I heard from Ms. Mensicus again — she received a question from a 50-year-old woman who is in so much pain from her arthritis that it hurts to walk across the room.

The writer tells Ms. M that she finds she is pushing her spouse away, and feels a great deal of guilt that she can’t be the companion she used to be — all because of the pain.

What do we do about pain and guilt?

That’s a good question, and a hard question.

It’s a good question because so many of us deal with this.

It’s a hard question because it has so many facets.

So, what do we do?

Have you explored every avenue to reduce your pain?

Now that may seem heartless or obvious, but I have been with so many people who run out of energy to keep trying. It’s a lot of work to make appointments, go to see the next doctor or health worker, do whatever has to be done. Some medications have icky side effects. And sometimes we don’t do what helps us feel better — exercise, eating right, and taking the medication, to name three basics.

But when you have a disease that brings pain, you have to say “OK, this is now my job. This is my daily work — to take care of myself.” I have seen people who take great care of others, and ignore their own needs for rest, nutrition, and regular appointments with health professionals. They then wonder why they have so much pain.

Put yourself first.

I know — that’s counter-intuitive when we’re dealing with guilt, because we think that putting others first is the way to feel less guilty. But when you have a close friend named PAIN, your needs have to be dealt with.

What do you need in order to function well? You may have to change some of your old habits. You may need an hour to put your legs up before you make dinner. Your shower time may have to be moved around. Others in the family may have to pitch in more — and by the way, that’s good for them.

Making space to take a deep breath, to take your time, to build in flexibility can make a difference in your mental and physical outlook.

Now, you can think about the person you live with and love.

We think that we put the other person first — but when you have a demanding diagnosis and a daily battle, you have to figure out what works for you. Then you have the inner resources to look at the person you live with and love and listen to what their needs and desires are.

Often the guilt we feel is about doing things differently.

It’s less guilt and more about refusing to accept that life is not the same.

Our friends and family may have already accepted that. So we need to catch up, and let them give to us. Receive the love and care they offer.

Refusing that care out of “guilt” is just bad manners, and a desire not to be vulnerable.

Sometimes our family and friends do need us. And we can’t be there the way they want us to be.

There are those times, and they aren’t often, that someone we love does need us, and we don’t feel well enough to respond.

That does feel lousy.

Guilt is an indulgence and an unnecessary hair shirt. (Remember the stories of the heavy, itchy, hair shirts that monks wore under their clothes so they were never comfortable — something was always bothering them? This practice was supposed to make them more conscious of God’s presence. I think that practice really made them feel like martyrs and victims — not to mention cranky.)

Wearing your guilt like a heavy itchy vest is similarly unproductive.

When you have let someone down, all you have to say is “I’m sorry.” Or “I wish it were different and that I felt well enough to really listen to you, or take you to the mall, or go to your holiday office party, or whatever the thing is, but today, I can’t. You know I do love you and I am grateful you are in my life. Thanks for being here.”

Then you let it go.

It’s not your fault for not being able, and it’s not their fault for wanting something from you. It just is the way it is.

If none of this helps, and you still feel lousy with guilt and depression, it’s time to take a bigger step.

We all know that depression goes with pain and this disease. If nothing you do makes you feel any better, get a professional who can listen to you and be with you.

You don’t have to figure it out all by yourself.

There are ministers, rabbis, social workers, nurses, psychologists, and some of us even have sturdy friends who can help us sort through the maze of feelings and worries.

But talk to someone, and if you need a little chemical assist, that’s OK, too.

The main thing is to have a life you want to live. Finding a therapist or joining a group or even taking anti-depression meds can be a short-term effort that leads to a long term payoff. You are worth the effort!