Chronic pain is a problem which is becoming increasingly common in western society. It is defined by the International Association for the Study of Pain as ‘an unpleasant sensory and emotional experience which is associated with actual or potential damage lasting longer than 3 months or beyond the expected tissue healing stage’. Pain is not only something which occurs as a result of physical trauma, but it can also be a result of mental and emotional trauma by which symptoms can transpire in the musculoskeletal and visceral (internal organs) structures of our body’s. Some examples of mental and emotional distress are depression, anxiety, fearfulness, stress and fear avoidance. Physical problems such as osteoarthritis, rheumatoid arthritis, disc deterioration, lower back pain, migraines and traumatic physical injuries can all persist to cause us to limit or avoid our everyday activities such as being at work and socialising with friends and family. Common reasons for limiting activity can be due to the fear of aggravating further pain or kindling a new episode of pain.
Pain in any form is a highly subjective experience and therefore understanding how pain occurs in our bodies can help us understand how we can manage it better. Some of the main structures which will contribute to our perception of pain are the brain, spinal cord and nerves, which span from our spinal cord. Pain receptors are located throughout our body which receive a message when trauma has occurred. From there, the message runs up the nerve, into the spinal cord and into the brain to allow it to register. Once the brain has picked up the message of pain it sends a message back down the spinal cord, into the nerve, to the location where pain was initially sensed to allow us to decide what we need to do to manage or ease the pain. This happens within microseconds and at the same time; the body also releases chemicals as a response mechanism to the pain. What many studies have found is that when the message of pain travels up to the brain, our response to it depends upon our previous experience of it to determine how we respond to the pain i.e. pain for one person can mean pleasure for another. With chronic pain, there are continuous messages being relayed up to the brain which inform it of pain. When such a problem persists, it can become highly debilitating and associated with these physical and psychological changes are emotional issues such as anger, anxiety, low mood and frustration.
However, there is a growing body of recent western research which has been focusing on a relatively new area of pain management known as mindfulness or mindfulness meditation, although of course mindfulness and its potential benefits is as old as the hills and has been known to many older systems of medicine, yoga, martial arts and the the healing arts for thousands of years. While popular belief may make us think that mindfulness meditation requires us to sit cross legged, with a straight back, pinched fingers and closed eyes, making humming noises, it is in fact something which can be achieved sitting in a chair, walking in the street, lying in bed and even whilst eating your food.
Mindfulness meditation is defined as a non-judgemental state of self-awareness in the present moment which focuses on breathing, movement and posture. It is not something which requires us to go somewhere to allow us to do it. Instead it is something which can not only be done anywhere, but it can help put us in control to take charge and manage the chronic pain. A problem which chronic pain commonly results in is it that it makes us believe that we are not in control of the pain that we experience and it thereby creates stress. When we undergo an unpleasant experience which is distressing to us, it can cause undue stress and tension to us which becomes a perpetual cycle. By using mindfulness meditation it allows us to break the cycle of pain and puts the person in a state of increased self-awareness. The idea of being more mindful and attentive to pain may seem counter intuitive as most people would rather avoid pain and find a way to escape it. However, by creating a fight against the pain and avoiding it creates a struggle against what is happening this creates a resistance within ourselves which is known as stress and therefore putting us back onto the cycle of pain and distress.
Three techniques which are commonly used for mindfulness meditation are:
1) The Body Scan – This technique involves finding a quiet place to lay down and bringing your attention to the areas of the body which are in contact with the surface on which you are laying. You can then begin to place your attention to the areas of your body in which you are feeling tension and allowing those areas to consciously relax. When you feel the body is in a relaxed state, you can then allow your mind to be present in the moment whilst letting go of thoughts which are attached to the past or the future., The next step is to undertake the ‘body scan’ which is where you begin to place your attention on your forehead or feet and gradually work up or down your body to and acknowledging any areas of tension which may be present. Notice how each part of the body feels, the temperature, and the sensation you feel and try to do this without engaging in judgemental labelling towards the sensation. Instead just notice how it feels. Finally, become aware of the entire body as a connected whole and maintain the awareness for a few minutes.
2) Sitting Practice – The body scan can also be done whilst sitting in a comfortable position. An additional tool which can be used with sitting practice is bringing the attention to the breathing pattern which is occurring. With each breath in, notice how it feels to have the oxygen inhaled into the lungs while the rib cage and belly expand. And follow each breath out, notice how it feels for the rib cage and belly to relax while the air is exhaled back into the atmosphere. Repeat this cycle of breathing anywhere and gradually build it into your daily routine, noticing how your breathing may change in times of stress compared to when you feel calm.
Breathing should be an involuntary process at rest which involves the gentle expansion and recoil of the lungs, ribs and diaphragm. At times of stress we use our upper chest to breathe rather than our belly which can bring about tension in the muscles of the neck and shoulder. One way in which we can see whether we are chest or belly breathers, is to bring our attention to it by noticing whether on each breath in and each breath out it is our chest or belly moving more. By noticing this pattern, it allows us to understand how we can begin to use our upper chest less whilst breathing and thereby breathing to become more efficient.
3) Walking Practice – Wearing comfortable clothing and, if desired footwear for walking practice can allow us to feel calmer and relaxed which can improve our awareness of our body. Begin by standing still and becoming aware of how the body feels, noticing the position of the posture and the weight of the body on the feel and how it feels on each foot Become aware of the subtle movements which are helping you stay balanced and upright. Take a few deep breathes from the belly and bring the attention to the present moment, letting go of thoughts from the past or those of the future. Begin to walk at a slower than usual pace and be aware of the gentle heel-toe contact the foot makes with the ground with each step/ Of the attention starts to drift, pay attention to the emotions your have at that moment in time without holding any judgemental thought thoughts towards them. Instead, just acknowledge that they are there. Gently bring your attention back into the present moment and continue the walking practice and breathing deeply from the belly. When it’s time to finish, coast to a gentle stop, pausing and taking a few deep breaths to bring the session to a close.
Each of the practices above can be done for as long as you wish. With each technique, should you find your attention straying from the present, acknowledge it and bring it back to the present moment and onto the mindfulness technique you are using.
With regular practice of mindfulness, which can be used anywhere, it may open up a new path for you on which chronic pain can be better managed to allow you to live a life which is not dictated and controlled by pain.
You may have found that the words which have been commonly used when instructing about the three techniques above are, ’attention’, ‘notice’, ‘feel’ and ‘acknowledge’. If we start by paying more attention to ourselves, take more care of our physical, mental and emotional wellbeing, notice how we genuinely feel and can acknowledge the feelings which our body is communicating to us, we may be able to take better care of ourselves and lead happier, fulfilling and pain free lives.
If you would like to learn more about using mindfulness to help in your well-being – not just in chronic pain, then contact the Rodger Duckworth Physiotherapy Practice here in Wokingham to make an appointment and one of our specialists with experience in this area will teach you. It is a powerful tool to carry with us through our lives.