Statistically, chronic pain affects 1 in 5 people today. But what can be done about it? To address the issue, The Pain Book: Finding Hope when it Hurts was recently released by HammondPress. Written by three medical experts working with people in pain, it addresses what pain is, and how people in pain can take simple, practical steps towards reducing pain and its impact. Eternity spoke to one of the authors, Dr Philip Siddall.

Q: So where did the book come from?

Well, it’s written by three of us who are clinicians at the pain clinic at Greenwich Hospital. So myself, I’m a pain specialist, I’ve been working at Royal North Shore Hospital and Royal Prince Alfred Hospital for about thirty years in total, Rebecca McCabe who’s a physiotherapist, very experienced in hospitals and private practice, and Robin Murray who is a clinical psychologist.

We’ve all had experience dealing with people with chronic pain for quite a long time. And we felt that there’s a need for a book written for people with chronic pain, in plain language, but covering the latest that we know of how pain works, understanding pain, being able to control pain, and also providing some skills for pain management. Some very basic things help physically, like relaxation, stretching, exercise, but also looking at other things, like meditation.

Finally, there are books around that cover skills or tools or strategies with managing pain but we also talk about courage and hope and gratitude, which most other books don’t talk about. We just know that they’re important qualities in people who deal very well with pain.

With our experience, we’ve seen people who’ve come through dealing with things such as spinal cord injuries. And seeing people who have dealt very well with it and these are the sort of qualities that you see. They hang on to courage, and they show hope, so I suppose we’re trying to say, ‘How can we get those qualities?’

It’s written for people living with chronic pain, although it would also be helpful for health professionals, and also for carers.

Q: This might be a strange question, but what is pain?

It’s an important question, even though it’s the sort of thing we all experience. There are two main types of pain

Acute pain is what we all experience with, for example, a fracture or a kidney stone. It’s really a warning system within the body, which warns us that there is some sort of damage going on, and needs to be repaired. In a sense, acute pain is great—it’s got a very important protective role.

Chronic pain, by definition, is pain that’s been around longer than three to six months, and chronic pain feels just the same, but the difficulty is that it no longer serves that sort of protective function. Because of changes in the nervous system, we still experience pain, even though what caused it originally may have settled down. Not to say it’s gone away, there may be arthritis in a joint, or nerve damage, but with chronic pain, the whole experience of pain sort of grows. Not only in terms of intensity, but in its impact physically, emotionally; so those feelings of depression, frustration, irritation grow. And even at a deeper level, some people can lose their sense of hope, their sense of meaning, their sense of purpose. And that’s really what people find difficult in chronic pain.

Q: Is there a way we usually misunderstand what pain is?

I think one of the misunderstandings, particularly with chronic pain, is this division between ‘it’s real’ or ‘it’s psychological’. Particularly for people who have pain and see health professionals, they might hear, “I can’t see a lot on your x-rays and your scans.” And the automatic assumption is that the person in pain just thinks, ‘It’s in my head’.

Similarly, when they’re dealing with pain, unless they have something visible, they can feel they’re treated in the same way. They sometimes say, “I wish people could see what was going on.” They don’t have this broken leg or this huge scar. The pain is terrible, but people don’t seem to appreciate what’s going on. They feel people are judging: “Well, they look alright … why are they always needing to take time off work? Why are they needing to rest, or take medication?”

Q: How can most people then better support those suffering from chronic pain?

This may sound very basic, but just listening to and believing people who are describing pain. Sometimes people say pain is as simple as what hurts, or what I’m going through. And rather than people thinking they need to justify themselves, somebody listening and hearing what somebody is going through is a tremendous thing. It’s as simple as that, saying, “What have you been going through? How has it been affecting you?”

Particularly for somebody who has been going through a difficult time, there’s practical things like giving them a lift, helping them to the shops, meals. Just asking them, “Is there anything I can do to help you practically?”

And emotionally supporting people and saying, if we’re talking about a Christian context, “I’ll pray for you.” I know sometimes it can be used as a bit of a brushoff but I think people appreciate it when people say that and then come back next week and say, “How are you going? How was this week?”

Q: So in the book, you talk about learning things like courage. So going into this, your mentality is that it’s not just that somebody’s a positive person and somebody else is a negative person but these techniques can be learnt?

That’s right, and I think sometimes that’s a feeling out there … Like some people have more courage in their genes or something. We also talk about gratitude and people think some are naturally more thankful. To a certain extent, there are people who seem to ooze those sort of qualities but I think the important thing that we’re saying in the program is that these things can be learnt as well.

There are some things, some very simple skills and tools and strategies that we can do that help to build that part of our life. Even the wussiest amongst us can become courageous. Even the most pessimistic can be thankful just by changing what we do and learning some simple skills.

Q: Are there particular stories that come to mind of people who’ve learnt to deal with pain through these techniques?

One person that springs to mind has been through a number of operations, hip operations, and during her most recent hospitalisation, ended up in intensive care, because the pain was just so difficult to manage. By the time we saw her, she’d had pain for a number of years, she was on a high dose of a strong painkiller, and that was having other effects on her life. She’d had to stop work, she was finding it difficult to go out and do things and see friends. Her life was very restricted, and she was becoming quite depressed.

She went through our program, learnt some of these things that we’ve talked about, learnt some of these techniques, relaxation, meditation. During the program, she found out that she needed another operation, and she was really fearful. She knew about her last experience and was very concerned about her ability to cope.

Both during and after, using these sort of skills, firstly, she felt more confident going in. She managed to reduce her painkillers before she went into the operation. And then she came out and she was out within a few days. There was no need for heavy painkillers or intensive care after her operation. She was just amazed that the things she learnt during the program did give her courage, did give her more confidence, took away some of her anxieties, and she’s gone on further since then. She’s cut out her painkillers completely.

She’s doing all of those things—exercise, started fitness classes, gone back to work—she’s just a great example, that once people learn these things, it gives them a huge amount of confidence in feeling like ‘I do have some things I can do, I’m not completely reliant on my medication’.

Q: As a Christian pain specialist, how does being a Christian affect your work?

I think particularly in dealing with pain as a professional, I have a relationship with God that supports the way that I try to help others. And I think that’s an important part, to me, of being able to care for people. Particularly to those who are Christians, being able to talk through those issues, and what a relationship with God means for them in terms of dealing with their pain, that’s not always an easy one of course.

For some people, it’s that constant issue of the problem of pain, as C.S. Lewis wrote. For people with chronic pain, saying, “Why is God allowing this to happen? Why am I in continual pain? It just doesn’t seem to serve any function. I wish I could do the things I wanted to. It’s disturbing my relationships with my kids, my family, my parents.” For some people, it’s things like ministry – they’d love to be able to do more at church, but the pain is stopping them.

I try to deal with those things in a sensitive way, and not to offer easy explanations as to why it might be happening. We tend to say, “This is the reason why you might be in pain”, which is often very difficult for other people. I think the great encouragement as a Christian is, while you never want to suggest that pain is a good thing, knowing that the Bible constantly talks about pain and suffering as something that strengthens us. Thinking about those words of Paul – “My grace is sufficient for you” – and he talks about the thorn in the flesh and wanting it to be taken away, and he says, “My strength is made perfect in weakness.” [2 Cor 12:9] I think for Christians, pain is an opportunity to grow closer and stronger with God.

I know I’ve seen people who have faced suffering, and there is something about them—there’s a depth, an understanding, a compassion, a strength—that has only come out of those times where they’ve been through. I certainly think that’s the hope for us as Christians, that God can support us in those times, and we can emerge stronger because of that relationship.

Q: Would you go so far to say that Christians have a better way of dealing with pain than non-Christians?

It doesn’t seem to be faith in itself that necessarily makes a difference, but it’s the sort of faith we have. So it’s not faith itself that guarantees that we’re going to deal better in terms of pain, but the opportunity is there. In terms of our relationship with God – I think that provides the opportunity to deal well with pain, but it’s dependent on that relationship.

If we see God as one who cares for us, who loves us, who supports us, in our weakness, and listens to us in our pain, then people tend to do better. For some people who see God as judgemental, and that the pain may be because they’ve done something wrong or because God is angry at them, they actually do worse in terms of dealing with their pain. It’s not quite as simple as if you have faith, you do better, but what’s the nature of that faith.

Q: Lastly, do you have a favourite verse that sustains you in your work?

Psalm 23 is a great favourite of mine. “Even though I walk through the valley of the shadow of death …” I love that image of no matter what we go through, that God is there, and God is with us. Particularly when we’re talking about pain, that’s one that springs to mind. God is with us in those things – that’s one of the things that sustains me.