Mindfully Managing Chronic Pain

Written by Elaine Smookler, RP. Faculty, Centre for Mindfulness Studies. Columnist- “Inner Wisdom” Mindful Magazine , Faculty, eMindful

Pain is something we all experience; we burn ourselves on the stove, we are injured playing sports or running for the bus, or it could be the response to a catalogue of debilitating diseases. Regardless of the reason for it — pain hurts. We may not like it, but pain serves an important purpose by alerting us to threats to the body. “Hey you! Move your hand away from the stove — RIGHT NOW!” This response to danger is the key to the survival of the species. But is pain always helping you to survive? How can we treat it? Why do some people struggle to find relief from pain? Could mindfulness become an important ally for people struggling with chronic pain?

Is Pain Always A Helping Signal?

It can be helpful to separate pain into two categories, acute and chronic. Acute pain can be stimulated by some harm to the body — let’s go back to the example of burning your hand on the stove. The moment your hand makes contact with the hot stove — ouch! You feel it, on the spot! Chronic pain, or pain lasting more than 6 months, might be caused by lingering inflammation or other associated conditions, but it can also be enhanced by more persistent pain pathways created in the brain. You can credit this to “neuroplasticity.” Neuroplasticity is the brain’s ability to constantly learn, make record of experiences, and change based on what happens — which can be a great thing! However, this wonderful ability can become a challenge when the subject is chronic pain. With chronic pain, the brain and nervous system can change to become more sensitized to ongoing pain signals, which can continue to be experienced in the brain long after the there is no longer a trauma or harm to the body. This can make chronic pain challenging to treat adequately. There’s no injury left to fix, but the pain hangs around.

Other factors also influence how much we suffer from pain. For example fatigue, stress, or a negative mood can make us more sensitive to pain, making it even harder to bear. The opposite is also true. You may notice that being refreshed, in a great mood, and feeling relaxed makes pain less intense and easier to be with. We come back to the brain again — when we’re stressed and engaged in the fight or flight response, our muscles tense and our body actually reduces the natural pain killers (endorphins) it produces, increasing the experience of pain.

How Can We Treat Pain Effectively?

What’s your first impulse when you feel pain? Do you immediately think about how you can get rid of it as quickly as possible? One of the conveniences of our modern lives is that have an abundance of over the counter and prescription pain medications available to help us cope with pain in daily life. But what happens when these heroic remedies don’t work or cast dark shadows as our need for them becomes unquenchable? Evidence from the medical community and chronic pain sufferers themselves have revealed that pain medications are often ineffective at adequately managing chronic pain. Even more importantly, they may not help you return to fully engaging in your life.

Why is this? One factor for people experiencing chronic pain, is that there is no longer an injury the body is trying to heal — it’s a learned experience in the brain, which medications struggle to assist. For acute pain, prescription medications like the opiate OxyContin can be of great assistance when used to treat an injury for short periods, like immediately after surgery. But opioids are highly addictive. We are currently living in the midst of the worst opioid epidemic of unintentional drug addiction the US has ever experienced, and much of it stems from the unnecessary prescriptions of narcotics for pain that they are ineffective for.

Adding a Mindfulness Prescription

In 1979 when Mindfulness first came into the public health sector, Jon Kabat-Zinn, a Professor of Medicine at UMass Medical School, used it to help patients find some relief from the stress of pain which was not being well-managed by medication. He trained a group of patients in a particular way of paying attention to present moment experience. By bringing a calm, curious and compassionate attention to what was being felt, and focusing in on the components of what they experienced as “pain,” such as prickliness, burning, tightness, throbbing, and so on, they experienced ongoing relief of chronic pain. It has now been well-documented that being able to be with “what shows up,” even if uncomfortable, can not only reduce perception of pain, but also help people learn how to better manage pain.

You may be wondering how mindfulness can make such a difference. Brain science talks about the tendency of the brain to operate in “automatic pilot.” This happens when the brain repeats certain actions over and over and creates shortcuts to make our lives easier. But when it comes to pain, we likely have repeated habits that actually make our pain worse without our awareness. This could be anything from pushing ourselves too hard and ignoring rising pain levels, or telling ourselves that we can’t bear the pain that we actually are bearing, consuming foods or beverages that increase our pain, or not managing our stress effectively and keeping ourselves in a chronic state of over-sensitivity to pain.

By increasing our awareness, mindfulness provides us with a manual over-ride to help deal with these unhelpful shortcuts. With effort and perseverance we can interrupt these painful habits and discover how to relate to your pain in ways that make it more manageable. You may discover that even when pain is still there, it no longer troubles you in the same way. This can free you up to engage more fully and joyfully in your life. But just like learning a new language, increasing our fitness, or becoming a virtuoso air guitar player — it takes training.

We are not saying that mindfulness is the only way. But it has been shown to make a difference for thousands of people either as a stand alone treatment or as a complement to other pain treatments.

eMindful is focusing an entire week of the Mindful Daily sessions on tips for how to apply mindfulness to managing chronic pain. These sessions will share the latest findings from the fields of medicine and mindfulness to gently support you in managing pain. By joining the thousands of people who have found success in mindfulness-based pain programs you are opening yourself to the possibility of a new life. We draw strength knowing that we are not alone and that learning to live with less pain is possible.

ON THE SPOT PAIN-MANAGEMENT

1.  Find a comfortable and relaxed position to sit, stand or lie down.
2.  Allow the eyes to close, or lower and soften your gaze and turn your attention inward.
3.  Take two to three deeper than normal breaths, feeling the oxygen and energy entering your body on the in-breath and letting go of tension, clenching or bracing on the outbreath.
4.  Now, allow your breath to return to its natural rhythm as you focus on the sensations of the breath wherever you feel it most vividly.
5.  If your attention is pulled to places of pain in your body, allow your attention to become aware of just the edges of the pain, not diving into the most intense part of the pain for now. As you breathe into the edges, invite the tissue and muscles around the area to gently soften. But do not try to force anything to happen as that may create more tension.
6.  Bring a kind and gentle quality to your attention as you continue breathing into the edges.
7.  Notice if you have any worry thoughts or difficult emotions, without getting caught up in them. Simply being aware.
8.  When you’re able, return your awareness to your breathing. Or, if you need to, remain, breathing into the edges of your pain for as long as it seems helpful, while inviting the rest of your body to soften and release whatever tension or bracing may be present.

You may not experience immediate relief or relaxation after this exercise. However, with time and practice, you can become more aware of your patterns and habits around pain. By consistently bringing gentle awareness to these patterns they can begin to unwind, your pain can lessen, and you can manage it more with more ease.

Adapted from Vanderbilt Health’s Osher Living Well with Chronic Pain Program.

Elaine Smookler is an eMindful instructor and registered psychotherapist, with a 20 year mindfulness practice.