Turning towards your pain

It’s been another week on the new eating plan, and my knee pain is still absent.  I am becoming increasingly convinced that the connection is inflammation (or, more accurately, lack thereof).  We will see how things develop as rowing season begins in ernest in the Seattle area.  (Lately, the weather has been too cold and miserable for fair weather rowers like me to venture onto the water.)

Diet is not a panacea for all types of pain, to be sure.  Today, I will offer some perspectives on how to live successfully with pain that does not remit so easily.

As discussed in the previous blog post, Pain, our BFF,  pain is an inevitable part of the human condition.  And for many of us, pain becomes chronic at various points in our lives.

When pain is chronic, we often create an inner dialogue about what we are experiencing.  “I am so out of shape, it’s no wonder I threw out my back.”  “Maybe something is really wrong that the doctors have missed.”  “I don’t know how much more of this pain I can take.”

Emotions also are often overlaid onto pain.  Sadness, fear, and my specialty, anger, are common responses.

So pain becomes more than pain.  It turns into the sensory experience plus the running inner dialogue plus the negative emotions.  No wonder we find it so exhausting!

What is the solution?  In the words of Jon Kabat-Zinn, founder of the Mindfulness Based Stress Reduction program, you need to “put out the welcome mat” for your pain.  Not because you’re masochistic, but because your pain is already there.  You might not like your pain, but learning to accept its presence (because it’s already there) is the first step in disentangling your sensory experience from all the negative thoughts and emotions.

Try this.  The next time you have pain, find a quiet place to sit or lie for a few minutes.  Take a few breaths to center yourself and quiet your mind.  Next, turn your attention to the area of your body where you are experiencing the pain.  As objectively as possible, observe the pain you are experiencing.  First, try to identify its precise location.  Where exactly in your body do you feel the pain?  Zoom your attention to its center.  Next, try to identify its borders.  Where does the boundary lie between pain and no pain?  Does this boundary change with time?

After you have located your pain, turn your attention to its qualities.  Is it dull or sharp?  Steady or throbbing?  Do its qualities change over time?  Go inside your pain.  Observe it moment by moment, staying non-judgemental all the while.  Think of yourself as a scientist or an explorer of the inner world of your pain.

Stay with your pain for a few minutes more, observing its location and qualities as they unfold over time.  You will probably find that your pain is not static, but rather dynamic, transforming in character and intensity even within the few minutes of this exercise.      

According to Jon Kabat-Zinn, if you move into pure awareness in the midst of pain, even for the tiniest moment, your relationship with your pain is going to shift right in that very moment.  By seeing the pain for what it really is, stripped of the negative thoughts and feelings that usually accompany it, it becomes immediately more manageable, more livable.  The sensory experience of pain might still be present, but the suffering is diminished.  Directing conscious attention towards softening and releasing the area of pain (even by the tiniest fraction) in these moments often brings additional benefits.

Some people resist trying this exercise. The notion of paying attention to the very thing that causes them so much suffering seems overwhelming at first.  This response is understandable: humans have a natural tendency to push away from their pain.  This exercise, in contrast, calls for the exact opposite response.  It invites people to get close to your pain, indeed, to inhabit their pain and recognize it for its true nature in that moment.

What does the evidence say?  A recent study found that participants in a single session of a mindfulness-based body scan reported less pain related distress and less interference of pain on social relations, compared with matched controls who did not participate.  A different systematic review of the effects of Mindfulness Based Stress Reduction interventions on chronic low back pain revealed similar and interesting results. Pain intensity did not decrease consistently as a result of the interventions, but pain acceptance did.  My reading of this evidence is that exercises similar to that described above do not necessarily reduce pain, but they do help people suffer less.  In the words of the Dalai Lama, "Pain is inevitable, suffering is optional."

Resources

Mindfulness Based Stress Reduction program website: http://www.umassmed.edu/cfm/stress/index.aspx

Audio clip and transcript from NPR entitled Meditation a Hit for Pain Management (2007): link

A book that changed my life: Jon Kabat-Zinn. Full catastrophe living: using the wisdom of your body and mind to face stress, pain, and illness. New York, Dell Publishing, 1990.  Amazon link

Research cited in this post:      

Ussher M, Spatz A, Copland C, Nicolaou A, Cargill A, Amini-Tabrizi N, McCracken LM. Immediate effects of a brief mindfulness-based body scan on patients with chronic pain. J Behav Med. 2012 Nov 6.

Cramer H, Haller H, Lauche R, Dobos G. Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complement Altern Med. 2012 Sep 25;12:162.