By Nicola Davies, Ph.D.
Arthritis is one of the world’s leading causes of pain and disability. According to both Arthritis Research U.K. and the Centers for Disease Control and Prevention (CDC) in the U.S., over nine million people in the U.K. and more than 52 million in the U.S. suffer from the condition. To those living with arthritis and other forms of persistent pain, the experience can be both physically and emotionally crippling.
For Vidyamala Burch, car accidents and surgical procedures during her teenage years had made spinal pain and partial paraplegia a constant and defining part of her adult life. However, she is a living example that chronic pain can be managed effectively. Burch is the founder and co-director of Breathworks, an organization that provides training and guidance for the management of chronic pain, stress and illness. The organization advocates for mindfulness, a concept that has helped Burch cope with her own pain for the last four decades.
“Mindfulness has given me my life back!” says Burch. “I’ve discovered that the present moment is bearable. I’ve learned to appreciate the good things in life that co-exist with my pain.”
What is Mindfulness?
Mindfulness involves being fully aware of the present experience. It is a state of mind in which emotions and concerns are neither judged nor acted on; they are merely observed as if from a distance. It clears the mind of emotional clutter and distractions that tend to create fear and an exaggerated and threatening perception of the present experience. Mindfulness cultivates awareness, contentment, patience and self-control. Often, it is associated with calmness and relaxation because it involves practicing meditation, but it is far from being a passive activity. Mindfulness is living within the present experience and accepting current conditions as openly as possible without allowing concerns about the past and worries about the future to affect your current mental state.
Mindfulness for Chronic Pain
Although mindfulness primarily is a psychological practice, it also is a widely accepted method employed to deal with physical pain. A 2010 publication by Robert Schütze, Clare Rees, Minette Preece and Mark Schütze for the International Association for the Study of Pain considered mindfulness the mental state of purposefully paying attention to chronic pain and to one’s thoughts about that pain. In this sense, mindfulness is an active mental process of understanding the situation surrounding the pain and deciding not to allow it to overwhelm you.
“This means you learn to accurately perceive your experience and to make choices as to how you respond,” explains Burch. “Mindfulness is the ability to live in the moment, to call the mind back from fretting over the past or future again and again and to be with whatever is happening right now.”
Burch believes mindfulness is so effective because it provides an accurate perception of how things are, thereby allowing people to let go of habitual distorted thinking and emotional patterns. “I think everyone is longing for the kind of peace and freedom mindfulness can bring, which is why it has gained so much popularity. People quickly recognize the truth of it.”
She differentiates between the two elements of chronic pain: the primary and the secondary suffering. Primary suffering refers to the physical discomfort in the body, while secondary suffering refers to the psychological discomfort from resisting the pain, which ultimately manifests as anxiety, depression or tension. According to Burch, “Mindfulness teaches you how to accept the primary and overcome the secondary, thereby reducing your overall pain greatly.”
Studies support Burch’s claims as to the effectiveness of mindfulness. In a 2008 study by Alex Zautra and colleagues, mindfulness was found to benefit people with rheumatoid arthritis and recurrent depression, both in terms of emotion regulation and in physicians’ ratings of joint tenderness. More recently, a 2015 chronic pain study by Dr. Peter la Cour and Dr. Marian Petersen suggests mindfulness has significant effects on lowering general anxiety and depression and improving psychological well-being, pain acceptance and perceived control of pain.
A Case Study of Mindfulness
Other practitioners of mindfulness have been successful in managing their personal conditions. Louise Alison Jensen, creator of The Happy Starfish blog, had a pre-existing pelvic condition that was exacerbated by a car accident several years ago that also damaged her lower spine. “I was left with very limited mobility and suffered chronic pain, which then led to clinical depression and an anxiety disorder. The more pain I felt, the more emotionally distressed I became. The more emotionally distressed I became, the more pain I felt. I was stuck in a loop,” recounts Jensen.
When she began practicing mindfulness, Jensen recalls, she experienced an initial struggle. The practice involved highlighting the pain, which can cause temporary additional discomfort but which she says is normal during the first few weeks. Gradually, she felt improvements and began to see pain as something that visited her body, not something that defined who she was. “As I stopped resisting the pain,” she says, “my tension decreased, my muscles began to relax and my pain lessened.”
Jensen learned that mindfulness meant being grateful for all that she had at present. “Before mindfulness, I felt despair when I thought about all I had lost and worried about how the rest of my life might be with pain and disability.” Leveraging her learning and experience with mindfulness, Jensen has since expanded her practice through classes and training. It eventually led her to become a mindfulness mentor for others living with chronic pain, anxiety and depression.
Learning and Practicing Mindfulness
Although Jensen recounts the initial struggle she experienced during the first few weeks of her practice, she notes that mindfulness dispelled the need for excessive medication. Since it is inexpensive to deliver and does not require any high-tech equipment, Burch says learning to practice mindfulness is relatively easy and practical. “Mindfulness is very simple. It doesn’t require a complicated theory and anyone can practice it, regardless of education, creed, gender or color. It is a universal quality of mind that anyone can cultivate when he or she is trained effectively,” she explains.
To begin the practice and hone the skill of mindfulness, here are five exercises for dealing with chronic pain.
Body Scan Meditation: Body Scan Meditation is a simple method of guiding one’s awareness inside the body. “I would recommend this as the best place to start when you have pain,” encourages Burch. This practice can be done while lying down or sitting up. Body scanning requires letting go of worries or tasks for the day by directing your full attention toward the different parts of the body, especially to areas where there is tension and pain. The goal simply is to get in touch with the physical body and be aware of every sensation from the head down to the toes, without feeling the need to interpret and change it.
Breathing Awareness Meditation: According to Burch, Breathing Awareness Meditation introduces a space between you and your troubles. Breathworks, the mindfulness center Burch founded, provides online audio guides for meditation centered on the breath, which can be done in 10 minutes, five minutes or just one minute. In each case, you begin by adopting one of three postures found to be most comfortable: lying on a mat, sitting on a chair or standing up. You must remain still and allow your weight to sink down into gravity and experience the breath.
If there is any feeling of tension, you must knowingly let go of those areas by softening the body, using the effect of gravity and with every careful exhalation. Thoughts may come, but you mustn’t engage in them and instead must allow them to simply pass through the mind. Thoughts are observed like clouds in the sky. Awareness must be anchored into the breath and, with every breath, you will feel the difference in sensation in the front, back and inside of the torso.
When the mind begins to wander, you must guide it back into the breath and follow the breath as it flows along the entire body. When the allotted time for meditation ends, slowly open your eyes, reawaken the fingers and toes and reengage in the activities of the day, while bringing along the awareness cultivated during meditation.
Tension Release Meditation: For chronic pain, it is common for tension and stress to build up in certain areas of the body such as the neck and back. Tension Release Meditation aims to dissolve this tension. The practice is, in many respects, similar to Breathing Awareness Meditation, but focuses the breath on the specific problem area. To release tension, you need to soften the shoulders, face, jaw, throat, belly and then, finally, the whole body. If there is pain, you accept it as much as possible. That acceptance needs to be cultivated. The breath should bring care and tenderness to the problem area. If other areas of the body begin to build tension, you can release your weight into the floor and let the discomfort be settled by the rhythm of the breath.
Emotional Clarity Practice: When a person is immersed in the experience of chronic pain, it is easy for emotional chaos to settle in. Fear, insecurity and other negative emotions can cloud your perceptions of yourself and the outside world. These negative emotions compound in the form of secondary pain, as Burch refers to it, and could take the form of stress, anxiety or depression. Emotional clarity makes you aware of your feelings and allows you to take charge of habitual reactions so you can build a more compassionate relationship with the pain experience. A person suffering with chronic pain can feel more integrated and become less resisting of the pain experience.
Beginners in the art of mindfulness can spend once a week “riding out an emotion,” as Gil Fronsdal, founder of the Insight Meditation Center in California, describes the process. When there is a strong emotion such as desire, fear or contentment, you are enabled to observe the emotion and how it begins, escalates and, finally, subsides. There is no need to act on the emotion, but instead just understand how it changes throughout.
Emotional clarity also involves a daily practice whereby a person makes a concerted and mindful effort to segregate emotions between positive feelings, such as joy, and negative feelings that bring with them a state of preoccupation, such as anger. Furthermore, this practice can help you recognize an emotion, define it, accept it and observe its sensory experience to understand how it leads to physical tension.
Walking Exercise: Meditation doesn’t always involve being still; cultivating awareness also is possible through a walking exercise. This practice aligns the movement of the breath, mind and body into one rhythm. It begins with a slow-paced walk during which you connect with the breath and observe the rise and fall of the chest. The focus is on the feet, noticing every step and how the ground puts pressure on each sole, as well as observing if there is any discomfort or imbalance. This progresses to an awareness of the different sights moving past, noticing the details of both familiar and new objects. The practice also includes being aware of the sounds both inside and outside the body, along with the scents that come and go through the nose while you are breathing. The Walking Exercise consists of being mindful of the breath and the mobility of the body within the world, and its practice can continue throughout the day as you re-engage with other activities.
Mindfulness is more than relaxation. It is an active mental activity that allows a person struggling with pain to be aware and accepting of the experience without becoming preoccupied with catastrophizing and negative emotions. Practices such as meditation, emotional clarity and walking can empower you to embrace pain and get more out of life.
Nicola Davies is a health psychologist, counselor and freelance writer who provides one-to-one self-management consultancy to people living with chronic conditions. You can follow her on Twitter (@healthpsychuk) or sign up to her free blog: http://healthpsychologyconsultancy.wordpress.com.
Last Reviewed Reviewed October 13, 2015.
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