Spirituality and Chronic Pain

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Spirituality and Chronic Pain

• W. Douglas Ensminger, D.Min.
• Chaplain Manager
• MEDVAMC

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Pain

• A more or less localized sensation of
  discomfort, distress or agony, resulting from the
  stimulation of specialized nerve endings. It
  serves as a protective mechanism insofar as it
  induces the sufferer to remove or withdraw from
  the source.
• (Dorlands Medical Dictionary, 25th Ed.)

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Suffering

• An individuals cognitive, emotional and
  spiritual response to pain, especially ongoing
  pain, when they perceive themselves to be in a
  situation where they are
• helpless,
• hopeless and
• their life is meaningless.
• (WDE)

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Spirituality

• Personal
• Universal and ultimate issues of meaning and
  purpose
• Relationship with all of reality
• Mysteries of life and death
• Quest for some transcendence of limits of time
  and space
• Basis for moral and ethical decisions
• May include emotional life-transforming
  experience/awakening

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Religion

• Shared
• Structured belief system that addresses spiritual
  questions
• Doctrine, rites and rituals offer a shared way of
  expressing spirituality
• Reinforces, recalls and interprets spiritual
  experience and understanding

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First Premise

• Spirituality is
• An Underused
• Treatment Modality

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Second Premise

• Clinicians providing care for Chronic Pain
  patients will frequently be involved in the
  spiritual and religious lives and concerns of
  their patients, patients families or caregivers.

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Third Premise

• In this life, pain is inevitable,
• Suffering is optional
• (Buddhist maxim)

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The Primary Question

• What Does Their Pain Mean to the patient?
• Stuff Happens the warriors stoic fatalism
• I deserve to suffer / I am being punished
• This is not fair!

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Issues Patients might raise

• How can I find meaning in this situation and
  transcend it?
• Is this all there is, or are we part of something
  bigger?
• Do you believe in God?
• Why do I have to suffer?
• What have I done to deserve this?
• Does my life still have any meaning or value?
• Why did I survive and my buddies died?
• I know I am suffering as punishment of things I
  have done!
• Am I to blame for the suffering my loved ones are
  going through?
• I dont mind pain and suffering, it brings me
  closer to God.

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Questions Clinicians should ask Themselves

• What provides the patient strength and hope?
• How does the patient keep going, day after day?
• What does suffering mean to the patient?
• What gives the patients life meaning and value?
• Is there any spiritual / moral business the
  patient needs to deal with to prepare them to
  move on with their life?
• What are the patients spiritual goals for the
  rest of their life?
• What type of spiritual or religious support does
  the patient desire?

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Spiritual Roots of Suffering

• Helpless
• There is nothing I can do to help myself!
• Hopeless
• I have nothing positive to look forward to!
• Meaningless
• My life has no meaning or value for anyone!

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Principle of Treatment

• The person who has a Why to live can endure
  almost any How.
• (Viktor Frankl/ Nietzsche)

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• Treating Helplessness
• restoring a sense of competence or agency 
•  
• Treating Hopelessness
• discovering something to anticipate.
•  
• Treating Meaningless
• filling the existential vacuum w relationships
  and responsibilities.
•  
•  

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RESPECT THE PATIENTS PRIVACY AND AUTONOMY IN
SPIRITUAL MATTERS

• It is up to the patient to decide how much to
  share with you.
• Each patients belief system should be honored
  and respected, even (especially) if it is very
  different from your own.
• Different cultures have widely varying ways of
  expressing thoughts and feelings what is
  expected / acceptable for one may be sick for
  another.
• Do not offer quick reassurance to alleviate the
  patients spiritual suffering. To do so may make
  it harder for patient to resolve deep-seated
  concerns. It may also be perceived as dismissing
  the importance of the patients spiritual life.

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KNOW YOUR LIMITS / BOUNDARIES

• Be aware of your own personal beliefs and biases.
• Clinicians may experience anxiety or distress
  when a patients religious beliefs differ from
  their own.
• Find ways to protect your own integrity that do
  not create communication barriers between you and
  your patient.
• If asked about your own religious or spiritual
  life, be careful to stay in your role. Maintain
  appropriate boundaries, the focus should be on
  the patient, not on the clinician.

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• Not everyone can relieve pain,
• but
• anyone can alleviate suffering