Mindfulness and pain

CRAIG HASSED: It’s a very natural thing that none of us enjoy pain, of course. That’s by the very definition, it’s something that we want to reject or not experience. Of course, there is emotional pain, anxiety and depression are examples, but of course, physical pain as well. And that’s just the part of being alive that we experience pleasure one moment, pain the next. And these things are transient. One of the things, of course, is if we get very attached to the one like pleasure, then of course, we find that there’s much more resistance and suffering often associated with pain when you invariably experience it. It’s like the whole of life. The ups and downs of life, success and failure.

But this of course, it’s like if as it were the two banks of a river through which our life flows is a pleasure on one side and pain on the other. So how can mindfulness help us to deal with physical pain? Now, if we’re actually interested and curious, one of the things we notice is that when we experience physical pain, that our mental and emotional state can have an enormous effect on how we experience it. We can go to a dentist, for example, and we haven’t actually even experienced any physical pain at all, but already there’s a considerable amount of suffering.

So we’re actually sitting on a very comfortable chair, it’s lounging back for example, and but the level of anxiety in anticipation of what might or might not happen, the level of suffering can be considerable even before anything’s actually happened. But when we experience something, so if there is, for example, a needle, our mental and emotional state can amplify that experience enormously. So if we experience a little bit of physical discomfort, but we add anxiety, fear to that, anger, frustration, then that can amplify the amount of suffering associated with it. So the suffering is not directly a response of the physical sensation. It’s the mental and emotional way of being with that sensation.

And so that obviously gives us an indication that in order to reduce suffering in association with whatever level of physical discomfort we might experience, that if we can work on the level of the mind, then it might have a significant potential to reduce the suffering we experience. And so that’s where mindfulness comes in. Now especially with chronic pain. One of the things that happens with chronic pain, is that if we are stressed and very active and angry and frustrated in response to the pain, then we develop a kind of hyper vigilance for the pain. We’re always looking for it, monitoring for it, reacting to it.

And that hyper vigilance, and the emotional reactivity to it, hyper sensitises the pain circuits in the brain to fire off more pain messages, just with the same stimulus. So mindfulness really works on two basic fronts. The first one is to be less hyper vigilant for it, so to be able to gently unhook the attention from the sensation when it’s noticed and being able to engage attention elsewhere in our day-to-day life. To reduce the emotional reactivity to it. To develop more acceptance. Less, as it were resistance to it, because the resistance of course is where the suffering really find a way in.

And learning to be present just moment by moment, as sensations open the flow rather around the anticipation of what might come, or reliving discomfort that’s already come and gone. So mindfulness can really operate on these kinds of levels. One of the first areas that was researched in mindfulness, and from a lot of the work of Jon Kabat-zinn, was working with people with very severe chronic pain. And people were doing quite intensive practise. 40 minutes a day. They had pain that the medical system couldn’t fix. And so people were learning to practise mindfulness meditation, to be mindful in day-to-day lives, to be less resistant, more accepting. Just flowing moment by moment.

And if they’re practicing about 40 minutes a day, which the majority did, then the great majority of people over 80% had major reductions in the amount of suffering associated with their pain, but also the pain as well. So reducing that hyper vigilance, reducing that emotional reactivity down regulates the pain centres in the brain to fire off less pain messages with the same stimulus. There are some other ways in which mindfulness can help with pain as well. Because the stress response has a pro-inflammatory effect. The opposite response, the relaxation response as it were, which is a common side effect of mindfulness, has an anti-inflammatory effect.

Muscle tension, if that’s a part of the physical pain, then learning to be calmer with the pain can reduce muscle tension. It is interesting that recent research has looked at whether mindfulness is just a placebo for pain. And what’s quite interesting is that it’s very different to placebo. Studies for example where you give a person a placebo for the pain, the pain message is reduced some what, because the experience of the pain is reduced. But the mindfulness practise actually works far more effectively than placebo, so a much bigger reduction in pain. But it works on different levels, or different areas in the brain, that make a decision whether or not to let those pain messages through.

So it might be that you’ve noticed that if your, maybe your attentions engaged with other things. Like if you’re really absorbed in what you’re doing, then you might notice that you don’t feel affected by discomfort that might otherwise be affecting you if you’re really fixated on it. And it’s that kind of mechanism. So that a person who develops mindfulness is able to notice the pain, but the attention doesn’t fixate on it, the person’s in a sense developing an ability to make a choice about whether to really focus or let those particular pain messages through. Now there is an important footnote here, though.

If we are experiencing physical pain because there is something that really does need attention, like we’ve broken our leg for example, you know and the pain is there for a very good reason. And that’s to get our attention to say, could you just stop and set this right for a moment. So you know, sometimes pain really does need our attention. But chronic pain of course, this is where mindfulness can really help, in conjunction with appropriate medical care, to help us to have much better quality of life. So there are many different mechanisms whereby mindfulness can have a beneficial effect on pain.

Through what’s going on in our brain, in terms of perception of pain, through what’s happening on an inflammatory level, and also our muscle tension level. So learning mindfulness meditations that are specifically focused on pain can be very, very helpful, and we’ll have one that’s provided for you that you can actually use as a part of this course.