Emotions, thoughts, and perspectives can all have an impact on the way we experience pain. Non-pharmacological interventions such as mindfulness are becoming more widely researched and are viable alternatives or adjunctive therapies for individuals living with chronic pain. Mindfulness-based approaches have been found to positively impact individuals with various pain conditions in terms of decreasing pain, improving quality of life, functioning, and pain acceptance (Bawa et al. 2015).
What is Mindfulness?
Mindfulness is defined as, “the awareness that arises when we pay attention to what is happening in the present moment, nonjudgmentally; right in the here and now” (Gardner-Nix & Costin-Hall, 2009). It is easy to get caught up in judgments – the ways we assess whether a situation, an emotion, an experience of pain, or a thought is either good or bad. Mindfulness brings an awareness of the present moment and allows us an opportunity to reframe our thinking and our experience of the world.
Mindfulness can be challenging for many reasons; however, in this practice, one must not push away, reject, or deny physical or emotional pain. Mindfulness approaches challenge us to develop a compassionate, open-minded acceptance of the pain. This includes acknowledging and even, at times, embracing intense pain, negative affect, and all aspects of the self.
There are still some unknown factors about exactly how mindfulness works to help with chronic pain management. One way that mindfulness works to reduce pain is by activating the parasympathetic nervous system. The autonomic nervous system controls involuntary functions such as heart rate, breathing rate, and blood pressure. These are things we don’t have to consciously think about for our body to do. When we are experiencing pain and stress, it is likely that our sympathetic nervous system, or the “gas pedal” is in overdrive, initiating our “fight or flight” reactions.
Mindfulness helps to reduce our stress levels and pain by activating the parasympathetic nervous system, which is the “brakes” or the “rest and digest” system. When the parasympathetic system is activated, our breathing rate slows and our heart rate slows. Mindfulness allows us to move to a state of relaxation, reducing our stress levels, and consequently giving us a clearer, more peaceful state of mind.
Mindfulness also helps us to develop more psychological flexibility and acceptance towards our pain. Rather than waking up in the morning and assuming that the entire day will be impacted by our pain, mindfulness allows us to observe the pain non-judgmentally, avoid catastrophizing, and build an understanding that pain does not define a person. Rumination and negative thoughts or attitudes may amplify the impacts of chronic pain. Using techniques such as meditation, we are able to focus our thoughts in a more controlled manner on other thoughts that do not revolve around pain or the experience of pain. This brings about a sense of calm, control, peace, and decreases our emotional reactivity to situations.
How is it done?
Mindfulness can be practiced anytime, anyplace, and anywhere. Mindful breathing is an excellent place to start. Often when we are in pain or stressed, our breathing is tight and shallow. We forget to take deep, slow, even breaths.
Diaphragmatic breathing, or deep breathing, can be done by placing one hand just below the rib cage and one hand on the chest. Notice where your breath goes. Now, try to send the air in and out of your belly. Breathe in “calm” and breathe out “pain” in your mind. Try this exercise for 5-10 minutes each day. If your thoughts wander, as they may, just try to bring them back to your breathing and the sensations you are experiencing.
Other techniques for mindfulness practice include mindful walking, mindfulness meditation, and imagery, and progressive muscle relaxation (PMR). For example, muscle tension often goes alongside pain and PMR focuses on relaxing the muscles, one at a time, which should be paired with breathing. Work through all muscle groups, both on the left and on the right side of the body. This exercise is best done lying down.
Another method that can be incorporated into pain management practice is taking a mindful “SEAT.” Sit up, take a few breaths, then engage in a check-in with yourself. “S” stands for senses and sensations. Think like a scientist or a movie director. What is the information your senses are receiving in this moment. Try to describe it without judgements or absolutes. “E” is for emotions. What emotions are you experiencing in this moment? “A” is for actions. What do you feel like doing or saying? “T” is for thoughts. What am I thinking right now? It is helpful to set an alarm on your phone or watch to remind you to take a mindful SEAT at various points in the day.
Mindfulness provides an opportunity to free ourselves from judgments and the habits this creates within our minds and bodies. Enter into meditation and mindfulness practice with an open, curious, child-like mind, and you may find that you can reap the benefits with practice and commitment. Mindfulness can be active, like mindful eating or walking, or more passive, such as observing thoughts or engaging in a guided meditation. Aim to incorporate at least ten minutes of mindfulness into each day.
Try what works for you and experiment with different mindfulness approaches until you find a technique that helps to build an acceptance or balanced perspective of your pain. In so doing, it is possible to decrease the suffering and emotional distress, allowing us to lead fulfilling, satisfying lives despite the experience of living with chronic pain.
Bawa, F. L. M., Mercer, S. W., Atherton, R. J., Clague, F., Keen, A., Scott, N. W., & Bond, C. M. (2015). Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis. Br J Gen Pract, 65(635), e387-e400. https://www.ncbi.nlm.nih.gov/pubmed/26009534
Gardner-Nix, J., & Costin-Hall, L. (2009). The mindfulness solution to pain: Step-by-step techniques for chronic pain management. New Harbinger Publications.