A mindfulness approach to chronic pain

This is the text of my That's Men for You column published in The Irish Times on 19th February 2008:

I am always reluctant to write about chronic pain and about psychological approaches to coping with it. This is because it is so easy to patronise people who are in pain when you are not in pain yourself.

Chronic pain is pain that can only be managed – it isn’t going to go away completely. As a person who is a coward when it comes to pain, I cannot imagine what it is like to have to cope with this torment day in and day out.

There is some research into psychological approaches to pain which offer the possibility of improving one’s way of coping with pain and that may be of help to readers in this situation. These involve acceptance and meditative practices.

Why in Heaven’s name should you accept pain? You shouldn’t, in my opinion, if the doctor, the physiotherapist or the chemist can help you to get rid of it. But if the pain cannot be made to go completely, the methods described here may help.

People who are in pain can be said to suffer from two types of pain. The first is the pain which arises from their injury or illness. That pain is largely, perhaps completely, outside their control. The second is the emotional distress which they feel because of the physical pain. It is this second type of pain that acceptance and some meditative practices can help to reduce.

Last year, researchers from NUI Maynooth, NUI Galway and the University of Almeria, Spain, published research showing that people subjected (willingly) to electric shocks had a greater level of endurance if they accepted the shocks instead of trying to distract themselves from them. This, though a small scale study, seems to confirm what many have believed for a long time about the importance of acceptance in dealing with pain and, indeed, with much else in life. The report on their research appeared in the journal, Behaviour Research and Therapy.

Mindfulness meditation has been used for years now at the University of Massachusetts Medical Centre to help people live with chronic pain and stress while experiencing a higher quality of life than before. Dr Jon Kabat-Zinn, who runs the pain clinic, has published an account of his work in the widely-available paperback Full Catastrophe Living.

Mindfulness involves continually bringing your awareness back to what is going on right now whenever it strays off into the past, the future or into fantasy. It sounds easy but it takes more practice than you might think.

In mindfulness you accept the pain that is inevitably there while expanding your awareness of those parts of your body that are not in pain, of the room around you, of other people and so on. This is not a substitute for medical treatment – it is something you do alongside medical treatment.

Blue Sky based in Dublin and run by people with a Buddhist and medical background offers a low-cost course based on Kabat-Zinn’s work.

Here is a simple, four-part mindfulness exercise to give you an idea of what the use of a mindful approach might involve:

1.
Notice your breathing. Notice your posture. Notice the points of contact between your body and the chair, floor, ground. Notice your clothes touching your body.
Every time you drift into thinking, just return to noticing your breathing.

2.
If you feel pain, notice the pain without getting involved in thoughts about it. Notice how the intensity of pain rises and falls but rarely stays the same.

3.
Notice the area of your body that surrounds the area of pain. Notice how that area is tensed up. Imagine that you are breathing into that area and allowing it to relax.

4.
Now, as well as your body, notice the room you are in. Notice how your pain is part of your experience. It is not your total experience. Now notice your breathing again.

Exercises like this do not, of course, get rid of the pain. Instead they are meant to help you to cope differently and to reclaim parts of your life and experience that the pain has overshadowed.