Making pain less troublesome - a mindfulness case study
Making Pain Less Bothersome:
A Mindfulness Case Study
Carmen hobbled into my clinic grimacing. I knew something else was going on, that was going to have a profound effect on her normal psychotherapy session.
Carmen had slipped disc in her back and was in excruciating pain. She entered my office, sat on the couch whilst wincing and quickly asked if she could lie down. Of course I said yes. We commenced the normal session reviewing events since the previous session, but we were seriously distracted by her squirming and grimacing and inability to concentrate. My tranquil approach did not have the usual effect of calming her down. Such is the effect of severe pain!
Putting on my doctor’s hat, I directly asked her about the pain. I let Carmen think I was asking diagnostic questions. In fact, I was leading her into a mindful relationship with her pain. I asked her to describe her pain in detail:
Its quality - whether it was sharp or dull or aching ,
Its precise location and boundaries.
How it moved and changed with the breathing
How it moved and changed over time
At first when I asked these questions, Carmen answered too quickly. I knew she could not possibly have really paid enough attention to the sensations to give an accurate answer. Of course, who wants to really pay attention to an excruciating pain? Our instinct is to want to block it out, to ignore it.
Knowing this, I persisted with the questions, encouraging Carmen to give herself time to really feel exactly how the pain felt. This way, she could answer the questions accurately. (Remember Carmen thought I was making a medical diagnosis so she was more motivated to cooperate).
KNOWING THE PAIN
As she really felt into the pain, Carmen stopped becoming agitated and stopped squirming. Her relationship with the pain had changed. The attitude of strong aversion had been replaced with an attitude of curiosity. The pain was no longer terrifying her and she was able to really pay attention.
Initially, she thought the pain was getting worse all the time. When she really paid attention, she noticed that the pain actually fluctuated, getting better and worse. She noticed that there were moments of relief without her actually having to do anything in particular, except for paying attention. She also noticed that her squirming was in fact making the pain worse and she was able to stop doing that.
Mindfulness is not just another analgesic.
The key to mindfulness is that it changes our relationship with pain.
We move from aversion to openhearted curiosity.
This allows the possibility of relating skilfully with pain
So that we can live creatively and joyfully
PAIN AND MINDFUL CURIOSITY
This lead me to explained to Carmen that she had actually changed her relationship with her pain. She was now observing it with an attitude of mindful curiosity. She was no longer running scared from it. As a result it had become much more manageable. Paradoxically by giving up trying to control the pain, Carmen had begun to feel much more in control. When Carmen left the session her pain was still quite unpleasant but it was no longer overwhelming.
The question now becomes how can Carmen or anyone else learn to relate to pain in this mindful way without becoming overwhelmed? In this therapy session, it was much easier because there was someone else present who helped Carmen to calm down. That person also happens to be a doctor that she trusted. As she can’t have a calm trusted doctor with her every time she experiences an exacerbation of her back pain, Carmen needs something else. She needs a regular mindfulness practice. As she does this, she will develop new neurological networks in her brain that allow her to sit with her pain with openhearted curiosity without getting overwhelmed.
In the 1980s, Jon Kabat Zinn, one of the key founders of modern day mindfulness started working with chronic pain patients in the University of Massachusetts Medical School. These patients were resistant to all the medical treatments for chronic pain which were available at that time. He managed to persuade the hospital surgeons and physicians to refer these treatment resistant patients to a mindfulness meditation programme which he had designed. Many of patients had dramatic improvements and since then there has been a swag of research showing that mindfulness has good results to helping people to manage chronic pain.
The first step to learning mindfulness is to find a good mindfulness teacher. If you wish to know more about how to assess the quality of mindfulness teacher click here.