By Linda Dickey
By now, everyone’s heard about the opioid problem. There’s no reason to repeat the statistics. Addiction rates and overdose deaths are shockingly high, and we know that prescribed drugs are implicated in thousands of cases. That’s why responsible doctors and many hospitals have made a strong effort to stop overprescribing the drugs. Dosage tapering is mandated, prescribing rates are tracked, and monitoring of staff is continuous.
Also, since it has been well established that pain has an emotional-psychological aspect, many hospitals now offer alternative modalities, such as cognitive behavioral therapy and other kinds of psychological therapy for chronic pain problems. I would argue that chaplain visits are making a difference, too.
It’s not surprising that many of our patients are concerned. I know next to nothing about the medicine part of dealing with pain. But I do know this: Patients are worried about addiction and dependence. Some have a family member who’s addicted to something—and they know there’s a genetic aspect to addiction. Or their worry is more global. They’ve come to the hospital to address a painful condition, and what they really want is for pain to end as a result of the treatment. They certainly don’t want to substitute one kind of pain with another that’s possibly worse: the pain of addiction that can lead to death.
In the last 10 years, I have visited many, many patients in a variety of settings—in hospice, in a VA hospital, in a cancer hospital, in a nursing home, and where I work now. Only twice have I visited patients whose pain was truly near or at a 10. I think I know what that’s like; I had appendicitis this year. My pain was near a 10. I couldn’t really talk or think — let alone walk — while it was going on. It held all of my consciousness while it lasted. That level of pain, which obliterates you, deserves as powerful a medication as possible.
For less extreme pain, chaplains have tools that can ease anxiety, like meditation, which most chaplains can teach patients quickly and easily. And we offer distraction. Think of the well-known selective-attention test in which subjects in a psychological experiment are asked to view a video and count how many players in white pass a basketball. Many of those who concentrate on this task entirely fail to notice a gorilla walking on the court. (You can see the original video here.) Pain can be the gorilla. Distraction can be an effective pain medicine — and it has no side effects.
Obviously, chaplains will gladly pray with patients who wish it. Many find that prayer helps, especially when the patient asks us to pray for others. Prayer also changes the subject by focusing the patient’s attention on his or her relationship with God.
To those who believe the correct theological response to pain is to deny it, or that it is God’s deliberate way of teaching us a deserved lesson, I want to say no! Patients may tell us about how others have it worse, and we can surely acknowledge this truth. But Jesus doesn’t ever tell people that suffering makes them better. He doesn’t say suck it up; make your upper lip stiff. He never says don’t complain, be stoic. In his Good Samaritan parable, the Samaritan treats the robber’s victim with oil and wine (medicines of the day). Healing people’s pain is what we want to do.
Some Catholics have a practice of “offering it up,” discussed elsewhere in this issue — and that idea is also in our toolkit. A fellow chaplain told me about her experience of offering up her pain from a late miscarriage for someone she knew who was suffering from terminal cancer. She said she didn’t know how the process worked, or even exactly what offering her own suffering for that of another person meant, but, she said, it seemed to give her pain meaning and purpose — which chaplains know all about.
I hope that chaplains will undertake research studies to demonstrate our value as part of the medical team in addressing pain. If we can prove that we add value without any risk of addiction — and I don’t think it will be hard to prove — we’ll be part of the solution to the problem of pain.
Linda Dickey, BCC, is a per diem chaplain at a hospital in New York City.