By Diane Dimon, Dr. RS
Coping with physical pain is no small challenge. It can be alarming, irritating, humbling, agonizing… And, if you or a loved one live with hemophilia, chances are you have regular doses of pain in your life.
Bleeding into the joints certainly can cause severe pain. Maybe there is ongoing pain from arthritis. Perhaps pain is brought on intermittently by minor traumas, over-use of a joint during exercise or sitting too long at one time. Maybe it’s caused by stress, the weather, or even excitement about a holiday, first day of school or prom.
Managing chronic pain is difficult. The traditional way to cope is with medications, many of which have undesirable side effects. The good news is that non-traditional therapies for persistent pain are now well-researched and proven effective. This article will explore meditation and other mind-body techniques for managing pain and offers instruction in four techniques that you can use right away.
MIND-BODY CONNECTION
It matters what we think. Forty years of research tell us that our thoughts, feelings, attitudes and beliefs impact our body, our abilities and our pain. Mind-body practices are based on this interconnectedness of mind and body and the power of one to affect the other. They treat the whole person – not just the physical body.
The new sciences agree that mind matters most. This includes quantum physics, mind-body medicine, biopsychosocial medicine, psychoneuroimmunology and neurophysiology, to name a few.
Here is an example from neurophysiology: The moment I have a happy thought, my body’s messenger molecules called neuropeptides instantly send out that exact thought to the 50 trillion cells in my body. In that instant, a chemical message translates my happiness and literally every cell in my body joins in on a cellular level. Happy cells produce “happy chemicals,” such as endorphins and serotonin. Similarly, when I have an angry or worried thought, I instantly have a body full of 50 trillion angry or worried cells, which produce chemical toxins or “stress hormones” such as cortisol and adrenalin. Can you guess which chemicals enhance pain and which reduce pain?
Some of the most commonly used mind-body therapies are meditation, deep breathing, mindfulness, cognitive reframing, positive mental imagery and self-love. These mental skills reduce pain as well as stress, anxiety, insomnia and a host of stress-related conditions. They also have the added benefits of increasing self-knowledge and self-care, and they promote an overall sense of empowerment and well-being.
A brief look at the anatomy of pain will help us understand how the brain processes pain signals and how mind-body skills work to counter pain.
HOW WE FEEL PAIN
Pain is complex. In fact, after years of research, we still do not fully understand exactly how pain is processed and experienced by the body. However, we do know that our experience of pain is profoundly influenced by our mind – our perceptions and our moods.
Currently, many researchers subscribe to the Gate Control Theory of Pain first proposed in 1965 by psychologist Ronald Melzack and anatomist Patrick Wall. In simple terms, this theory states that pain results from a series of electrical and chemical exchanges involving three major components: the peripheral nerves, the spinal cord and the brain. There is a “gating system” in our central nervous system that opens and closes to either allow or block pain messages to the brain. The core of this theory is that psychological as well as physical factors guide the brains interpretation of painful sensations and subsequent responses.
The illustration below will give you a visual of how sensory messages travel. Sensory messages travel from stimulated nerves in the body to the spinal cord. These nerve signals are then sent through open “gates” in the spine up to the thalamus in the brain. The thalamus acts like a switching station that interprets the sensory information according to three psychological factors:
One’s emotional state
How much attention is given to the pain
The perception of the sensation based on prior conditioning; e.g. if the sensation is thought to be dangerous or not
All this information is integrated and guides the individual’s response. If the brain sends a message back down to close the pain gates, the pain signals are blocked. If the brain orders the pain gates to open wider, the pain signals intensify.
Following are some examples of how thoughts and emotions impact our experience of pain and our ability to cope.
People often find their pain worsens when they feel depressed, and it improves when they feel uplifted or become involved in fun activities.
Athletes often do not notice the pain of a fairly serious injury until the “big game” is over when they can pay attention.
A child who has heard horror stories about visiting a dentist will likely feel alarmed and experience significant pain from even the gentlest of dental probes.
Chronic stress causes muscle tension which exacerbates pain.
Anticipating pain before it occurs causes anxiety as well as muscle tension, which makes the pain feel stronger and last longer.
A feeling of helplessness often leads to negative thinking, which tenses muscles and opens pain gates; e.g. “This pain is unbearable, it’s never going to get better.”
Many of these examples can be applied to situations for those living with a bleeding disorder. One may not notice the pain of a bleed when preoccupied by school, work or other activities, and it is only when the hustle and bustle slows down that we take full notice of the bleed and the pain that has developed. For children not yet adjusted to regular infusions, the anticipation of pain can cause anxiety and create an experience that exacerbates pain and stress. Further, our pain may be increased when we succumb to helpless negative thinking brought on by the chronic nature of the condition.
Here are some mind-body factors that open and close pain gates:
Some factors that open pain gates (leading to more pain)
Stress
Anxiety regarding pain/negative thoughts
Focusing on pain
Mood: depression
Physical inactivity
Lack of sleep
Some factors that close pain gates (leading to less pain)
Relaxation/Meditation
Cognitive reframing/positive self-talk
Distraction from pain
Mood: wellbeing
Physical exercise
Adequate sleep
DOES THIS MEAN PAIN IS “ALL IN MY HEAD”?
Although mental and emotional factors can greatly affect the experience of pain, this is NOT saying pain is made up, imagined or psychological in origin. Pain is a physical sensation in the body. It is real and distressing; however, it can be altered by skillful use of the mind!
THE PERCEPTION OF PAIN
Our goal is to shift our perception of pain. Gandhi once said, “You can’t change the wind, but you can adjust the sails.” We are learning to adjust the sails of perception of pain so that we no longer set off the stress alarm around it. As long as there is no “acute” pain that requires an emergency response, we can learn to view it as a challenge rather than a danger, and thereby avoid intensifying the sensations by tensing muscles and opening pain gates.
When pain strikes, ask yourself, “Is there any danger here?” If not, stay calm. Instead of reacting with fear, resistance and tension, we can learn to relax into it, accept it and maybe even make peace with it as a “difficult old friend.”
This is not resignation, indifference or denial. Instead, it is called equanimity, an inner balance of mind that responds to life with greater calm, clarity and compassion. We bring curiosity and kindness to ourselves, to our body and to the pain, allowing us to live more fully and cope more skillfully.
LEARNING THE SKILLS
Meditation and other mind-body skills are self-management strategies. They are practices and not pills. Accordingly, one must participate in them. Like an athlete or musician, you get coached, you pick your favorites, you learn, you practice and you enjoy the results.
There are a variety of techniques to choose from. Some involve relaxation strategies that reduce stress and the physical tension around pain. Others use cognitive strategies to outgrow stressful thinking patterns about the pain and cultivate a stress-free perception of pain. All of these relaxation and cognitive techniques help to counter pain, thereby increasing a sense of control over pain and the factors that influence it. Here are four Mind-Body Skills that will help you manage your pain more skillfully.
SKILL #1
Meditation and Mini-Meditation *
Meditation is a classic mind-body technique that instantly relieves stress. It creates a unique state of heightened awareness and physical relaxation called relaxation response that reverses the stress response and reduces pain, anxiety, depression and other stress-related conditions. The effects of meditation usually last far beyond the meditation itself, and you become more skillful at managing life’s challenges. Here is a “formal meditation.”
Preliminary Steps: In a quiet location, sit comfortably with your eyes closed. Invite your body to relax. Set aside all concerns and give yourself permission to “just meditate.”
5-5-5 Breathing Exercise: Inhale through your nose, slowly and fully, counting to 5. Hold for a count of 5. Then exhale through your nose, slowly and fully, counting to 5. Repeat 3 times.
Use a Focus: As you breathe naturally, place your attention on a chosen focus, such as your breath. Follow the rhythm of each breath as it naturally moves in and out of your nose. Do not control your breathing; just observe it as it is. If you prefer, you can use a relaxing word or phrase for your focus, such as “one-two,” “peace-ful” or “all-is-well.”
Practice Non-Judgment: When your mind wanders, just notice and gently bring it back to your focus. Try not to indulge your thoughts, fight them or judge them. Don’t worry about how you are doing. As best you can, maintain relaxed alertness and non-judgment. “Oh well, where’s my breath? There it is!” Be gentle with yourself and take the experience as it comes.
Continue this for 15-20 minutes: You may set a quiet alarm, peek at your watch or simply ask your mind to alert you when time is up. Then stop your focus and remain in silence with eyes closed for a minute or so. Open your eyes and continue your day.
Practice this technique in the morning and evening, preferably at the same time and location.
Note: The above technique can also be practiced in 3–5-minute Mini-Meditations. These are short pauses that fit into a busy schedule and instantly relax tension in the body and reframe upsets in the mind. Mini-Meditations act like a reset button on a computer, whereas formal meditations act like a reboot. Pause whatever activity you are doing, breathe deeply three times and then meditate for several minutes (instructions above). Your eyes can be opened or closed. Do Mini-Meditations during moments of pain as well as stress, anxiety, depression, or when you are feeling rushed or frazzled. Try it before a test, a confrontation, a medical procedure or when you are having trouble sleeping. With practice, these pauses can be as refreshing as a few hours’ sleep.
* For more meditation training and a 20-minute meditation experience that you can use again and again, please see the training CD “Finding Stillness Through Meditation” by Dr. Diane Dimon.
SKILL #2
Mindfulness of Pain
Mindfulness is more than a relaxation technique; it is also a cognitive technique that retrains negative thinking patterns that cause stress and exacerbate pain, anxiety and depression. It replaces catastrophizing thoughts with positive self-talk to cultivate a stress-free perception of pain.
Mindfulness is non-judgmental moment-to-moment awareness. It involves keeping your attention in the present moment without judging things as good or bad. Your goal is simply to observe and accept whatever is happening now, with no intention of changing or fixing anything. It is living each moment - even painful ones - as fully and consciously as possible with a sense of curiosity, kindness and trust. Mindfulness can be practiced while sitting “formally” or in the middle of activity, and also during experiences of pain. Here is a ‘formal’ practice of Mindfulness during pain:
Sit comfortably with your eyes closed. Take several deep breaths. Relax your body. Begin by placing your attention on the rhythm of your breath. For 1-2 minutes, follow the breath as it flows in and out of your nostrils.
When you feel pain in your body, pause your attention there, and gently and lovingly allow yourself to be with the pain. Put direct attention on the uncomfortable sensations and experience what they actually feel like. Let yourself experience it with a beginner’s mind, without conditioned reactions. For instance, have you ever let yourself really feel pain without judging it as bad? Are the sensations hot, cold, diffused, sharp, achy, throbbing, tingling, pinpricks…? Explore.
Try not to fear the pain, resist it or tense up. Let go of judgments about how things should be. See if you can relax into the pain and make peace with it instead of trying to eliminate it. Give it a name. If the pain has been with you for a while, see if you can touch it with kindness and compassion, and treat it like a difficult old friend.
Of course, if at any time the pain becomes too much, you can reassure yourself that there is no danger and that you are safe, and you can end the meditation.
Practice this for 5-10 minutes at a time. When you are finished, take another deep breath, and slowly and gently open your eyes.
SKILL #3
Loving-Kindness Toward Self and Body
Every living creature needs love to thrive, including our body. Research confirms that loving is literally good for our health by promoting health-supporting body chemistry. However, loving the body can be difficult, especially when there is pain and illness. This Loving-Kindness Technique uses repeated phrases to evoke goodwill, appreciation and friendship toward self and body. It uplifts as well as relaxes. The following is a “formal” practice; it can also be done as a quick blessing in the middle of activity.
Close your eyes, sit comfortably and set aside all concerns. Breathe deeply several times and invite your body to relax.
Begin to recite inwardly the listed below (or similar that work for you). Direct the phrases to yourself, to your body as a whole or to specific difficult body parts that are associated with pain, tension, sadness, anger, shame… Adjust the words and images to fit, and mentally for five minutes or so. At first this may feel mechanical or awkward, or it may feel wonderful. Either way, the heart opens and loving-kindness grows. Experiment, be patient, and with practice you’ll begin to feel a wonderful sense of wellbeing, acceptance and connection with yourself, your body and life in general.
May I be filled with loving-kindness;
May I be well and safe;
May I be peaceful and at ease;
May I be genuinely happy.
May my Body be filled with loving-kindness;
May my Body be well and safe;
May my Body be peaceful and at ease;
May my Body be genuinely happy.
The formal practice of Loving-Kindness can be practiced anywhere and it can be expanded from Self and Body to also include Loved Ones, Neighbors, Strangers, Difficult People and All Beings.
SKILL #4
Mental Imagery for Pain
Mental imagery combines relaxation and the power of your imagination to access the unconscious mind and produce calming, energizing and healing responses in the body. If you have ever closed your eyes and pictured yourself lying on the beach as a way to relax, you have used imagery. The unconscious does not know the difference between what is “real” and what is “imagined,” so images are like powerful suggestions that encourage your body to do what you are imaging. You deliberately focus on a particular image that “sees” the changes you desire; the more senses you use, sight, sound, smell, taste, touch, the more vivid and powerful your image becomes.
Mental Imagery can be used for relaxation, healing, pain reduction, insight into illness, changing behaviors, accomplishing goals, etc. The following is a guided imagery for pain reduction:
Calm yourself, sit comfortably, relax your body and take three deep breaths.
Explore different mental images for decreasing pain (see below). Then pick the one(s) that work best for you:
Imagine holding a remote-control device (similar to a TV remote control), except that it is connected to your level of pain. Imagine slowly turning down the “pain volume” until you can barely hear/feel/experience the pain.
Imagine placing your pain in a strong metal box, and then closing, sealing and burying the box.
Imagine your pain is being washed away by a cool, calm river flowing through your body.
Whichever mental image you choose, make it as vivid as you can. Allow your mind to experience your image with as many senses as possible; see it, touch it, hear it, think about it, feel it…
Cultivate non-judgment, non-attachment and receptivity. If doubt or disbelief arises, just notice and return to your image. Keep a relaxed mind.
Practice this for 5-10 minutes at a time. When you’re finished, take another breath and gently open your eyes. The more you practice the image, the deeper the mind accepts it.
IN CONCLUSION . . .
Chronic pain is challenging. Whether it’s jabbing, burning, aching or throbbing – any way we describe pain, we want it to stop. The good news is we have tremendous power over pain because our experience of pain is profoundly influenced by our mind’s perceptions. I invite you to explore these mind-body techniques and see how they will serve you to feel less pain and experience greater health and happiness!
* For further information on How We Feel Pain:
Mind Body Medicine: How To Use Your Mind For Better Health, Dennis C. Turk PhD. Pgs 111-125.
Mayo Clinic Guide to Pain Relief: How to Manage, Reduce and Control Chronic Pain, 2008
Diane Dimon, Dr.RS is Director of Matters of the Mind, a California-based company that teaches a full range of meditation and other mind-body techniques for improved health, happiness and high-performance. She conducts nation-wide seminars, retreats, private instruction, and keynote presentations. Her clients include healthcare providers, hospitals, businesses, universities, youth and individuals from all walks of life. She offers Continuing Education for nurses and therapists. Dr. Dimon has been practicing mind-body skills for 40 years and holds a doctorate in Religious Studies, specializing in the study of consciousness and the mind-body connection. She is author of the Meditation Training CD Finding Stillness with Meditation and her upcoming book Mindful Eating.
Her seminars include:
Meditation for Anxiety and Stress Reduction
Mind-Body Skills for Pain Management: A Research-Based Approach
Mindful Eating: Lose Weight with Peace, Pleasure & Purpose
Meditation for Youth: Relieve Stress, Improve Learning, Increase Happiness
Loving Kindness: Loving Self, Loving Others
Imagine That! Therapeutic Mental Imagery to Create and Heal
Compassionate Communication: A Language of Peace and Empowerment
The Science of Happiness: A Breakthrough Approach
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