What is pain?
Pain is a complex topic because it is complicated to understand medically and presents in many varieties as a patient living with it. Neuroscience has told us that there is no “Pain Center” in our brain in the same way that we have, for example, a language center, a visual cortex, a motor cortex, a limbic system (emotion center), etc. The definition of pain as defined by the International Association for the Study of Pain (IASP) as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” In previous years, it was misunderstood by many practitioners that physical and emotional pain are two separate entities. This is one-hundred percent false! Many patients’ experience begins by seeking a physician to “fix” for their pain and when they are told there is nothing there, the patient hears, either implicitly or explicitly, it is all in their heads. As you can see from the definition by the IASP, pain is always in our heads! It is a sensory AND emotional experience. By definition, it is an experience. And this is where meditation will be weaved in.
Before I get into it, I want to acknowledge that pain is different for everyone because pain is directly affected by biologic, sociologic, and psychologic factors. Your biology will allow for disease processes to come and go depending on your body’s genetics and your lifestyle (diet, exercise, sleep, alcohol/illicit drugs intake, sleep, hydration, etc.) which will affect your overall health. Sociological contributions to your pain will depend on your socioeconomic status, culture, race, ethnicity, neighborhood, family, friends, and access to foods and medical care, among others. Psychologic factors will include your childhood trauma, default self-talk, history of abuse, war, or death. Pain varies in intensity, quality, and duration for each person regardless of its initial onset and therefore is unique to your experience. We can agree that pain is due to many factors and so let’s now agree that it therefore requires a multifactorial approach in management! Diet, such as avoiding processed foods and increasing anti-inflammatory foods needs to be a part of the solution; Movement such as starting PT/OT, working with a physical trainer, or finding your own space for routine stretching and exercise needs to be a part of the solution; Finding a physician who you trust who wants to lower your medication with the goal of removing as many as possible needs to be a part of the solution; and scheduling regular sessions with a Pain Coach (see link below) or finding a Psychologist who can treat you using CBT, ACT, or biofeedback as well as practicing daily meditation/mindfulness needs to be a part of the solution. While socioeconomic status affects how accessible some of this is for you, mindfulness is available for free to everyone.
Besides mindfulness, what else can I do?
Much is stated above in regards to diet, exercise, stretching, and good sleep as the basic building blocks for overall good health which directly helps with pain managment. For those in pain, let’s split it up into the two types as seen in the medical world: Acute and Chronic.
Acute pain is new pain and expected to be short-term. Short-term is a general statement, of course, because it depends on the injury. If you get a paper cut, this pain is expected to last 1-3 days but recovering from knee surgery has a different trajectory which can be anywhere from 12-18 months. The best non-pharmacologic pain management tool, and unfortunately quite under-utilized, is ice! There are gel packs that form to the body part and should always have material placed between the ice pack and the skin to avoid injury. Use off and on for 20 minutes each. While movement is always encouraged, even post-op, rest is also part of pain management. If you have rolled your ankle, you may not be walking as much as usual, but maybe you could do a few core exercises and leg raises. If you have been walking on an injured leg or working with an injured arm, schedule in time to rest and elevate the limb. Arm elevation is simply placing a pillow under your elbow to raise it to the height of your heart (about halfway up the line between your belly button and collar bone) and another pillow to raise your hand slightly higher (think: on your chest just below your collar bone). For many, compression is very helpful. Placing an ace bandage or a brace can help stabilize the area though this should not be relied on too much as prolonged use can lead to dependence on it. I always recommend topical medications over oral options to bypass the many side effects that come from taking pills by mouth. My favorite topicals are Voltaren Gel (generic name: diclofenac sodium gel is an anti-inflammatory cream which works as well as ibuprofen), Icy-Hot, and the Salonpas with Lidocaine patches which are all found over-the-counter. The main side effect to look out for is a rash, but of the many hundreds of times I have prescribed these, none of my patients experienced that so it seems to be pretty remote from my experience. The only complaint I received was that the patches were not sticky enough and would fall off of their bodies and instead stuck onto their clothing. Lastly, use ointments and patches only on intact skin.
Chronic pain is pain that is more long-term. Patients who have had an amputated limb, a stroke, multiple back surgeries, arthritis or other inflammatory diseases are a few examples of chronic pain. We now know that opioids actually do more harm than good. For those who are already on that train, the only solution is to get on the lowest dose possible. For those who have not started, the game is simply to avoid ever having to take them. Taking opioids increases the number of opioid-receptors in our brain which leads to higher pain/lower tolerance and a need to continually increase the dose. Much of the treatment is just as above with a couple of notable exceptions. The first is to highlight ice is *still* useful! Many patients will switch to heat because it feels better, but the truth is you should not abandon the ice packs. The best way to use both is to alternate between the two sandwiching the heat between the ice pack sessions. While heat does bring in circulation and with it the repair cells, it can also increase swelling which can ultimately exacerbate pain. Ice packs will help reduce any unnecessary swelling. Secondly, in dealing with chronic pain, rest is no longer recommended. There may be modified movement, but movement nonetheless. Regular yoga, walking, jogging, biking, whatever! Start low and slow then increase the intensity over the years.
How to begin Mindfulness
I recommend starting by setting an intention first thing in the morning. To get you started, I will brainstorm some ideas specific to dealing with pain:
- Today my pain is welcome to show up how it may, but it will not affect my mood.
- Good morning pain. I see you and I promise I will pay attention to you later, but you don’t get to take over my whole day.
- Today I will only discuss my pain on a need to know basis; it doesn’t deserve more attention than it needs.
- Today I will avoid <insert unhealthy coping mechanism> to deal with my pain.
- Today I will be grateful for all of the parts of Me.
Some people do well with setting this intention in the morning and it sets the mood for the day. I have other patients tell me that it helps their morning but once they get into the routine of the day, they forget. In these cases, I suggest making a visible reminder. You may have a little dry erase board in your office where you can write your intention down as a reminder throughout your day. Some type it out on their phones then save it as their phone’s locked-screen wallpaper. Others use a totem; they might wear a piece of jewelry or bring a picture of a loved one that is motivating them to make these changes. Others don’t have enough privacy at work and have coded reminders such as an alarm that plays a tune that will remind them of their intention. Creativity helps a lot here!
Why is it important to set an Intention?
When someone is in a state of suffering or discomfort, it is human to default into coping behaviors. For someone with pain, they might cope by becoming sedentary, avoiding exercise, reaching for a quick processed meal, treating themselves to sweets, alcohol, or drugs to feel better, and many will resort to negative self-talk. Resorting to coping mechanisms is nothing to punish yourself for. Just note it. Be aware of what your coping mechanisms are. Coping mechanisms exist because they work!! But they work in the short-term and often cause more harm in the long-term. An intention will set your goals for you and your health overall. It helps you remember what your long-term goals are while focusing on what you can do today.
How to meditate with a focus on pain?
Meditation does not have to be in a particular position. You do not need to sit cross legged with your hands on your knees if that does not serve you. I personally prefer laying down on my back except on days when I am sleepy because then I will fall asleep! Often I choose to be seated up in a comfortable straight-backed chair. The point is, find your position of most comfort. If you have a migraine, it may help to lay down with an eye mask to block out the light. If you have lower back pain, it may help to lay down flat with a couple of pillows under your knees. You just want to be able to find your point of maximum comfort to the best of your abilities where you can lay still without frequent adjustments.
“What is here now when there is no problem to solve?”
Loch Kelly
If you are not listening to a guided meditation, you should set a timer. Again, start short when you are beginning. Set your timer for 10 minutes and remind yourself that this is the only time in the whole day that you get to do this for yourself. When sitting down to meditate, the goal should not be to rid yourself of discomfort/pain. The goal is to be curious about what is happening right now. To be in the now. I really love the phrase “What is here now when there is no problem to solve?” which I first heard from Loch Kelly, a psychotherapist and meditation teacher. This turns your attention to this moment with things as they are. Instead of labeling what you are feeling as pain, let’s get curious. Can you describe the pain to yourself with descriptive words? Pin-prickling, burning, throbbing, numbing, etc. Can you feel the borders of it? Can you describe that border? Is it a clear border or does it blur out? Does it change when your focus is on it? Can you make it burn more? Burn less? Start deep breathing and imagine the clean air you are breathing is is bathing the area of pain with healing. You can breathe it out until the timer beeps or move on to an area that does not have pain. For this example, let’s pick the left hand. Notice how this hand feels in space. Can you feel what it is to be a hand? Can you feel the borders of each finger, how one finger feels against the one beside it? Are you able to feel the border of your hand against the floor, or fabric of your clothes if your hand is resting on your knees?
Depending on how much time you allow yourself to spend in meditation, try to scan your body and explore as many body parts as you can individually. End again on your location of pain and notice the difference within it. Does the quality of the pain change? Does the intensity? Then end with gratitude. Notice how good it feels to allow yourselves these few minutes for just you. Gratitude for the parts of you that feel better. Gratitude for the pain to let you have something to compare the non-painful parts to, so that you can appreciate that even more. Lastly, thank yourself for doing the work and showing up for yourself.
In Summary
Pain, like most things in life, will ebb and flow. Always keep this in mind on those bad days. Appreciate the good days knowing full well of how we are all riding these waves. To have pain is to be human; each person experiences it in their own way in their own time. Allow the bad days to occur in peace, knowing these too will pass.
If you still have any questions, please feel free to message me and I may be able to point you in the right direction. Be well!
Resources:
Find a Pain Psychologist Provider (Pain Coach):
https://aapainpsychology.org/find-a-provider/#!directory/map/ord=lnm
Ice Packs, can be found at multiple locations, this is just as an example:
Voltaren (diclofenac sodium) gel:
I have nothing to disclose. I do not profit from you clicking any of these links and encourage you to find what is in your price range. These are simply here to simplify and help point you towards an easy start.