Mindfulness & Chronic Pain: article

By Kate Partridge, Ph.D.
Published in Winter 2012 Issue of The Health Professional magazine.

The term “mindfulness” has recently become a buzzword in the health field, and with it comes the implication that it can be a panacea of some kind. Many health professionals hear the term and wonder what mindfulness is or how it might be helpful, even transformative, for their patients – and often for themselves.

The growing body of scientific research literature about the benefits of mindfulness is easily accessed through the Internet. In addition to numerous studies showing significant physical and emotional benefits to patients with a wide range of health problems, recent very exciting neurological studies are revealing the structural and functional brain changes that are associated with these mindfulness-related clinical improvements. An excellent resource in this regard is the Mindfulness Research Monthly (www.mindfulexperience.org).

Mandy (name changed) is a woman in her 50s whose leg was crushed under the wheel of a moving bus about five years ago. In addition to becoming significantly disabled, she has suffered severe and unremitting pain. She is also highly sensitive to medications of all kinds and has been unable to take a number of medications that might have been helpful, including anti-depressants. Three years ago Mandy took an eight-week course in mindfulness meditation and she has continued in individual counselling. The mindfulness meditation has been an enormous help to her. “My personality type is hyper and anxious, and I’m a worrier. Paying attention to what is going on helps me to stay calmer. It’s a wonderful reprieve from all the stress. I’ve also learned to relate to my leg and to the pain with kindness and sympathy, not with the anger and fear I had before. This has allowed me to accept the pain for what it is and feel more relaxed about it, and it has also helped to diminish the pain itself.

“It gives me a lot of pleasure to know that I can bring myself out of that anxious hyper state without having to depend on drugs – and I’ve tried a lot of them. Mindfulness meditation is very real, something I can do for myself, and with practice I’ve gained some control over my situation and can impact it positively. It has been a huge breakthrough for me to learn to accept the pain rather than resisting and fighting it.”

Susanna (name changed) is in her 40s and has suffered from fibromyalgia for the past 16 years, as well as painful recurrent bladder cancer. After only eight weeks of daily mindfulness practice, she noticed a significant reduction in pain. Now that she has been practising meditation daily for nine months, she has been able to make a huge reduction in the amount of pain medication she is taking: she stopped the Sentanyl patch completely and her consumption of narcotic medication has decreased to about an eighth of what it was. Susanna is sleeping better, and she feels happy and content even though she still has some pain.

“I’ve made peace with the pain. We were at war – I was angry and resentful about it – I had gone from being an accomplished athlete to zero because of the pain, and I hated it. Now I don’t do this. I treat myself and my pain with compassion. This has given me the drive to get out and help others move in the same direction, and I’m taking courses now to become a meditation teacher.”

In health and rehabilitation settings, mindfulness meditation can be invaluable in helping patients to better regulate their health. Within two or three weeks of daily meditation practice, patients begin to experience a marked improvement in their ability to relax physically. More importantly, many patients notice they are less emotionally reactive to the stresses of their illness, injury or chronic pain. Over time, they become kinder to themselves and they are less likely to be angry with or frightened by their illness or pain, which significantly reduces their stress load. What is changing and improving is their relationship to their pain or illness. Finally, they become more aware of the connections between what they think, feel or do and their health or pain status. This makes it easier for them to take more responsibility in regulating their own health behaviours.

For a helping professional to be able to effectively teach clients mindfulness skills, there is a very important prerequisite: the professional herself or himself must have a personal daily practice of mindfulness meditation. Reading about mindfulness meditation is not a substitute for developing the language of awareness that grows with the practice. It isn’t possible to understand the gentle but powerful changes that arise from mindfulness practice without doing it yourself, on a regular basis. When you cannot understand this, you cannot properly support your clients in their practice.

To understand how it might be useful to you, as a health professional, to learn to practise meditation, think about the stress in your own busy life. How do you keep your nervous system balanced – both energetic and calm – in the face of this stress?

One central skill is to be able to recognize when your nervous system has been spending too much time being stimulated by the sympathetic nervous system and not enough time being restored by the parasympathetic nervous system. The sooner you can notice this imbalance, the easier it is to re-establish your centre, which is where you will have the best access to both your energy and your calmness. Mindfulness meditation and other mindfulness practices are designed to cultivate this ability.

A very useful definition of mindfulness comes from Dr. Jon Kabat-Zinn, the founder in 1979 of the first hospital-based mindfulness program (Mindfulness-Based Stress Reduction or MBSR). You are being mindful when you are paying attention, on purpose, in the present moment – without making any judgments about yourself or what you are attending to. This seems pretty simple, but in fact it is not at all easy to do in any sustained way. And yet there are enormous benefits, psychological and physical, to being able to bring a sustained mindful and non-judgmental presence to whatever you are doing.

Mindfulness meditation is a systematic way to cultivate mindfulness. Although it is derived from the 2500-year-old practice of Buddhist meditation, it is not a religious practice, nor does it require any particular belief system. In fact, it is more useful to think of mindfulness meditation as a kind of physiotherapy for the mind. Through the practice, you become very intimate with the patterns of flow of thoughts, emotions, physical sensations and actions that make up your here-and-now reality. This increased awareness allows you much more choice in how you respond to the circumstances of the moment.

Several different mindfulness techniques are taught in MBSR, and to be effective, they must be practised on a regular basis. They each cultivate the ability to focus attention deliberately (that is, to concentrate) in a fluid and flexible way that stays alert to the nuances of moment-to-moment changes in the field of awareness, including sensory experiences, body sensations, emotions and thinking. In the body scan, there is a systematic scanning of sensations throughout the body. In sitting meditation, the focus of attention is a specific area (usually somewhere within the chest or belly) and on the sensations that ebb and flow within this area as the breath goes in and out. There is no attempt to breathe in any particular way nor to deliberately relax the body (although this is often a side effect of these practices). The benefits are broader and deeper than mere relaxation.

In these practices, there is no attempt to stop thinking. This is a common misconception about mindfulness meditation. People say, “I could never meditate because I can’t slow my mind down.” However, meditation was designed for the purpose of slowing the mind down; a slowed-down mind is not a prerequisite. We call it the “practice” of meditation because we’re not naturally skilled at paying attention, on purpose, non-judgmentally. Developing any skill takes practice.

From a more subjective viewpoint, the benefits of mindfulness meditation include an increase in emotional stability or equanimity – being able to stay calm and grounded regardless of what is going on around you and inside you. At the same time, you have the luxury of much fuller and richer sensory experiences of food, music, art and sex, for example. Perhaps most beneficially, the practice of mindfulness leads to a broader, deeper awareness of and compassion for oneself and for other people, thereby enhancing your personal and work relationships. If you are a helping professional, your work can be transformed by your increased inner calm, your open, clear and non-judgmental awareness of clients, and your compassion.

Here are a couple of very practical reading resources that may kick-start your meditation practice, each accompanied by a CD with guided meditations: • Real Happiness: The Power of Meditation by Sharon Salzberg • A Mindfulness-Based Stress Reduction Workbook by Bob Stahl and Elisha Goldstein

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Dr. Kate Partridge is a registered psychologist in private practice in London, Ontario. In addition to working in groups and with individual clients within the framework of mindfulness-based cognitive behaviour therapy, she teaches workshops to train health professionals of all kinds to develop a mindfulness approach to stress and pain management with their own clients. She also offers a certification course called Rehabilitation Stress Management. www.drkatepartridge.com