Pain, Suffering, and Spirituality:

How the Catholic Faith can Help Chronic Pain Patients

Robert Hauptman BMSc, MD, MCFP

Pain Consultant

President AMA Section of Chronic Pain

Objectives

●To discuss the problem of chronic pain in Canada

●To briefly look how the nervous system changes in chronic pain

●To discuss treatment options

●To discuss suffering and pain and how the Catholic Church can help our patients cope with their pain

The Problem of Pain● Chronic non-cancer pain (CNCP) affects substantial and growing

numbers of Canadians

● The prevalence of CNCP in the general population is about 20 to 30%● Visits for chronic pain are a substantial proportion of a family physician’s

schedule, given the prevalence

● Low-back pain is among the most common cause of CNCP

● Given the fact that Canada’s population is aging, chronic pain will likely become a more significant public health issue in the near future

National Opioid Use Guideline Group (NOUGG), 2010.

This issue is NOT going away!

Epidemiology of chronic pain from three large, high quality surveys of adult general populations

✓Blyth et al PAIN (2001): N = 17 543 Australia pain most days for 3 months:

18.5%

✓Eriksen et al PAIN (2003): N = 20 000 Denmark pain lasting more than 6 months:

19 %

✓Breivik et all EJP (2004): N = 30 701 in 12 European countries

pain >6 months > 5/ 0-10 pain scale = 18%

Impact of CNCP● Individuals with chronic pain fare worse vs. the healthy population in terms

of quality of life, diminished functional status, and lost productivity1

● Average duration of pain: 10.7 years (range 9.4–13.2 years)2

● Almost 50% unable to attend social and family events2

● Prevalence of concomitant depression in individuals with CNCP is more than 30%3

● Mean number of days absent from work over 1 year due to chronic pain: 9.32

1. Whitten CE, et al. Perm J. 2005;9(2):41-8.2. Moulin DE, et al. Pain Res Manag. 2002;7(4):179-84.3. Rashiq S, et al. Pain Res Manag. 2009;14(6):454-60.

Chronic Pain: Societal Costs

Work losses: $42 Billion / yr

Health Care: $11 Billion / yr

Total: $53 Billion / yr

This is more than diabetes, cancer and heart disease combined!!

Schopflocher, 2011

“Chronic pain affects an estimated 116 million American adults – more than the total affected by heart disease, cancer and diabetes combined. Pain also costs the nation up to $635 billion each year in medical treatment and lost productivity”

What Patients Tell Us

●Not believed

●Not heard

●Accused of addiction

●Abandoned

●Alone

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What is Pain?

●Pain is the physiological process that warns us of potential or actual danger

●Generally pain is associated with tissue damage

●Pain is a sign of a healthy brain

●Pain is protective

●Normal pain is not a disease but a symptom

●Acute pain = healthy brain

What is Chronic Pain?

●Pain that lasts longer than 6 months or beyond normal tissue healing

●Not associated with tissue damage

●Chronic pain is a symptom of an unhealthy brain

●Rewiring and amplification of the nervous system

●Chronic pain = unhealthy brain

●Chronic pain is a disease

Tissue damageInflammationNerve compression

5-HT, Bradykinin, Cytokines,Histamine, Prostaglandins

EAAs NMDA receptors SubP, NGF, NK1, CGRP, NO

Descending excitation/inhibition

Dynorphin A, CCK5-HT, NE, GABA

AttentionExpectation

Affect

Acute Pain Pathways 11

CCK = cholecystokinin; 5-HT = 5-hydroxytryptamine; NE = norepinephrine; GABA = γ-aminobutyric acid; EEA = excitatory amino acid; NMDA = N-methyl d-aspartate; SubP = substance P; NGF = nerve growth factor; NK1 = neurokinin 1; CGRP = calcitonin gene-

related peptide; NO = nitric oxide.

No tissue damageAbnormal Na ChannelsSpontaneous pain

5-HT, Bradykinin, Cytokines,Histamine, Prostaglandins

EAAs NMDA receptors SubP, NGF, NK1, CGRP, NO

Neuronal plasticity

Impaired Descending Pathways

Dynorphin A, CCK5-HT, NE, GABA

Altered Perception

Impaired Pain Processing

Peripheral Sensitization Central

Chronic Pain Pathways12

CCK = cholecystokinin; 5-HT = 5-hydroxytryptamine; NE = norepinephrine; GABA = γ-aminobutyric acid; EEA = excitatory amino acid; NMDA = N-methyl d-aspartate; SubP = substance P; NGF = nerve growth factor; NK1 = neurokinin 1; CGRP = calcitonin gene-

related peptide; NO = nitric oxide.

How Do You Explain Pain to Patients?Hardware vs. Software

Hardware: • Nerves, spinal cord and

brain• Measured with MRI, CT, X-

ray

Software:• Program which runs the

hardware• Measured with brush,

pin prick

Pain and Suffering

Environment

SUFFERING

P

A

I

N

NOCICEPTION

Emotions

Cognition

The Experience of Chronic Pain

● Physical● The location and cause of the pain ● Fibromyalgia, OA, chronic back pain

● Cognitive● What the patient thinks about the pain● Influenced by previous experiences and up bringing

● Emotional● The feelings a patient has around their pain

● Spiritual● The deeper meanings of pain and suffering

Nociception

Pain

Suffering

Behaviours

Social

“Pain is something that

happens to a body…

Suffering is something that

happens to a person.”

How do we assess suffering?

●The NRS Pain Scale

●Pain Catastrophizing Scale

●History

●Collateral information

●“What are you doing for fun in your life?”

CNCP Management: The Six Pillars

●Lifestyle modification – exercise, sleep and

nutrition

●Psychological interventions

●Physical therapies

●Optimizing medications

●Interventional therapies

●Spirituality and Faith

CNCP Management: The Six Pillars

● Lifestyle modification – exercise, sleep and nutrition

● Psychological interventions

● Physical therapies

● Optimizing medications

● Interventional therapies

●Spirituality and Faith

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●“Every problem we experience has a spiritual dimension, bot often we leave the spiritual dimensions of things unconsidered”

Matthew Kelly “Rediscover Jesus”

Religious beliefs might engage descending inhibitory pain systems via the DLPFC

Wiech K. et al. Pain 2008; 139:467-476

●Adverse emotions (chronic anger, etc) are associated with increased pain and with increased opioid requirements (Bruehl et al. 2002)

●Lack of forgiveness is associated with low back pain (Carson et al. 2005)

St. John Paul II

●Mother died when he was in third grade

●His only sibling – his older brother – died 3 years later

●He discovered his father dead on the floor in their apartment

●He did hard labor in a stone quarry in WWII

●He was run down by a German truck and nearly died

●He was shot by an Islamic assassin when 60

●He suffered from debilitating Parkinson’s disease

Salvifici Doloris:On the Christian Meaning of Human Suffering

●St. John Paul II’s apostolic letter on the meaning of suffering

●Human suffering is a reality and a great mystery

●The story of humanity is the story of Jesus Christ

●We must look to Jesus to answer the question of suffering

The Purpose of Suffering

●Charity

●Humility

●Transformation

●Punishment

Charity

●Sometimes suffering makes an important good possible

●If God eliminated suffering, the corresponding good also would be eliminated

●“We could say that suffering…is present to unleash love in the human person, that unselfish gift of one’s “I” on behalf of other people, especially those who suffer.” (SD 29)

Humility

●Suffering can bring us closer to what is good and draw us away from obstacles to achieving happiness

●Pain can turn us away from evil and draw us closer to others and to God (SD 12)

●Suffering breaks down our desire to be God

●“To suffer means to become particularly susceptible, particularly open to the working of the salvific powers of God offered to humanity in Christ. In Him God has confirmed his desire to act especially through suffering” (SD 23)

Transformation

●History provides many examples of sinners transformed to saints through suffering

●“Down through the centuries and generations it has been seen that in suffering there is concealed a particular power that draws a person interiorly close to Christ” (SD 26)

Punishment

●Sometimes sinful actions lead directly to painful repercussions and suffering

●However, “While it is true that suffering has a meaning of punishment when it is connected with a fault, it is not true that all suffering is a consequence of a fault” (SD 11)

Jesus Christ and Suffering

●Christ endured the greatest suffering of all

●Not only was his suffering physical and mental but deeply spiritual

●He endured the greatest pain of all – alienation from the heavenly Father caused by the totality of human sin

●“And about the ninth hour Jesus cried with a loud voice, saying: Eli, Eli lamma sabacthani? that is, My God, my God, why hast though forsaken me?” Matt 27:46

Suffering and Salvation

●Suffering has a purpose – a higher call

●Through the suffering of Christ man is not only redeemed but suffering is given a purpose (SD 24)

●The sufferer can share in the redemptive work of Christ (SD 19)

●“A source of joy is found in the overcoming of the sense of the uselessness of suffering … The discovery of the salvific meaning of suffering in union with Christ transforms this depressing feeling … the suffering person “completes what is lacking in Christ’s affliction” … the certainty that in the spiritual dimension of the work of redemption he is serving the salvation of his brothers and sisters” (SD 27)

●Colossians 1:24

●“… man can endure anything if he has reason to live. Conversely, man can endure nothing if he does not.”

● Christopher Kaczor Professor of Philosophy

Catholic Answers

The Protestant’s Dilemma:The Cross without Suffering

Back to our Chronic Pain Patients

●Pain is a number – a description of a feeling

●Suffering is how pain affects our patients spiritually, physically, mentally and emotionally

●Our job is not as much to relieve pain but to relieve suffering

●Hope is found in dealing with all dimensions of pain including the spiritual

Practical Tips

●Help patients to reflect on how pain and their choices have affected their lives

●Explore positive ways to reclaim back their lives including SMART goals

●Explore the deeper meaning of pain and spirituality including how pain can give us a new purpose and deeper meaning of our lives

●Remember the Cross – we don’t have to suffer in vain

●The sacraments of reconciliation and eucharist

SMART goal setting

●Specific

●Measurable

●Achievable

●Realistic

●Timely

Patient Resources

●“The Tears of God: Going on in the Face of Great Sorrow or Catastrophe” Father Benedict Groeschel

●“The Problem of Pain” CS Lewis

●“The Rhythm of Life” Matthew Kelly

●Web based resources:● People in Pain Network● painAction.com

Conclusions

●Chronic pain is a common condition caused by changes in the neurological system

●Although our patients present with pain, it is their suffering that we need to address

●Suffering involves considering the whole person including their spiritual side

●The Catholic Church offers hope and meaning in those who suffer through the Cross of Christ

●rshauptman@gmail.com