Mindfulness for Pain

Reading time: 6 minutes

This month, Dr Kitty Wheater, Mindfulness Chaplain, delves into the complex world of coping with chronic pain and gives advice on how to manage it with mindfulness.

About ten years ago, I met Vidyamala Burch at a mindfulness conference. Vidyamala is a softly-spoken New Zealander who founded Breathworks, a mindfulness-based programme for living well with pain and illness, over twenty years ago in the north of England. She lives with chronic pain, and is also in a wheelchair, after two spinal injuries in car accidents as a young woman.

I learned two lessons about chronic pain that day. The first was from watching Vidyamala manage her own pain. Every twenty minutes, a timer would go off, and Vidyamala would stand up for a short time because this helped alleviate her pain. Sometimes, if in mid-conversation, she might wait a moment or two before she shifted; but when she stood up and sat down, she did so calmly, without anxiety, and without apology. Her experience had taught her what she needed to know; she trusted that knowledge, and trusted herself.

The second lesson was contained in a short practice that she guided. ‘Notice where in the body feels pleasant,’ she counselled. ‘It could be something very small. The sensations at the backs of the knees, or the contact between the eyelids.’ I had never turned to my own body in this way and deliberately looked for small, ordinary places of ease and comfort. Indeed, when I teach this practice, students and staff often say that it had never occurred to them to look, either.

Because here is the thing about pain: it is evolutionarily designed to loom bigger and bolder than anything else in your perception, whatever else the latter might contain. Our minds are primed to hook onto whatever has a flavour of the unpleasant or difficult, and nothing is more unpleasant or difficult than pain. When we hook on, the field of awareness narrows, so that pain fills it up entirely. In the moment, it feels as if nothing else exists. Chronic pain, when we experience pain constantly over a long period of time, can slowly but surely come to write the story of our lives.

Because evolution has primed every attentive neuron in the nervous system to zero in upon pain, our reaction to pain follows predictable lines. This is the good news: messy, frightening, depressing, and frustrating though pain is, we can start to see clearly how our experience of it plays out through the nervous system reactions of fight, flight, and freeze.

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How the nervous system reacts to pain

We fight pain through fixation. Internally, this will take the form of rumination: worrying and planning. You may notice recurring fixated thoughts: ‘I don’t want this,’ ‘why is this happening’, ‘how can I make this stop,’ and ‘what does this mean’. Externally, you may find yourself running from one potential ‘cure’ to the next; you may spend hours on the internet, researching pain, reading about pain, troubleshooting pain, bouncing the problem off anyone who might listen, trying one hot bath or miracle stretch or massage ball after another.

The ‘fight’ reaction is very understandable from an evolutionary point of view because we experience pain as a threat – particularly because it is right inside us. If there were a lion or a bear attached to your arm or leg or head, you would need to fight it and to do so very quickly. This is why the ‘fight’ reaction is so powerful and so involuntary.

We flee pain through avoidance and denial. We avoid anything that we fear will trigger the pain: movement, stillness, and particular situations. We may even avoid things that are supposed to ‘help’, such as physio or exercise, because engaging in it can activate pain, and remind us that it is still there. We often engage in numbing, whether through the obvious candidates – pills, alcohol – or the sneakier, dopamine-fuelled ones: work, food, sex, video games, Facebook.

Fleeing, like fighting, makes perfect nervous system sense. If we can flee, why wouldn’t we? But the problem with chronic pain is that it is in us, not outside us. When we pause to rest from our flight, the pain is often still there. Moreover, because we have tuned out from the direct experience of pain, we may have pushed ourselves past our current physical limits, incurring pain flare-ups. These are themselves frightening and disorientating and may send us right back into fight mode. Many of us oscillate between the two interminably, but endless cycles of fight and flight may actually tip us into the nastiest of the nervous system reactions to pain: freeze.

We freeze through dissociation and despair. In pain, the body feels like a profoundly unsafe place to be, and so we leave it. In this state, you will find that you are actually less aware of the direct physical experience of pain, but you are highly vulnerable to its emotional load.

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Mindfulness for pain

The fight, flight, and freeze reactions to pain are all based on something very simple: the nervous system’s perception of pain as a threat, on equal footing with a bear, lion or tiger. But chronic pain is not a predator. It is a messenger, the body’s way of speaking. ‘Something’s happening here,’ it’s saying; ‘I think you need to know.’ In the face of strong evolutionary impulses to shut down, run away from, or block out those messages, mindfulness for pain means practising gentle, deliberate, and curious listening.

Here are my ‘three Rs’ for working with pain: Resource, Recognise, and Respond.

1. Resource

In a state of pain takeover, the first step is to begin to broaden perception so that other places in bodily experience – those of neutrality, even pleasance – can become resources and oases of safety for the attention. In pain, the body can become a place that we no longer go; tuning into places of respite and comfort in the body helps us begin to befriend it. We need this, ultimately, to process pain through embodied experience, rather than conceptual overlay.

You can try my nine-minute Resourcing for Pain practice. In this practice, you’ll begin to tune into places in the body that offer grounding, steadiness, and support for the attention. The soles of the feet, and sit-bones on the chair, are often helpful. Allow your awareness to begin to settle and pool in these places; if focus is drawn away to pain, or thoughts, simply acknowledge where it’s gone, and gently bring it back.

Nine-minute Resourcing for Pain practice.

Then, begin to notice where there might be other places in the body that feel pleasant or neutral. This doesn’t have to be very big; just a slight sense of comfort, ease, or warmth. It could be as simple as the contact between the eyelids, or the weight of the hands in the lap. Spend a couple of minutes here, tuning in, and exploring.

For a longer, more in-depth exploration, try this 25-minute practice:

Mindfulness of What’s Pleasant practice.

2. Recognise

For this part of the practice, once you have resourced the awareness, check in with your experience in the present moment. What sensations do you notice? What thoughts, and what emotions?

If there is pain, see if you can notice with curiosity where it is in the body, and what are its qualities. Is it tingling, aching, or stabbing? Notice the thoughts that come up with it. They could be thoughts of not liking or fixing; notice if there are avoidant thoughts, where the mind jumps immediately to something distracting. Finally, notice what emotions come up with the sensations, and name them internally: there may be frustration, irritation, or fear.

3. Respond

After resourcing and recognising, we move to Responding. Holding the direct physical sensations of pain gently in awareness, you might quietly voice the question: ‘What does this need right now?’

Drop it into the mind, almost like dropping a pebble into a pond, and notice what comes back. Often, because this inquiry is grounded in present-moment experience, the needed response is something very small and simple: a particular gentle movement, hot drink, or comforting stretch. This may be quite different from the kind of reaction that comes out of the default fight, flight or freeze.

Physical pain is among the most challenging experiences we have, because it is both potent and confusingly non-linear. As we begin to down-regulate, pain can even increase temporarily. This is because the numbing and bracing effects of the fight response are beginning to dissolve, meaning that pain that has been ‘backed up’ comes through. This is very normal but often prompts panic, trapping us in further cycles of bracing and discomfort.

With time, clear and gentle practices, and good support, we can discover something that might have surprised our fighting, fleeing, and freezing self: that it is possible to live with pain; and that it is possible even, like Vidyamala, to live very well.