13. Pain

 

From the Physical and Psychological Perspective

 

Statistics regarding chronic pain:

 

1. Over 11 million people experience migraine headaches

 

2. 23 million people have chronic back pain

 

3. 37 million people have chronic pain associated with arthritis

 

4. 3 – 6 million people are diagnosed with fibromyalgia

 

5. 3.5 million people experience pain associated with cancer

 

There are many treatments for the management of pain:

 

1. Pain medication

 

2. Antidepressants (due to their effects on serotonin and norepinephrine – the neurotransmitters)

 

3. Anticonvulsant drugs for some people with nerve injuries

 

4. Topical agents

 

5. Surgery

 

6. Nerve blocks

 

7. Trigger point injections

 

8. Thermal (heat and cold) therapies

 

9. Electrical and ultrasound stimulation

 

10. Chiropractic Manipulations

 

11. Acupuncture

 

12. Biofeedback

 

13. Rehabilitation programs at pain clinics

 

Pain has something meaningful to say and as such it needs to be taken seriously. According to pain management experts:

 

The question is not “why did I get this pain (Why me?)?” The better questions are “What is the source of the pain, How do I manage the pain? What factors influence the pain, and What can I do in order to work with (and live with) the pain?”  

 

Activity level

 

We need to look at our activity level and see if it has decreased due to the pain that we experience. Of course some movements will clearly increase our pain so we can avoid doing them. However, if we cut out our activity in order to prevent pain, there may be a long-term cost. Lack of movement immobilizes muscles, weakness them, and over time increases disability.

 

Has your pain dramatically reduced your own activity level? Are there things you can begin to do slowly but surely?

 

Stress increases the amount of pain we experience. Please consider if any of these stressors are present for you:

 

1. Sensory overload

 

2. Repressing emotions

 

3. Chronic fatigue

 

4. Loss of sleep

 

5. Digestive issues such as constipation or overeating

 

6. Life and living conditions in constant turmoil

 

7. Fear

 

Managing our stress

 

Guided meditations using pleasant imagery and progressive muscle relaxation exercises can help with stress management.

 

On the top of the list for stress management techniques is meditation. It can work on the level of concentration where the mind becomes relaxed and feels peaceful. It also works on the level of insight where you recognize the impermanence of pain (even chronic pain) and the selflessness of the experience (more on this aspect of meditation with the next set of contemplations).

 

Sharing our lives with others is a wonderful way to reduce our stress and gain support for our difficulties. However, when one person in a relationship has chronic pain, sharing this experience becomes more challenging. For example:

 

1. The things you used to do to share time together becomes more difficult

 

2. Time and money previously spent on leisure activities are spent on doctor visits

 

3. Others do not understand your limitations

 

4. Most people are not interested in other people’s pain (we generally only focus on our own pain)

 

5. It is a difficult subject because some people believe that by talking about it, the pain may get worse

 

7. When people see that you are having a “good day,” they may believe that your pain is not that bad.

 

It is very important not to take people’s reaction to your pain personally.

 

Thinking errors in regards to pain:

 

1. Blaming others or oneself for the pain

 

2. Catastrophizing (imagining the worse possible outcomes as a result of having the pain)

 

3. Filtering (only seeing the problematic aspects of the situation)

 

4. Entitlement (thinking that pain isn’t fair)

 

Do you have any of these thought forms?

 

Wisdom is never the answers we get from others, no matter how clear they may be. It comes from asking the right questions so that the answers arise from within.

 

The Buddha asked fundamental questions about aging, illness, and death. He wanted to know how to transform the suffering that all beings experience from those three circumstances.

 

In the next set of contemplations we will shift our orientation regarding pain from a physical and psychological perspective to a spiritual focus.  

 

PREPARATION ASSIGNMENT #35    PHYSICAL PAIN

 

From the Spiritual Perspective

 

One approach to working with pain on a spiritual level is to meet the pain with compassion. The following is an explanation from Stephen Levine:

 

When you stub your toe, more than physical pain is generated; grief is released into the wound, followed by a litany of dissatisfactions and “poor me’s,” a damning of God sent heavenward. When we trip and fall in the darkness we are all too ready to curse ourselves for being so clumsy, as well as for not being able to hold our bladder until dawn, for not counting the hours in our just-expended 1,000-hour light bulb, and the bruise is suffused with self-judgment and an irrational sense of responsibility.

The next time you have a minor wound, such as a stubbed toe or bumped elbow, note how long it takes that wound–when you soften to it and use it as a focus for loving kindness–to heal. Then compare it with the number of days it takes a similar wound to heal when you turn away from it, allowing the fear and resistance that rushes toward it to mercilessly remain.

This softening and opening around pain has been shown in several double-blind studies to provide greater access of the immune system to an area of injury. It opens the vice of resistance into a never-considered acceptance of the moment. It denies hopelessness a home. It proves we are not helpless, that we can actively intercede in what we previously believed we had only to endure.

Working with our pain, or the pain of loved ones, cultivates compassion that allows us to stay one more moment at their bedside when we are most needed. It allows us to not run away.

To open some of our healing potential, soften around the pain to melt the resistance that isolates it. Enter it with compassion, instead of walling it off with fear. Pass through the barricades of fear and distrust that attempt to defend the pain. Let what seems an improbable love–the ultimate acceptance of our pain–enter the cluster of sensations that so agitate the mind and body.

It takes patience to let go of doubt. So many fears warn us against opening beyond the numbness that surrounds pain. But when we allow ourselves to be open to and investigate these fears, we come to see them and our negative attachment to them, our compulsive warring with them, as a great unkindness to ourselves. As we open into our pain we may weep with gratitude when at last the pain does not so much disappear as become dispersed through the gradually expanding spaciousness of awareness.

As pain teaches us that fear can be penetrated by mercy and awareness, from some inherent knowing there resonates from our suffering a perfect teaching in compassion. We find in our pain the pain we all share. Softening around pain with mercy instead of hardening it with fear, the heart expands as “my’ pain becomes “the” pain. Odd as it may sound, when we share the insights arising from our pain we become more able to honor the pain.
 
Following a tributary from the personal to the universal, we can find in our pain the pain of others as well. In our own wish to be free of suffering, others are calling out to be freed from their difficulties. Finding them in ourselves, the loving kindness that we extend to all sentient beings moves Earth toward heaven.

   Friends, the following are some instructions regarding working with pain

   through meditation.   

 

   Feelings, according to the Buddha, are not emotions. Feelings (Vedana Pali) are the  pleasant, unpleasant (painful), or neutral (neither pleasant nor unpleasant)

   quality of all sense experiences.  

 

Every mind moment we are experiencing a sense experience through one of the six sense doors (the sixth sense being the mind), and with every sense experience a feeling arises. The quality of feeling that occurs is beyond our control. It arises because we have made contact with the world in that moment.

 

However, many of us believe that we have control and that we can create a life that only has pleasant feelings. In fact, most people spend their entire lives working towards that end – “What can I do to maximize pleasant feelings in my life?”

 

The issue isn’t the desire to experience only pleasant feelings. It is believing that we have a choice as to what kind of feelings we will experience.  We do not!

 

When we do experience pleasant feelings we say to ourselves, “Ah, my strategy is working.” That tends to reinforce the illusion of control.

 

At the root of our desire to experience these pleasant feelings is a deep universal drive to achieve contentment and a sense of complete fulfillment in our lives – which is possible

The difficulty is that we mistake happiness, which is based upon experiencing pleasant feelings, for contentment which is independent of our circumstances or the feelings that we are experiencing.     

 

The goal in working with feelings as a meditation object is to learn how to be present with or open to these feelings so that we can realize that they are impermanent, unsatisfactory, and selfless.

 

To say that feelings are impermanent means:

 

1. They are actually pulsations of feelings which arise and fall away from moment to moment.  

 

2. The place that the feelings arise keeps changing. For example, we may believe that we have a “pain in the knee.” In actuality, the place that we experience the pain within the knee area keeps shifting. It is only because we avoid directly exploring the pain that we miss this important insight. Try to  notice this about pain.

 

3. The sensations in the body that are associated with the feelings keep changing (for example, they may change from warmth to cold, from pulsation to pressure, and so forth).

 

To say that feelings are unsatisfactory means:

 

1. Pleasant feelings do not remain and there is nothing we can do to prevent their dissolving.

 

2. Unpleasant feelings can cause grief, resistance, fatigue, and other unpleasant side effects.

 

To say that feelings are selfless means:

 

1. The feelings arise due to causes and conditions and “we” cannot control them.

 

2. In actuality, it is only a moment of consciousness along with feeling as its object that arises and passes away. There is no self or individual who is personally having the feelings. I do understand this realization is very difficult in the midst of severe pain so you may wish to reflect on this after the pain subsides

 

As a consequence of recognizing these three characteristics, we experience peace and freedom from suffering. So how do we go about realizing these characteristics? As you know, a great training ground for this experience is through insight meditation.

 

While focusing on your breath whenever pain arises in the body and you become aware of it, simply notice its impermanent nature and gently but firmly go back to working with the breath.

 

However, when pain becomes intense or apparently unrelenting and your mind is called to that feeling again and again, shift your focus from the breath to that painful feeling. This is an opportunity to experience the true nature of feelings on a deeper level.

 

Be careful that you do not get hooked in the mind’s stories such as, “Not my knee again, maybe I should stop sitting, I wonder how bad the pain will get, what if it doesn’t let up, should I change positions,” and so on.

 

Instead, we need to open to the pain. Some other descriptors of opening to the pain are to relax into the pain, allow the pain, become intimate with the pain, surrender to the pain, or become one with the pain.

 

Although our first impulse is to fear, resist, or avoid the pain, when we begin to focus on it we find that it is not as bad as we thought it would be. Most of the suffering we experience comes from our contraction around the pain. When we open to the contraction and it relaxes, we are able to directly experience the painful feelings themselves. Remember that if resistance to the pain takes center stage, that resistance becomes the new object of meditation for the moment.

 

Non-cognitively open to the pain in the present moment. There’s no need to label the feeling, to justify it, to analyze it, to reflect on it, or wonder about it. Let the feelings themselves reveal their true nature – that they are impermanent, unsatisfactory and selfless.

 

Pain is a part of life as is pleasure. However we do not have to suffer because of it. We will cover feelings in much greater depth when we move into the Second Foundation of Mindfulness.

Share this with anyone who may benefit.