People in pain live in a land where those without pain have no frame of reference. Moments of relief can quickly be followed by the fear of pain’s return.

Chronic pain often brings mental and emotional suffering that can make it difficult to focus on anything else or to experience joy. Anger, worry, sadness, grief, powerlessness and hopelessness are common and can feel overwhelming. Practicing mindfulness helps reduce these feelings by reminding us we are not powerless and making us more aware of how our bodies react to pain. Through mindfulness we can achieve a state of peace and well-being, even in the midst of pain.

WHAT IS MINDFULNESS?

Mindfulness is awareness of present-moment experience with non-judgment. Present-moment experience unfolds through sensations in the body, feelings in the heart and thoughts in the mind. Mindfulness is paying a particular kind of attention to present-moment experience without judgment and with acceptance.

By acceptance, we mean adopting an attitude of “This is happening. Now what?” as opposed to wanting things to be other than they are or standing still and asking, “Why me?”, both of which can increase feelings of suffering. By asking “Now what?” we are indicating our readiness to move forward, to be fully alive again.

Through practicing mindfulness, we can train our brains and minds to focus on what we choose rather than allowing our attention and emotions to be controlled by the sensations, feelings and thoughts related to pain.

THE MIND-BODY REACTION TO PAIN

Some theories of pain suggest that the brain and body’s reaction to pain is similar to their reaction to stress; our bodies and brains can become stuck in a state of chronic over-reactivity to pain. This complex system of reaction is theorized to involve the neural, endocrine and immune systems, so when the accompanying thoughts and feelings involved in the mind-body’s complex reaction to pain are set in motion, anxiety and depression can result.

Research indicates that we may be able to decrease our body’s reactivity to pain by practicing mindfulness. Training the brain to reduce perceived danger can help reduce pain signals. As we learn to stop reacting to pain with anxious, fearful and hopeless thoughts, we reinforce messages to the brain that we are safe and don’t need it to continue sending constant pain signals in our body.

When our muscles and mind relax, we can become more aware of sensations other than pain.

TURNING TOWARD OUR EXPERIENCE: JUDGING MIND

The mind tends to judge experiences as good/pleasant, bad/unpleasant, or neutral. When something is pleasant (eating chocolate, for example), we typically react by attempting to cling to it and becoming consumed by thoughts about how to get more.

When the mind judges something as unpleasant (physical pain, uncomfortable thoughts or emotions), we try to avoid the experience by replacing it with other activities (overmedicating, overdrinking, oversleeping, overeating, etc.), which increases our suffering. We can reduce or even eliminate our suffering by learning to accept the moment as it is, without judging it.

BEING IN THE MOMENT; MINDFULNESS OF BREATH

Training our minds can begin by practicing being in the present moment without judgment, using Mindfulness of Breath.

Mindfulness of Breath practice involves getting into a posture that allows us to be relaxed but alert — sitting in a chair, cross-legged on a pillow or lying down — and turning our attention to the breath, the rise of the chest and belly with the inhale and the fall of the chest and belly with the exhale.

The mind will invariably wander; this is what minds do. The practice is simply to notice when the mind wanders, note silently to yourself, “Wandering,” and bring the attention back to the breath. This is the practice, over and over again. Try practicing this two to five minutes per day, and gradually increase the time if it feels useful for you to continue.

Mindfulness of Breath practice trains the attention to stay focused and to switch attention from one object to another. As we grow more skilled in this formal practice, we can utilize it in everyday life to notice when our mind wanders to the sensations of pain or to worried or hopeless thoughts. We can observe this pattern with compassion and then bring the attention back to the breath. Indulging in worried and hopeless thoughts is self-destructive.

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LET IT GO: FROM BREATH TO OBJECTIVE WITNESS

The practice of attending to breath can be expanded to include an awareness of dominant sensations, feelings or thoughts. Can you observe your experience from the perspective of an objective witness, with an attitude of interest and compassion? We’re accustomed to reacting to our experience by catastrophizing it, wanting it to be different or judging it — and ourselves. We often attempt to either change it or escape from it. By observing our experience, we’re simply allowing it, noticing it with interest and compassion and not reacting to it. If whatever arises feels like too much, simply let it go and return the attention to the breath.

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Assessment

When Mary began Individual Mindfulness training, she was experiencing severe chronic pain from sciatica and a herniated disc. She felt consumed by pain, anxiety, depression and insomnia and was in bed much of the time due to the pain. When I asked what brought her a sense of joy, she reported that she wasn’t currently experiencing any joy or positive feelings.

After reviewing Mary’s lifestyle, we discussed options for improving her well-being, including getting adequate sleep, eating healthily, drinking adequate water, reducing stress and engaging in gentle and mindful movement.

Mindful Practice

We then moved to mindfulness meditation practices, including Mindfulness of Breath, as well as specific practices for being mindful of sensations in the body and practices for working with difficult thoughts and difficult feelings. Mary learned how to become less reactive to pain by practicing non-judgment, acceptance and other mindfulness attitudes.

Cultivating Joy, Taking in the Good

As Mary began to experience periods of pain relief, we introduced meditation practices for cultivating joy and other positive emotions. We started with the practice of Taking in the Good (attributed to meditation teacher Rick Hanson), which involves engaging with something that feels good and brings you pleasure, however simple. It could be noticing a beautiful blue sky, feeling the sensation of wind on your skin or tasting your favorite food. Once you’re engaged in the pleasurable experience, pause to notice how it feels in your body, heart and mind to be in this experience. Allow yourself to simultaneously be in this good experience and take it in, absorbing the good feelings into your body, heart and mind so that the experience solidifies in your memory. Then recall the experience several times throughout the day.

Because Mary enjoyed being outside and listening to the birds, I suggested that she start the Taking in the Good practice with enjoying looking at the brilliant blue sky and listening to bird-song in her yard.

Finding & Focusing on Joy

Within several weeks, Mary reported she was finding moments of joy in the simple things throughout her days, such as watching birds build a nest, noticing the beauty of trees, taking a walk in the woods, receiving kisses from her dog. She reported that the more she noticed and appreciated these small moments, the more she experienced joy and happiness throughout her entire day. I reminded Mary that whatever we focus our attention on will grow.

At the end of the six-week mindfulness training, Mary reported that her pain was significantly reduced, with only a few brief episodes of minor pain. When they did arise, she felt better able to cope and felt she no longer reacted to them with fear and anxiety but met them with relaxation. Mary was able to resume most of her regular activities with the exception of lifting heavy objects. Her insomnia and feelings of depression had resolved, and she felt that her life was returning to normal.

Mary’s story illustrates how mindfulness can reduce pain, anxiety and depression and increase our ability to cope with residual pain.

mindfulness4Pain is a part of life, but we can decrease the suffering by meeting the pain with acceptance and compassion and by creating experiences of positive emotion that bring joy to our lives. Mindfulness meditation is being present with and turning toward all of our experience, with non-judgment, non-reactivity and compassion. Using mindfulness, we can learn to be less reactive to difficult sensations, feelings and thoughts and learn to respond to or accept them instead.

LETTING POSITIVE EMOTIONS SINK IN

Our brains have a negativity bias, which means that when we experience difficulty, we focus our attention there, so the brain develops a clear memory of it. But when we experience positive emotions or experiences, we tend to gloss over them, and they don’t make it into our long-term memory. Therefore, in periods of difficulty, it’s easy to feel consumed by the pain and suffering and feel like nothing is good.

We can cultivate positive emotions by deeply experiencing what brings us joy and pausing to reflect on the experience so it makes it into our long-term memory. {PP}

References

Chapman, C. R., R. P. Tuckett and C. Woo Song.2008. Pain and stress in a systems perspective: Reciprocal neural, endocrine, and immuneinteractions. The Journal of Pain. 9:122-145.

Frederickson, B. L., M. A. Cohn, L. A. Coffey, J. Pek and S.M. Finkel. 2008. Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. Journal of Personality and Social Psychology 95:1045-1062.

Grant, J. A., and P. Rainville. Pain sensitivity and analgesic effects of mindful states in Zen meditators. 2009. Psychosomatic Medicine. 71(1): 106-114.

Zeidan, F., J. A. Grant, C. A. Brown, J. G. McHaffie and R. C. Coghill. 2013. Mindfulness meditation-related pain relief: Evidence forunique brain mechanisms in the regulation of pain. Neuroscience Letters 520(2):165-173.