Being mindful of pain, and the paradox of mindfulness

Meditation offers us a powerful paradox: that becoming more mindful of our pain reduces the amount of pain we experience.

The use of meditation techniques to treat chronic pain is becoming increasingly common, largely as a result of the pioneering work in Mindfulness-Based Stress Reduction started by Jon Kabat-Zinn in 1979 at the University of Massachusetts Medical School. Dr. Kabat-Zinn’s scientifically validated work has touched the lives of tens of thousands of people and helped to establish meditation as a highly respected tool in the treatment of chronic pain, stress, and depression.

Some people initially find the idea of using meditation to deal with pain incongruous. After all, isn’t meditation about developing greater awareness? And wouldn’t that mean becoming more aware of the pain itself in an almost masochistic kind of way and therefore experiencing greater suffering? For others, who think about meditation as a technique for “tuning out” and turning attention away from the body, meditative techniques can be seen as a welcome, if almost unattainable, form of escapism.

See also

• Mindfulness pain relief distinct from placebo effect
• Mindfulness and chronic pain: every moment is a new chance
• Science shows what meditation knows: pain is not suffering
• Pain is not wrong

In fact, meditation is neither masochistic nor escapist. In meditation we do in fact become more aware of ourselves, but what is most important is that we become aware of and change the way that we relate to our pain. It is that change in relationship that makes meditation a potent tool in pain management.

So what is this change in the way that we relate to pain, and how does it have the effect of helping us to deal more effectively with it, or even to reduce the level of pain we experience? The quality we cultivate through meditation practice is mindfulness. Mindfulness is much more than simply being aware. We can be aware of pain without being at all mindful of it. Mindfulness is a particular kind of awareness, which is purposeful, focused, curious, and rooted in our moment-by-moment experience.

With mindfulness we purposefully observe our experience as it takes place, including any pain that may be present. The mind naturally tends to see pain as being a “thing,” and to give it a degree of solidity, permanence, and coherence that it doesn’t in fact have. In mindfulness meditation we train ourselves to see the many different sensations that we collectively label as “pain.” We may even gently make mental notes of the most prominent sensations that we notice. For example we may note the presence of “tingling,” “pulsing,” “throbbing,” “heat,” “cold,” “aching,” “tightness,” etc. When we let go of the rather crude label “pain” in this way and instead note what is actually present, we can find that each individual sensation is easier to bear. Sometimes we notice that there is no pain present, or that the sensations that we’re experiencing are neutral or even pleasurable.

Additionally, in exercising curiosity about our pain we are also gaining another important benefit in the form of the quality of acceptance. The mind, quite understandably, tends to see pain as something that is undesirable and therefore to be pushed away. This pushing away shows in the body as physical tension in and around the area of pain, causing additional discomfort and even intensifying the original pain. It’s as if, having accidentally touched a hot stove, we were to react by trying to push the stove away. In doing so we would of course simply intensify our pain. So, in mindfulness meditation an attitude of curiosity allows us to let go of our resistance and to see the pain for what it is: an ever-changing variety of interwoven sensations. Much of our resistance to pain is mental rather than physical. When we experience pain the mind can, like the body, try to push it away. We experience desire for the pain just to go away. We crave its absence. Unfortunately, as we all know, wishing that something were so does not make it so, and our frustrated desires do nothing but add mental suffering to our physical distress.

In mindfulness meditation we observe more than just any pain that may happen to be present. We become aware of the whole physical body, emotions, and thoughts, and of how each of these interacts with the others. One thing we can then begin to see is that although pain is present in our experience it isn’t the whole of our experience. Mindfulness gives us a sense of the physical and mental “landscape” within which our pain is experienced, and which helps to give a sense of perspective to our experience of it. At times of stress it may seem as if pain is the only thing that we experience, but this comes about because we have a kind of mental “zoom lens” that is closely focused on the pain. Change that zoom lens for a wide-angle lens and the pain seems much smaller and therefore more manageable.

Without mindfulness, our experiences tend to proliferate in an unhelpful way. We may experience physical pain, and this leads to thoughts such as “This is never going to end,” “This is just going to get worse,” “I can’t bear this,” or “I must be a bad person to deserve all this pain.” In turn, these thoughts lead to anxiety, despondency or anger, because we tend to believe the stories we think when we are unmindful, and this adds further to our suffering. The practice of mindfulness includes becoming aware of our thoughts and seeing that our thoughts are indeed just thoughts and are not facts.

Thoughts are not facts. This can be a revolutionary discovery, and also a liberating one. When we learn to see thoughts as just another experience coming and going against the background of our overall physical and mental experience, we free ourselves from the kind of runaway thinking that is so characteristic of stress. We can see thoughts like “I can’t stand this” coming into being, realize that they are thoughts rather than facts, and instead of indulging in them and encouraging them we simply note them and let go of them.

Finally, mindfulness can help by reminding us that pain is not “the enemy.” Pain is the body’s naturally evolved way of letting us know that something needs attention, and can play a vital role in maintaining physical well-being. It’s easy to see how important pain is when we consider what life would be without it. There are medical conditions in which people can’t experience pain, and those people find that life is very hard indeed. Imagine, for example, trying to warm yourself at a fire without being able to tell when your skin was overheating: serious burns would be a distinct possibility. So we can see that pain is an essential part of being human. Of course when pain goes on for a long time, or when it’s particularly intense, it can be hard to remember that it evolved as a helpful function, and it’s easy to see it as an enemy. The meditative approaches outlined above help us to develop acceptance of our pain, but an even more powerful aspect of mindfulness that allows us to accept our pain is the quality of lovingkindness.

Mindfulness has a quality of appreciation and welcoming that can radically transform our relationship to difficult experiences. Buddhist meditation techniques can be used, for example, to cultivate an attitude of lovingkindness towards those people that we find difficult and towards whom we experience aversion, anger, and even hatred. Millions of practitioners over thousands of years have found that the cultivation of lovingkindness leads to the lessening of conflicts and the growth of love and appreciation for those who were previously enemies. Lovingkindness transforms our relationships.

The development of lovingkindness can also be used internally, by cultivating lovingkindness for painful experiences (or self-compassion) so that we can accept them as a part of life. Wishing our pain well can be a powerfully healing experience in which we let go of inner tensions and barriers on a deep level and come to see that our pain is a part of us, and a part of us moreover that is greatly in need of cherishing and love.

But do these approaches actually have medical benefits? Do they reduce pain, or do they simply allow us to handle our pain better? Clinical studies are unequivocal in demonstrating that the practice of mindfulness meditation both increases the ability to deal with the effects of pain and reduces pain overall. A study published in General Hospital Psychiatry followed 51 chronic pain patients who had not improved with traditional medical care. The dominant pain categories were low back, neck and shoulder, headache, facial pain, angina pectoris, noncoronary chest pain, and GI pain. After a 10-week program of meditation, 65% of the patients showed a reduction in pain of greater than 33%, and half of the patients showed a reduction in pain levels of more than 50%. It should be remembered that these were patients whose pain had shown no improvement with traditional medical care. In other words people with the most difficult cases of chronic pain still showed dramatic improvements in their condition.

A more recent study, at the University of Montreal, shows that Zen meditators were better able to detect painful stimuli than non-meditators, but that the sensations weren’t processed by the brain as “pain.”

The practice of mindfulness is particularly effective because it “decouples” the physical sensations of pain from mental and emotional processes that heighten suffering. Pain comes to be seen as “just another sensation” and the fear of pain is significantly reduced. The development of mindfulness, as Buddhists have known for 2,500 years, brings about mental and emotional freedom and a decrease in suffering.