Introduction
Pain is a constant in life, it’s not a question of if but when. At one time or another, we will all experience pain.
The purpose of today’s session is to start exploring how mindfulness practices can help us work with strong sensations and pain. The American doctor Jon Kabat Zinn taught mindfulness meditation to his patients with chronic pain with great success (MBSR). Studies of people with chronic pain conditions undergoing MBSR (Mindfulness Based Stress Reduction) show a dramatic and consistent reduction in the average level of pain during the 8 weeks of the programme.
We will start with investigating our habitual reaction to unpleasant sensations or pain, and how this creates more suffering. This will lead us to explore how mindfulness can help us shift to a more skilful response to unpleasant sensations, which involves relating to them differently. Finally we will explore a number of specific mindful strategies that we can use when we experience strong sensations during practice and in life, that lead to more well-being and freedom.
- The conditioning to reject pain
Pain is the body’s messenger telling us that we need to pay attention, and take care the best we can, by avoiding further injury and looking after the body. As the Persian poet Rumi says– “These pains you feel are messengers, listen to them”
Rationally, we understand that pain is a signal to pay attention, that we have to take care of something, but when we experience it, we tend to react negatively to pain, to think that something is wrong and that it needs to be controlled.
We all have a conditioning to not like pain.
We do it because we are conditioned to resist and push away unpleasant experiences, and to want to retain pleasant experiences. This is happening moment to moment, the meditation teacher and psychologist Tara Brach calls it the dance of sensations and our response to them.
Very often when we’re in pain, the world can get very small and our mind starts obsessing, our body and heart contract, we become completely identified with our pain.
I know, I do it. The day I was going to prepare for this talk I woke up with a sharp pain in my middle back, so I could observe first-hand my habitual reaction to pain. I started worrying about what it meant, making up stories about it, why did it happen, what did I do wrong, I shouldn’t have…, blaming myself, catastrophising…
Our habitual strategies to deal with pain are: to dissociate from the body, distract ourselves from the pain, ignore the messenger and stay busy, tell ourselves worry stories about the pain and what it means, we obsess on how to fix it, we blame ourselves or others for being sick or in pain.
We become a defended self, a separate self, a small self.
Self-reflection: closing the eyes for a moment and asking yourself: How do I respond to pain? Bring a curious and gentle attention to your own patterning, without judging yourself for it. How do you relate to pain? Maybe think of the last time that you had a headache, or the flu, or a sore back…Was pain the enemy? Did you feel that something was wrong, did you try to control it, or ignore it, was there any mental obsessing? Or did you try to remain present and listen to the messenger?
Sense what it feels like when you resist the pain, do you notice a sense of separation or oppression?
And opening the eyes again.
- What mindfulness teaches us about pain
One key teaching in mindfulness practice is that pain is inevitable, and suffering is optional. Pain is universal, every living creature will experience pain.
The experience of unpleasant sensations on their own is not suffering. Our suffering depends on how we are relating to these unpleasant sensations, what we add to these sensations. It arises when we have a reaction of aversion to the pain and then we contract against the pain, we resist it. Any moment that we resist our reality we suffer, because it creates a sense of separation, we no longer feel that we are part of the flow of life. In the moments that we are trying to control pain and pleasure we are not fully present in the moment.
This can be illustrated by the following equation: Suffering = pain x resistance or worry
Pain is a constant in life, but we can change our relationship to it. If I have pain and I worry a lot about it, the resistance goes up, so I suffer more. But if I have pain and I open to it, I make space for it, then there is no resistance and no suffering. We can apply use numbers to illustrate how this works. For example, we can have pain of 4 (a mild headache) but a resistance of 7 because we worry it might develop into a full blown migraine, which creates a suffering of 28. If we only have a mild resistance to it (maybe 3) because we are not prone to getting migraines and so we are not worried about our headache, our suffering is a lot less (12).
We can have pain and not resist it because we know it is okay: for example, people who do weight-lifting, or people who get tattoos or piercings, or women giving birth naturally .
I experienced this at the birth of my children, I had prepared for a natural birth using hypnobirthing, and no medication. Hypnobirthing teaches to change the vocabulary we use to describe our experience during birth, for example to use the words intense sensations instead of pains, and waves instead of contraction, we are taught to trust the body, “that it knows what it does”, to open to our experience, and let life run through us, it instils in us a deep knowing that nothing is wrong, it is just very intense sensations, it is normal. While I cannot say that the birth of my children was pain free, they were both relatively smooth while still intense, as I trusted in the process and gave in to the sensations as best I could, instead of fearing them and resisting them.
We experience resistance or worry around pain when we think that it is an indication that something is wrong.
In Buddhist psychology it is called the second arrow. First we get pain or we get sick, that’s the first arrow, and then we think that something is wrong, we worry on how much worse it will get and how long it will last, we start blaming ourselves or others for the sickness or the injury, and that’s the second arrow, it adds to our suffering.
Here is what is written in the Sallatha Sutta, on the The Arrow: The Blessed One said, “When touched with a feeling of pain, the uninstructed run-of-the-mill person sorrows, grieves, & laments, beats his breast, becomes distraught. So he feels two pains, physical & mental. Just as if they were to shoot a man with an arrow and, right afterward, were to shoot him with another one, so that he would feel the pains of two arrows; in the same way, when touched with a feeling of pain, the uninstructed run-of-the-mill person sorrows, grieves, & laments, beats his breast, becomes distraught. So he feels two pains, physical & mental. As he is touched by that painful feeling, he is resistant.”
- Mindfulness strategies to help us work with strong sensations / pain and reduce suffering
Awareness is the antidote to suffering.
There is an old saying that awareness is like a container of water. If you place a tablespoon of salt into a small container of water, let’s say an expresso cup, the water will be too salty to drink. But if you place it into a much larger container, for example a bath tub, then the water won’t taste as salty. We have simply changed the ratio of water to salt.
Awareness is like that container of water. When we cultivate mindfulness, that is when we increase the mind’s capacity for being aware or mindful, we are able to adjust the ratio of the experience of awareness (the water) to the object of our awareness (the salt).
It means that with increased mindfulness our awareness of the pain changes. We are aware not only of the pain but of many other experiences that are not the pain. We realise that we are not defined by our pain, we are much bigger than our pain.
Bringing self-compassion
Awareness allows us 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 need to 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.
When we notice that we are in pain, 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. Vietnamese Buddhist teacher Thich Nhat Hanh “I care about your suffering”. Remind ourselves that other people experience this too.
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.
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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.
We can start with deepening our awareness of the physical sensations: we practice noticing the changing sensations, a constellation of sensation rather than a pain continuum. Taking it moment by moment we become aware of the impermanence of all sensations, there might be pain at one moment, and not at another moment. It creates space for other experiences like joy or beauty to be felt at any moment, instead of the continuum of pain.
Then we can deepen our awareness of our emotions around the pain: We might be aware of anger or grief, sadness, about the loss of life that comes with the pain. Using the RAIN practice for working with difficult emotions that we have practiced before (Recognise, Allow, Investigate and Nurture), we can learn to bring nurturing to the part of us that suffers, and soothe these difficult emotions. Offering acceptance and loving presence to our emotions, instead of being overcome by them.
And finally we can become aware of our thoughts, stories, attitude towards the pain: Our mindfulness teaches us to let go of the fear-based story around the pain, to release it, to recognise that those are just thoughts and that we don’t have to believe them. We can see how the mind’s stories create a lot of our suffering, and bring self-compassion to ourselves, recognising that it is hard right now.
The poet Mark Nepo describes being terrified of pain when he started his cancer treatment. Here is what he writes about the bone marrow tests: “For the first time I realized I had a choice. The pain of those seconds would be the same, but I could ground myself, including my fear, in the very real fact that my life would resume after those 50 seconds. There would be light after the air, once again, after the pain. For the first time, I felt in my soul that I was larger than my pain. This empowered me. So many times, in our despair, we see our pain as something that will never end. In fact, this often defines our moments of despair: when we believe that our pain contains the rest of us. In contrast, there is this sense of peace to work toward: the belief that our life contains our pain.”
Conclusion
We all have a conditioning to not like strong unpleasant sensations and try to push them away, but our habitual strategies to deal with pain actually add to our suffering. Mindfulness teaches us how to cultivate a wise relationship with pain, so we can get access to our body’s intelligence, and as we shift from being reactive to pain, we can become the open presence that witnesses the sensations coming and going, without identifying with them. This is what we are going to practice today in our guided meditation. We will explore more mindfulness techniques for working with intense pain next week.
