post, is often referred to as the biopsychosocial model of pain.  This model makes important distinctions between pain, suffering, and pain behaviors.  Pain is normally considered as activity arising from specialized nerve fibers that signals the central nervous system that a traumatic event is occurring.  Suffering is the affective response to these stimuli from the nerve receptors.  Pain behaviors are the “overt actions people engage in when they suffer or are in pain.  These behaviors can exacerbate or decrease the experience of suffering; consequently, they become the primary focus of intervention.” (Grant & Haverkamp 1995)  Distinguishing the physical pain from the emotional suffering and the resultant behaviors is more than theoretical parsing, for it opens up a window of freedom in what seems to be the deterministic cage of pain. There may be little that one can do about the physical pain other than pain-relievers and surgery, but the emotional suffering and the pain-related behaviors are still an area where the sufferer may have some choices that can improve an over-quality of life.

An example may suffice to illustrate the point.  A 40-year-old man suffers chronic back pain and is only able to find some relief when in a supine position on a hard surface. The pain is the searing physical sensation in the lower back whose intensity changes with the position he is in. The suffering includes thoughts of all the things he would like to do, but cannot do as well as feelings of sorrow, anger, and worry. The pain behavior involves finding a hard surface and lying down to relieve the pain. This particular pain behavior does not cure the chronic pain, but provide temporary relief of pain and discomfort.

The biopsychosocial model differs from the traditional disease model in that it seeks to manage pain, not cure it.  The difference between the two is highlighted even further in that the biomedical model places the diagnosis and the cure solely in the hands of the physician, whereas the biopsychosocial model seeks to empower the sufferer by widening the range of choices for thought, emotion, and behavior and placing the management of pain squarely in the sufferer’s hands with the aim of reducing the impact (not necessarily the intensity) of pain on daily life.

The abbreviated version of the Serenity Prayer offers us a guide to what might be accomplished by examining the physical, social, cognitive, emotional, and spiritual facets related to chronic pain:  “God grant me the serenity to accept the things I cannot change, courage to change the things I can and the wisdom to know the difference.” Managing pain is about wisdom and courage in the face of a harrowing affliction. Demonstrating such wisdom and courage often requires a great deal of faith, faith that can move mountains. And if the mountain doesn’t move, perhaps we are the ones who need to move instead. The psalmist once wrote, “by my God have I leaped over a wall” (18:29).  The wall is still there, but the believer through faith in God finds himself in another, better place.

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