Pain and Mindfulness

The origins of using mindfulness to treat pain

The origin of using mindfulness as a treatment for pain goes way back to a talk that Buddha gave some 2,500 years ago. Out of many things that the Buddha talked about in his 84 long years on this earth, one thing in particular that can be used to help people understand and work through pain, and really any uncomfortable situation that life throws at us. It is how we interact with the world – our responses and our habits related to pain. What the Buddha talked about was that when we feel something uncomfortable or painful, there are these two arrows that hit us. The first arrow is the initial sensation. It’s that initial feeling of ache of pain, the initial uncomfortable sensation that just registers in our nervous system. But what is more interesting is the second arrow. The second arrow that arrives is what he calls a mental one. One amplifies the evaluation of the original arrow. It’s that sort of unpleasantness that we report when we feel something like back pain, when we feel something like tendon pain, whatever it is that we’re seeing our physio for, or complaining to our doctor about. It’s not the pain itself necessarily that’s the problem but the unpleasantness of it, and the intrusiveness of it.

Reducing the unpleasantness of pain

We deal with pain on a daily basis, and without it we can’t as a species survive. But when we do things like take medication, or go see a Physio, or even something more extreme like getting surgery, our overall goal is to reduce the unpleasantness. And what mindfulness can do is give us an opportunity to reduce that unpleasantness. It’s an opportunity to get a foot in the door to a habitual process that normally most of us wouldn’t have even considered happening. Here’s an analogy. You’ve got a guitar and you’re playing it on full volume – it’s plugged into a giant amplifier. Now, take that guitar out of the giant amplifier on the concert stage and just hear the original sound of the strings being strummed. We don’t have to plug it into the enormous amps and listen to the volume on 10 in order to hear it. But that’s how some people’s nervous systems are working. They’re amplified at full volume. They’re taking the original pain and turning it up to levels it doesn’t need to be at. So what mindfulness does is that it offers us an opportunity to turn down the volume.

What is mindfulness?

When we refer to mindfulness, what are we actually referring to? Mindfulness is just the capacity to pay attention to something in the present moment, without judgment, and without evaluation. It’s not about focusing on what happened before, or what might happen tomorrow, but on what’s going on in your body right now. Here’s a short exercise for you to try. Stop for a second and focus your mind towards what’s happening to you right now. Try to notice your own heartbeat. How fast or slow is it beating? How hard or soft do those beats feel?  Now try to feel the rise and fall of your chest. How big is the movement? Now, was that challenging or easy?

The three states of being

Buddha talks about this, and researchers still use it to this day. Every moment we’re given sensations that are either of three categories; Pleasant, unpleasant, or neutral. It’s the unpleasant sensations that we’re focused on, because when these unpleasant sensations come in, a domino falls and evaluation starts. You start feeling annoyed and registering your dislike, and often what that does is amplify the original pain. We upregulate our threat response across a wide variety of physiological processes, from hormonal to neurological, where the body upregulates its threat response. What we know from decades of pain research is the greater you perceive the threat, the higher your pain is likely to be.

How can I reduce the unpleasantness of pain?

We know from studies on long-term meditators that compared to the average person who doesn’t meditate, when we put a hot poker on their wrist, the long-term meditators will report a less intense sensation than those who hadn’t been meditating at all. Now that’s great for those who have the time to dedicate to this practice, but what about the rest of us? Research suggests that just one 30 minute session, no more, no less, of meditation can have nearly the same effect on people. So when you’re working with people in a clinical context and they’re in pain, for example they come in with intense back pain, neck pain or shoulder pain, if you can get them to pause and slow down, and have them just pay attention to the sensation (i.e. turn down the guitar volume), then you can start to see a positive change in how they’re perceiving pain. Psychologists do this all the time to change behaviour. Just the mere act of stopping and feeling what’s going on can allow us to distinguish between what is originally there (the first arrow) and what we might be amplifying (the second arrow).  Now, mindfulness and meditation are two different things. And being mindful in everyday life can have great effects on pain. Whereas meditation is this isolated practice, mindfulness can be drawn out from like a concentrate out of a juice and given to people in whatever context they prefer.

How can I be more mindful?

Initially it takes a bit of practice to be more mindful, and there are a variety of ways to do it. You can be mindful in any context as long as you’re paying attention to the present moment in a non-judgemental, non-elaborative way. You may me mindful:

• When you’re walking
• While you’re working
• When you’re watching TV
• When you’re playing sports
• When you’re talking with someone

Here’s an example… Jenny, 60 year old, likes walking her dog, so she pays attention to the sense of her body moving in space as a way of down-regulating her pain. It’s that simple.

How effective is mindfulness in treating pain?

Mindfulness has been proven to be more effective than opioids. Let that one sink it. We know that mindfulness can help reduce pain in just a 30 minute session, and we know that in the long-term this has positive impacts on people’s intensity of pain, and unpleasantness. Which, flows through to improving how much they participate in their life. They get to do more of the things they love doing and it connects them back to a sense of what’s important to them. Which is the whole point of physio.

Conclusion? Pain is a reality, but suffering is not.

When we feel a sensation, when we feel a pain, there’s a tendency for us to inflame it, to exaggerate it, and to make it worse. This is often an unconscious action and just a part of how our nervous system has evolved to protect us. But we have an opportunity that doesn’t require years of practice, and that takes just 30 minutes to slow down, pay attention, and learn how to separate the judgment on what we’re feeling in the moment, to just feel it. Because it’s inescapable. Unfortunately we think we can escape from these things, but the hard truth is that pain is a reality, but suffering perhaps is not.