Pastoral Care for Pain Patients in Palliative Care

Pain is a complex and very personal topic and yet it is part of the general human experience. Each one of us has our own stories of how we experienced pain at different ages and in different situations – and how we responded to that pain from within. Again and again, we were able to find a way to deal with it.

A lot of circumspection is required when accompanying pain patients – it is important to give them the freedom to decide how much pain is tolerable and where a limit has been reached. Pain leads to borderline experiences, to the acknowledgement of certain boundaries. In order to face up to pain it is important to first relieve the patient of the fear that they will have to endure unbearable torments. Pain treatment is possible without clouding consciousness today. Likewise, pain does not have to pose a threat in the dying phase, which is a common fear. Our task is to take the standpoint of the sufferer as much as possible and to empathize with how she wants to position herself in this borderline experience. 

So, when a pastor is called in, he or she is above all a companion. His or her goal will be to take seriously the suffering person’s pain, worries and fears and, above all, not to leave the patient alone. Experience teaches that sometimes even warm, awake listening and compassion can bring relief. The pain can then be expressed in words, communicated in the best possible way and a solution can be found together. However, it will always be the patient who sets the direction in which we should look together.

Physical, mental and spiritual pain 

The question of the meaning of pain often arises in this process. Sometimes people suspect that pain simultaneously bears a message within it and that also it requires great courage and strength to not give up. It takes trust to hold space that an answer will come.

We can encounter pain on all levels: corporeal, mental and spiritual. Wherever it occurs, pain disturbs wholeness and meaningful order. This is true whether I am physically hurt, experience separation from a loved one, or suffer failure regarding a life task. These are three doors through which pain can come into our lives and which may evoke heightened, super-awake consciousness.

From birth onwards, many developmental steps in life are accompanied by pain. Here we can ask ourselves the question of what wants to be wrested from us, what needs to change. Physically this can lead to a confrontation with myself and in the best case – when I succeed in mastering or overcoming the pain – to an increase in my own strength. Mental pain can be escaped by learning to love more and more selflessly. Spiritual pain can ultimately lead to a very personal insight or truth.

People have experienced again and again how pain can become a signpost, an aid to birth and development, helping them to attain new goals that they set themselves. For example, Adalbert Stifter wrote to Gustav Heckenast about his experience with depression, which afflicted him repeatedly: “I won’t give up the pain because I would have to give up the divine as well.” First, any pain throws us back on ourselves and isolates us. But when we can consciously bear pain, we can become more compassionate, even able to build more community and be open. That is probably what Stifter meant by the “divine.”

Pain from a Christian point of view

Dealing with pain plays a role in all religions. From a Christian point of view there is the one who, as the Son of God, did not avoid pain during his incarnation and, as a brother to human beings, accepted and suffered a sorrowful death in order to become truly human, with all that human experience entails, and to achieve salvation using human strength. Basically, from this point of view, everything we encounter on earth – even pain and death – can be searched for meaning and the question of meaning can be both posed and positively answered. The mere confidence that perhaps, in the future, we will be able to comprehend this meaning may provide comfort. The theologian Friedrich Rittelmeyer, who had to endure long stretches of pain in his life, wrote: “What suffering can bring us is always more than what suffering can take away from us. The high art is to face suffering in such a way that it brings us the greatest blessing, which is hidden in it alone.” (1) The fact that someone with such a personal knowledge of suffering would speak here of a ‘high art’ of suffering points to a long path of practice which must be followed to achieve.

A different voice on pain, similarly accomplished through his own experiences, is that of the neurologist and psychiatrist Viktor Frankl, who summed up something Nietzsche said, shedding light on the fact that each person’s handling of suffering and pain is very individual: “Anyone who has a Why to live can stand almost any How”. (2) Here, too, the “how” of being able to bear pain involves experiencing pain as a wake-up call to the essential, to the “why”. Then suffering can be felt as something that can lead to larger questions and contexts of meaning in life that have not yet been within one’s own sphere of reference.

The poet and writer Joseph von Eichendorff put this struggle with pain into the form of a prayer, which perhaps speaks what is felt in the heart of many a one who is suffering (3, p. 274):

“What I wanted lies smashed,
Lord, I am not lamenting it,
And my heart is still.
But now also give me strength to bear
What I do NOT want.”