By Kiran Tamirisa
As a physician specializing in pain management, I have seen many patients react in many different ways to their conditions. Physical pain all too often leads to emotional or spiritual pain. But although they can be closely tangled together, they can be separated. As the Indian mystic poet Rabindranath Tagore (1861-1941) said, “Let me not beg for the stilling of my pain but for the heart to conquer it.”
We can define pain as “an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage or described in such terms.” A key feature of this definition is that it goes on to say, “pain is always subjective.”
One can classify pain as acute and chronic. Acute pain is generally associated with an injury, is sudden in onset, and resolves once the cause is treated. It responds well to several treatment modalities. Chronic pain may or may not be associated with injury or disease and usually persists after the cause has resolved and is unresponsive to treatments. Acute pain tends to have a sharp, intense quality and may serve as a warning sign that your body is threatened — for example, fracture of a bone.
In pain transmission, a mechanical injury releases chemicals that create electric energy at nerve endings. Electrical stimulus is then transmitted to the spinal cord by peripheral nerves, which connect to second-order nerves that carry the pain stimulus to the lower centers in brain called the thalamus. From the thalamus, the nerves connect to centers in the cerebral cortex that interpret the pain like sharp, dull, burning, etc. Also, some nerve fibers are connected to the limbic system, which controls our emotions. Thus, a pain stimulus can alter one’s emotions. From here the nerves travel down the spinal cord, connect to the pain centers there, and influence pain transmission. Thus, emotions can also affect the pain. Therefore the main control of the pain transmission is in the spinal cord.
I compare the spinal cord to an equalizer of a public address system, where several connections are made from the input and output and can change the sound. Similarly, the spinal cord modifies pain and changes its character and intensity. We understand now that by controlling the brain, we are able to change the way we can perceive the pain. Also, nerves and their connections change constantly depending upon their inputs. Religion and spirituality can influence inputs from the brain and alter the way pain is transmitted in the spinal cord and thus play an important role in the experience of pain.
Although some people use “religion” and “spirituality” interchangeably, they are different. Religion is a set of practices and beliefs and involves a relationship with a god. Spirituality is the experience of connectedness, meaning and purpose in life and integrating aspects of self, which may or may not involve relation with God. Spirituality gives individual autonomy with one’s own interpretation of the soul.
Both spirituality and religion, with their many common elements, can influence lifestyle, attitudes, and feelings about pain and death. Religion can help people live more profound lives as well as strengthen or console people during suffering and in preparation for the inevitable consequence of illness by providing a meaning to life and death. Religion can supply family and healthcare professionals with a sense of strength, security and faith during the times of need like a flashlight showing the path in darkness.
Spirituality is a personal understanding of the principles of religion. Healthcare providers with this understanding can help realize how and why the patients perceive and express their pain, and they can help with the healing of pain.
In my Hindu tradition, suffering and pain are seen as a consequence of one’s inappropriate actions during this life or a previous life. It is not seen as a punishment, but as a consequence of previous actions (something very similar to a loan from the bank!) Hindu traditions promote coping with suffering by accepting it as just a consequence and understanding that suffering is not random. Hindu religion distinguishes between the body and the soul. While the physical body can feel the pain and suffering, the soul does not. As the soul is not affected, there need be no concern over temporary suffering. Patients may gain comfort by viewing the pain as only a temporary condition and one that does not affect their inner Self.
Suffering is thought to be a part of the unfolding of karma and a consequence of past inappropriate action. Suffering is also inherent in the cycles of living and rebirth. Hindu traditions promote the acceptance of suffering as being a just consequence under the laws of karma; the realization that suffering is transitory while in this world, and not affecting one’s true Self; and the view that suffering is not solely negative.
In essence, pain is an emotional response to stimulus. Many factors — social, familial, cultural, psychological, spiritual — can alter this response. Emotional stress like depression and anxiety may aggravate the response to the pain. On the other hand, pain can lead to depression and anxiety. Chronic pain, leading to depression, which in turn leads to increased pain, creates an unhealthy cycle. Therefore, healthcare professionals should address not only biological pain but also the psychological and social needs of the patient to treat the patient holistically.
Also, pain sufferers who are both religious and spiritual are likely to have a better psychological well-being, positive strategies and better health.
Spirituality-based strategies are commonly used to cope with chronic pain. Many chronic pain patients use religious and/or spiritual forms of coping such as prayer and spiritual support to cope with their pain. Some researchers have found that some types of religious and/or spiritual coping are adaptive, while other types are maladaptive. Positive coping includes collaborative problem-solving with God, helping others in need, and seeking spiritual support from the community and from a higher power. Negative coping includes deferring all responsibility to God, feeling abandoned by God, and blaming God for difficulties. Positive coping results in improved well-being and fewer symptoms of depression and anxiety.
Abundant literature speaks to the importance of religion and spirituality in treating chronic pain. These coping techniques should be tailored according to the individual. This is not in lieu of regular treatment but in addition to it.
Sometimes people doubt how spirituality and religion can alter pain perception. The way I explain is by comparing it to sunglasses — which do not alter the sunlight, but do alter the way we see it, making it comfortable to our eyes. Similarly, spirituality and religion change the pain perception and assist to cope with it with less suffering. Pain is inevitable; suffering is optional.
Kiran Tamirisa, MD, is a pain specialist at Mercy Health in Oregon, OH.