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The problem and management of pain

June 2008 | by Low Tut Choon

Pain and suffering are part and parcel of human existence. The Bible speaks of only two periods during which neither pain nor death exist on earth. The first was in the Garden of Eden and lasted until Adam fell. The second is after God ushers in the new heaven and new earth when ‘there [shall not] be any more pain’ (Revelation 21:4).

God’s judgement on human sin, starting with Adam and Eve, involves both spiritual and physical death – ‘for dust thou art, and unto dust shalt thou return’ (Genesis 3:19). Sickness and the slow decay of our bodies – whether it be arthritis, heart disease or senility – is the sure manifestation of this dying process and the pain that follows in its wake.

The apostle Paul declared, ‘we know that the whole creation groaneth and travaileth in pain together until now. And not only they, but ourselves also, which have the firstfruits of the Spirit, even we ourselves groan within ourselves, waiting for the adoption, to wit, the redemption of our body’ (Romans 8:22-23). He is referring specifically, of course, to believers, and no doubt his statement embraces both physical and spiritual pain, but it serves to underline the nature of the overall human condition.

Pain is synonymous with suffering, sorrow or anguish. Paul employs the word ‘travail’ commonly used to describe childbirth. The mother groans in pain but when the baby is born the sorrow is turned to joy. So, like everyone else, believers suffer pain in the flesh, but we also wait for that joyful moment when our earthly body will be redeemed and our mortal bodies will put on immortality.

The purpose of pain

Does pain serve any purpose? Yes, it is a signal that something has gone wrong. Without pain someone with a slipped disc might continue to carry heavy loads and further aggravate his condition. Pain is useful, and we should heed its warning.

A constant headache could indicate stress at work and that the sufferer should probably take a vacation. Similarly, a child with abdominal pain could have appendicitis and needs to see a doctor urgently. Whatever the cause, symptoms of pain cause us to slow down, seek medical advice and adjust our lifestyle accordingly.

Sometimes we drive in the fast lane for too long and have no time to sit down, pause and ponder. Pain is one way to stop us in our tracks and make us think about life and its meaning. C. S. Lewis used to say, ‘God whispers to us in our pleasures, speaks in our conscience, but shouts in our pains: it is his megaphone to rouse a deaf world’.

If the pain is indicative of a medical condition, our first reaction should be to seek medical advice, while at the same time committing the matter to God in prayer. Once the condition is treated the pain should go away. But what if no medical cause is found and the pain persists? Should we ask God to remove that ‘useless’ pain?

Paul faced this problem with his ‘thorn in the flesh’. Whatever it was, it troubled and hindered him, and he was surely right to pray that God would remove it. But instead, the Lord told him: ‘My grace is sufficient for thee: for my strength is made perfect in weakness’ (2 Corinthians 12:9). Someone rightly said, ‘do not ask for easy task, but ask for strength to equal the task’. In the same way, while seeking relief, we should also look to God for grace and strength to endure any pain or disability with which he has clearly entrusted us.

You may ask, ‘If God is good and all-powerful, why does he allow suffering and pain?’ For centuries Christians have been perplexed by this problem and even now there is no complete answer. Clearly, the Fall of man is the basic cause of all human suffering and cosmic futility, but we do not know why God has chosen to leave the cosmos under the curse of Adam for so long – nor why his faithful people are not exempted from the consequential suffering.

The example of Job

However, the Bible is not silent on the subject! The book of Job describes a classic example of pain and suffering. Through Satan’s instigation, God allowed Job to suffer the loss of possessions, family and finally health. Although he suffered greatly and complained bitterly at times, not once did he rebel against God.

Rather, he said, ‘the Lord gave and the Lord hath taken away; blessed be the name of the Lord’ (Job 1:21). And again: ‘Though he slay me, yet will I trust in him’ (Job 13:15). And yet again: ‘But he knoweth the way that I take: when he hath tried me, I shall come forth as gold’ (Job 23:10).

Job teaches us an important lesson – despite pain and suffering we can continue to trust the sovereign wisdom of God. Even when God allows Satan to take away everything, including the things we hold most dear, we can still remain steadfast and immovable in believing in his Fatherly goodness. Our faith in God should not depend only on his blessings.

Job passed the test and proved Satan wrong. However, his wife did not do so well. She could not bear the loss and in her anger she told her husband, ‘curse God and die’. She typifies those who associate God with only the good things in life. ‘Shall we receive good at the hand of God, and shall we not receive evil [i.e., misfortune]?’ (Job 2:10).

Understanding pain

We all experience bodily pain, but pain can be more than just physical. Man experiences ‘total pain’ – every aspect of his being can be affected by a traumatic event. A mother who loses her child in an accident will be overwhelmed with emotional and psychological pain. The outpouring of grief, denial and guilt can be worse than physical pain.

A man with advanced HIV may face a grim future of loneliness, rejected by family members and friends. The resulting psychological pain may lead to despair, depression and suicide.

Pain is complex because it is a subjective and personal experience. No one can feel the pain of another person, either in its physical experience or its emotional, mental and even spiritual dimensions.

Many factors affect a person’s perception of and reaction to pain. We have all seen children screaming in pain following an injection, while others of the same age have endured the same procedure with courage and fortitude. Adults differ in the same way.

Managing pain

However, although it is difficult to measure, the medical profession now seeks to monitor pain as closely as temperature, pulse or blood pressure. A scoring system is used, with the person in pain assessing his own ‘pain score’ and allowing doctors and nurses to know whether pain relief treatment is working. This is the basic approach to pain management, but effective management depends on knowing the nature of the pain requiring treatment.

Broadly, pain can be divided into acute or chronic. Acute pain is common and associated with trauma or accidents, surgery or conditions ranging from headaches to heart attack, appendicitis and even childbirth. The pain gradually subsides as the condition improves or the wound heals.

If the pain is not too great, non-prescription pain-killers like ibuprofen or paracetamol are effective, though all drugs must be used strictly in accordance with the instructions. If the pain is severe, much stronger drugs like morphine may have to be used under medical supervision. People tend to be afraid of this drug because of the fear of addiction but if used for a short period no problem should arise. The disadvantage of such strong drugs is the side effects which can be quite troublesome. Interestingly, some people would rather have the pain than the side effects.

Chronic pain is pain that lingers on for a long time, sometimes for years. Common chronic pain conditions include low backache, cervical spondylosis (causing neck and shoulder pain), osteoarthritis, persistent abdominal or pelvic pain and recurring migraine. Although pain-killers bring some benefit, such sufferers may have to live with the pain for the rest of their lives. As a result they may develop insomnia, depression and even suicidal thoughts. This makes treatment more difficult but at the same time more challenging – and also emphasises the need and value of spiritual counsel for such people.

Pain that disturbs sleep must be treated, because prolonged sleep deprivation can give rise to a whole new set of problems. Those with chronic pain are encouraged to remain active and functional, to prevent them from sliding into a state of despondency and depression. The support and understanding of both the medical team and family members is very important in the care of this special group of people. A wide range of drugs has been used to treat chronic pain, and in recent years pain specialists are resorting to interventional procedures to complement drug therapy.

Cancer pain

Because cancer patients now live longer on account of better drugs, more of them are also experiencing pain. The severity of the pain varies. Doctors tend to be more aggressive in treating cancer pain than non-cancer pain because the pain is liable to intensify. Another reason is that doctors want to make those with terminal cancer more comfortable.

Patients with advanced cancer are usually given morphine. Those with intractable pain are treated with special techniques that destroy the nerves, or high dose radiotherapy to shrink the tumour. Cancer victims no longer need to die in pain but can do so with dignity.

Treatment of pain would be incomplete without the help of support from nurses, physiotherapists, medical social workers, occupational or vocational therapists and, of course, pastors and Christian friends. Although spiritual support is specially helpful to believers it can also be a source of comfort to non-Christians and may even lead to ‘death-bed’ conversions.

All such agencies are part of God’s common grace and play a role in helping the sufferer through the journey of pain. If, as believers in Christ, we are in a position to render such consolation we can bring strength, courage and hope during the final days of the sufferer’s life on earth. As we do it to the least of these our brethren, we do it to the Lord Jesus (Matthew 25:34-40).

Conclusion

Whether from a theological or practical perspective, there is no simple solution to the complex problem of pain. All concerned need to hold fast to one overriding principle – God remains sovereign even as the whole world reels in pain, whether through sickness, wars, calamities or man’s cruelty to man.

For those who suffer silently in pain, the Lord God is a Great Resource of strength, comfort and hope: ‘The eternal God is your refuge and underneath are the everlasting arms’ (Deuteronomy 33:27).

He will help his children weather the storm of pain with patience and courage, through his own sufficient grace and comfort. One day there will be no more pain in heaven where we will ever be with the Lord (Revelation 21:4).

Dr Low Tut Choon