Mindful strategies for intense pain


Last week we started exploring how mindfulness can help us relate differently to strong sensations in the body. We learnt that pain is inevitable and suffering is optional. Suffering is created by our reaction or resistance to the pain. The more we resist, the more we suffer. Instead, with awareness, we learn to bring a kind and mindful attention to the pain and to our resistance to it. By doing this, we can stop identifying with it.

We start with the second wing of mindfulness: allowing our pain with loving presence, saying “yes”, “you belong” to the pain and to the resistance that arises.  Doing this creates a space, a tender presence that can hold the pain and the resistance with compassion

The first step is to bring kindness and self-compassion to ourselves, like we would do to a child who has hurt herself. This can elicit a softening and opening at the heart, and bring in a sense of relief..

Then we deepening our awareness with the triangle of awareness: we can break our experience of pain down into three parts, the physical sensations associated with the pain, the emotions that are triggered in us, and our thoughts about the pain, our pain story, how we relate to our pain. With awareness we can start to untangle these three components and realise how our emotions and thoughts about the physical sensations that we experience add to our suffering.

Today we are going to explore specific strategies we can use when confronted with intense pain.

Working with intense pain:

The same principles as for less intense pain apply such considering the pain experience as an unpleasant constellation of sensations. When we attend to our experience of pain moment-to-moment, we begin to notice the impermanence of all experience, how the sensations change moment-to-moment: they might increase, decrease, spread or consolidate, harden or soften, transform, move, spread or wane….

If the sensations are intense, it is important to go slowly, deepen our attention a little at a time, so we don’t feel overwhelmed. We might need to practice resourcing first before contacting the area of intense pain.

What is resourcing?

Resourcing is simply moving our attention away from the strong sensation to a pleasant or neutral area in the body, or to connect to something external to the body, to an image, message or memory that gives a sense of ease and safety. This aids the sympathetic nervous system to relax the body. When we practice resourcing, it can also help to visualise ourselves as the ocean, holding the waves the pain. Picturing and sensing that we are larger than our pain.

We can also use a technique called Titrating and pendulating

Titrating means contacting just a little of the felt intensity at a time, this allows you to include and integrate the experience in a stable and mindful way. We go back and forth between the pain and our chosen pleasant or neutral place. It helps to create more space and ease in relating to the intense pain. We call this back and forth movement “pendulating”.

For example: if you experience very intense back pain, you can call this painful area Zone 1, and the area of neutral or pleasant sensations Zone 2. First, take some time to establish a mindful presence in Zone 2, letting the neutral or pleasant sensations soothe and stabilise your nervous system.

Once you have established enough stability within yourself, you can start exploring with mindfulness the unpleasant sensations in Zone 1. You do that slowly and a bit at a time, returning to Zone 2 every now and then, to help you create more space and ease in relating with the painful area.

You can also titrate and pendulate using your breath and the resource of the open space around you: breathe in and gently contact the area of pain. With the out-breath, imagine letting go in the boundless space around you. Gradually, you will be able to experience the space bathing and infusing the sensations, and to become less identified with them as they release into space.

Extending on this, you can use your imagination, sense of sight and hearing to reconnect with the space that is always here, within and around you. Start with the external space around you, using a soft gaze or listening to the sounds around you to sense the space all around you.

Then you can start sensing the space within you, sensing a soft space of awareness around the strong sensations, imagining the sensations floating in that space.

Later you might be able to begin to sense the space inside the sensations. Just as there is vast space inside an atom, within all cells, there is vast space inside sensations as well. Visualising the space around and within the sensations can help to shift your relationship with strong pain.

It is also very important to know when to turn away from our pain, when it becomes too intense. Our awareness helps us to recognise when we are strongly contracted, reactive and off balance.

It can be helpful to use the resource of the breath and to practice relaxing with the outbreath. Making the breath long and deep, matching the length of the in-breath with the length of the out-breath, without pausing between them (coherence breathing). It calms the nervous system and can help to relax with what is happening.

And remember that working with pain can be exhausting, and it is wise and compassionate to take a break whenever we need and to engage in another activity, to regain perspective and balance: watching a movie, going for a walk in nature, listening to music, calling a friend, taking some medicine…


Source: Tara Brach and Christiane Wolfe, Mindfulness Meditation Teacher Certification Programme 2020

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