Thursday Theology: Good News for Chronic Sufferers

Pain is an enduring feature of the world the Holy Spirit dispatches us to as bearers of Good News. Now and then we’ll meet a person whose pain is great and unrelenting, stretching over years. To speak credibly of God love’s in Christ to someone like this is a daunting challenge that ties all too many tongues. If you know that tongue-tied feeling, you’ll be glad indeed for today’s reflection. The writer, Bruce Modahl, knows more than most about incessant pain and incessant promise. He lives with both every day, as you’ll discover.

Pr. Modahl is the editor of Crossings’ quarterly newsletter and a regular Thursday Theology contributor. He is also the author of The Banality of Grace, released this month by Cascade Books. We urge it on you with thanks to God.

Peace and Joy,

The Crossing Community


Chronic Pain and the Happy Exchange

By Bruce K. Modahl

For some 25 million Americans chronic pain is a daily companion. Acute pain lasts the six months or less for the damaged tissue to heal. Chronic pain goes on long after that and may not even be related to an initial injury or surgery. Chronic pain conditions include failed back, fibromyalgia, post-stroke pain and much more.

I am one among the 25 million. The details I share are particular to me, but the overall experience is common to those with chronic pain.

I had knee surgery and successful rehab for the knee. During the recovery period my back began to hurt. I attributed it to the amount of time I spent lying on my back during recovery. My doctors and I expected a course of physical therapy to rectify the situation.  In the course of the next ten years I had ten sessions of physical therapy, chiropractic treatment, acupuncture, epidurals, countless injections into my lower back, three back surgeries, a surgically implanted pump delivering morphine directly to my spinal canal, and psychotherapy. A variety of specialists prescribed a plethora of medications which brought no relief but did bring garbled speech and fuzzy thinking. Finally, I developed a movement disorder centered in my mouth and jaw which makes speech difficult, to say nothing of preaching. This movement disorder may or may not be a side effect to the medications. It may or may not get better.

I am not critical of the specialists. They were using all the tools known to them to treat pain. The problem is the treatments are effective with acute pain. Acute pain is our warning system that something is amiss. With chronic pain the warning system itself has gone awry.

After these ten years, a neurologist at the Mayo Clinic in Jacksonville, Florida, a son of the congregation I served in River Forest, Illinois, referred me to the Pain Rehabilitation Clinic (PRC) at Mayo. The program lasts three weeks, from 8 am to 5 pm Monday through Friday. The staff includes physical therapists, occupational therapists, medical doctors, psychologists, and nurses. My cohort consisted of 15 people ranging in age from 22 to 83.

In a small-group session an occupational therapist talked to us about goals for our lives. Three of the seven people in the group said they wanted to feel close to God again. Once they had felt close to God. They wanted it again. What caused the rupture in the relationship was clear to me. People with chronic pain live under judgment.

People with chronic pain experience judgment from many sides. Medical professionals grow frustrated when their treatments do not bring relief. A rehab specialist dismissed me when his treatment plan did not work. Another told me the movement disorder was my fault for taking those medications and there was nothing to be done about it. “You don’t need to come back to see me,” he said. More than one person in my group were referred to a psychiatrist. They were told that since there was no organic cause of the pain, it must be in their heads.

Family members may be supportive, but our pain affects their lives. They don’t have to say much for us to take it as judgment upon ourselves. Friends and colleagues wonder when we’ll snap out of it. I lost track of how many people told me, “If you just went to the gym and developed proper core strength you’d get better.” One bishop commented, “What a waste,” when I explained to him why I could not accept an interim ministry assignment and why I retired early. I know he did not mean to be unkind. But it keyed into how I felt. I was a waste.

I rehearse this litany because it is typical for those living with chronic pain. Life as we have known came to a gradual end when the chronic pain started. Then began a restricted life infiltrated with pain. Someone once observed, “When you have a tooth ache, it’s hard to think about anything else.” Many people live with that ache day in and day out.

All of these are but echoes of the only Judge who matters in the end. In my morning devotion I read Psalm 21, “The Lord will swallow them up in his wrath and fire will consume them.” That judgment was personal and has stayed with me, underpinning all other critical words.

The discussion in our small group continued during a break after the session with the OT. One member of the group said, “I try going back to church, but everyone is so judgy. I’m not dressed right. I don’t look right. And I don’t agree with many of the things the church says about women and birth control and divorce and on and on. And the sermons are all ‘do this and don’t do that.’ The preacher goes off on tirades about ‘those people.’ It’s all judgment and I feel bad enough already.” She added, “I do look forward to Eucharist.”

This was a challenge, and I addressed it by pointing out that we sure enough live under judgment. But what is the sign of judgment we Christians live under? People talk about being under a cloud of judgment or under the weight of judgment. But we don’t live under a cloud or weight. The sign of judgment under which we live is the cross.

I pointed out that at the cross Jesus took on the world’s judgment. At the cross he bore God’s judgment on a sinful humanity. He took all that to his grave. In exchange he gave us forgiveness, endless second chances, eternal life, all the inheritance of God the Father’s only Son. And did I mention forgiveness? In the kingdom of God there is no more judgment. The purpose of judgment is to set things right. At the cross God sets everything right.

I told them we call this the Happy Exchange or the Sweet Swap. Many of us know the phrase originates with Luther and the Sweet Swap is Bob Bertram’s whimsical take on it. I did not go into any of the background. I did tell them that the happy exchange is a way we can use Christ. At least once a day we can bring to him all our sorrow and guilt and sadness and give them over to him. He wants them. He takes them to the grave. And he gives us in exchange all of his blessings, which we then can use to bless others. I told them when the sermon is sour we can preach to ourselves. Read the gospel for the day and consider how Jesus takes what is bad and gives good things. And then we go to the altar for the Good Thing that is Jesus’ body and blood in the Lord’s Supper.

By their reaction you would have thought I had just given them a very valuable gift. They asked me to write it out. I did so at home that night and gave it to them the next morning.

+ +  +

People ask how PRC works and the best I can do to describe it in brief fashion is to recount an analogy one of the PRC staff members used. He describes how you bring your toddler into the grocery store and pass the bakery where they are giving out free cookies to children. The child wants one and you consent. The next time in the grocery store the cookies are not free but he wants one. You say no, but he raises his demand for a cookie and you give in. The next time his demand is even louder. So it is every time we treat chronic pain with anything from rubbing the painful area to medical intervention to talking about our symptoms we are reinforcing the already upregulated pain sensors. When you determine to stop the child’s behavior and refuse the cookie there will be an increase in the intensity of the child’s demand. But stick to it and the child will learn he is not getting the cookie. In PRC we learn ways to stop giving cookies, stop reacting to the pain. Little by little the pain decreases in intensity and duration.

After PRC I began a new life. We call it the C life. The A life was before chronic pain; the B life was with it; the C life is after rehab. As with any rehab, it is ongoing. For myself I rejoice that the heating pad is retired to the shelf and all the pain patches were destroyed. The pain pump is soon to be removed and good riddance. I know I’ll never go back to that A life. But, by God’s grace I know my life is not a waste.

Finally, in acknowledgment of the Evangelical Lutheran Church (ELCA), the insurance provided through the church, coupled with Medicare, covered the full cost of the program at the Mayo Clinic. For that I am profoundly grateful.


Thursday Theology: that the benefits of Christ be put to use
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