Those who have experienced chronic pain know how difficult it is, and how it can severely limit quality of life. It can be hard to sleep and maintain emotional stability. When you look “fine” on the outside, others may not know what you are going through. Chronic pain can be exhausting, often leading to frustration, anger and depression. Emotions run high; we may feel it’s not fair and question why we are being singled out for this pain. We may increasingly choose to stay home, separating ourselves from the very social activities and friends who might help normalize our lives. This, in turn, can encourage a hopelessness that nothing will ever change. 

When we feel the throbbing or burning pain, we tend to tense the muscles in our bodies, which only serves to intensify the perception of pain. This is where mind-body techniques can be so helpful. While they do not magically make pain disappear, they really can make a difference in our ability to engage in and enjoy our day-to-day lives. 

Pain management through medication is a complex process that requires a close working relationship with a physician. Our bodies want to heal. Mind-body techniques work with the body; they are effective in the management of chronic pain without the negative side effects of medication, including the looming threat of addiction. These techniques help restore a sense of personal control over our own destiny. There are many people with chronic pain who have been able to reduce their medication dosage by integrating mind-body practices. 

Helpful mind-body techniques include, but are not limited to, mindfulness meditation, guided imagery, positive psychology strategies and hypnosis. Various forms of body work, such as massage, craniosacral or Reiki, can also help. Some of these techniques necessitate intervention by licensed professionals while others require more active participation, with a whole-hearted willingness to enter into new ways of thinking about our situation. We need to be motivated to do whatever it takes to learn a new practice, and a commitment to keep on practicing regularly without giving up. Retraining the body and mind is hard work; it won’t just happen by reading a book, yet such efforts have made a significant difference for many individuals who suffer from illness and pain. 

Mindful Awareness and MBSR

Mindfulness practice has its roots in Buddhism, and through the work of American scholar Jon Kabat-Zinn and others, this philosophy is available to each one of us, regardless of our belief systems. Through years of personal study and practice, Kabat-Zinn, a research biologist at the University of Massachusetts Medical Center, founded the Stress Reduction Clinic. Physicians there refer post-operative patients and those with severe or chronic pain, extreme depression and anxiety. The resulting Mindfulness-Based Stress Reduction Program (MBSR) is a structured group program where participants meet for several hours a week over an 8-week period, with an added day-long retreat. Through weekly training in yoga and meditation, combined with deep discussion, participants learn to mobilize their own inner resources for coping, growing and healing. 

Positive changes have been noted in both physical and psychological status for MBSR participants who adhere to the meditation techniques both during and after the course. Among the many health benefits reported are reduced physical symptoms and level of pain. A recent study of patients with chronic low back pain found that those who participated in an MBSR program reported a 60.5 percent advantage in reporting clinically meaningful improvement on a disability questionnaire over those who received usual care. Various studies have suggested positive effects on improvements in pain, pain acceptance, quality of life and functional status. In the MBSR program, participants learn how to retrain their bodies through gentle yoga practice and how to retrain their minds through mindfulness meditation. They became more aware of their moment-to-moment experiences, and letting go of intrusive thoughts and feelings.  “You can’t stop the waves, but you can learn how to surf,” is Kabat-Zinn’s oft-quoted description of mindfulness practice. Much information on MBSR is readily available online, including CDs, MP3s and books. If possible, finding a MBSR class with teacher interaction is highly recommended. 

Manage Your Relationship to Pain

Mindful awareness encourages a nonjudgmental awareness and acceptance of the current moment with whatever is presenting itself now, including both emotional and physical discomfort. It requires a willingness to be curious rather than apprehensive, to explore rather than avoid. In an internalized dialogue, one might say, “My lower back really hurts right now. This seat is so uncomfortable! I don’t know how much longer I can stand this. I’m going to get up now.” Or, one might say, “My lower back really hurts right now. I’m really curious about where this is going to go. Let’s see what happens if I maintain steady, relaxed breathing and place my focus on my back for a while, going inside to explore with my mind the part that hurts the most.” Initially, it takes courage to “stay with it,” and go into the pain, but with practice it is possible to explore rather than fight the pain. In this way we can manage our relationship to pain by changing our perception of it. Learning how, each time, it can be different, sometimes worse, often better. 

Converting Pain into a Sensation

It is only natural to label pain negatively but doing so can actually increase our perception of pain. The word “pain” is naturally allied with concepts of “bad” and “fear”; this association will also influence how pain is experienced. Try instead to replace pain with “sensation” and the feeling as “discomfort.” This change in language can modify a more negative interpretation into a less emotionally loaded perception that can, in turn, reduce the experience of pain.  

Focusing Elsewhere through a Body Scan

Most of us have experienced or witnessed the phenomenon of being injured, yet we are so distracted by our current activity—such as playing sports or helping others in an accident—that the perception of pain doesn’t arrive until we are no longer distracted. Mindfulness practice can help us achieve the same effect. 

One powerful method is the body scan. Lie down or be seated in a comfortable position. Begin breathing in a natural and relaxed manner, even if pain is present. Begin by placing full-hearted attention on the left big toe. Become aware of any sensation, such as heat, cold, tingling, pain or tension; pay attention to that sensation. If there is tension, ease it slightly. When a thought or perception interrupts, notice it briefly, and then consciously shift attention back to the body. Move to the other toes, around the left foot, ankle, lower leg, knee, thigh, hamstring and then continue with the right leg. Continue scanning up through the entire body, front and back, arms, shoulders, neck, and head and facial features. Place loving attention on the entire body, one part at a time, noticing sensations, being curious even with discomfort, and moving on to the next. As thoughts occur, accept them briefly and then send them on their way while returning to the practice. 

Change Thoughts to Transform Experience

Among the many books on mindfulness and Buddhism that can inspire us when we are experiencing pain and feeling frustrated is How to be Sick, by Toni Bernhard. A highly competent law professor, Bernhard fell ill one day with what seemed to be a virus and has never recovered after well over 10 years. With no clear diagnosis, she has the symptoms and lack of energy of someone with acute influenza to the point of spending considerable time in bed. She cannot work, go to family weddings or visit grandchildren; yet her view on life is positive and inspirational. Bernhard had studied Buddhism and practiced meditation for many years previous to her illness. She uses strategies every day to reduce discomfort, pain, anxiety and depression. 

Bernhard warns against giving into the darkness, stating that, “every mind state, thought or emotion that we experience repeatedly becomes stronger and more habituated.” She is careful with the language that she uses in order to be more positive. She refuses to become her illness, saying that although there is sickness, she is not sick. Among her strategies is to remind herself that she is not the only one suffering—everyone is, in one way or another. She extends self-compassion toward herself and her body, and then to all people suffering. 

Ann Reeves, PsyD, is a Wilton-based licensed psychologist who integrates mind-body strategies into her practice of psychotherapy. She also conducts day-long nature retreats. Connect at 203-451-6208. See ad, page 17.