Meditation for Chronic Pain
Are you suffering from chronic pain? Some people who endure injuries seem to go on for years with ongoing pain, even though in most cases our tissues heal with time. There is often a sense of hopelessness as the person tries physiotherapy, chiropractic, acupuncture, injections, and so on, yet nothing changes. Even worse, people with chronic pain following an injury are often told by professionals that they are fine, their tissues have healed! Friends, family, and co-workers start to scrutinize complaints. People with chronic pain begin to feel isolated. However, the pain that they experience is very real.
There is hope. Research tells us that the possibility to reduce pain and recover, even years later, still exists. A tremendous amount of scientific research has emerged in the last ten years surrounding pain physiology and how our brains process pain. The good news is that with time and practice, we all have the ability within us to reduce pain and regain control of our lives. One practice, known as mindfulness meditation, is starting to emerge as an effective and scientifically proven means of doing so.
First, let me give you a very simplified run down of how pain works. Painful stimuli are processed in three different areas – at the site of injury, in our spinal cord, and then (most importantly when it comes to chronic pain) in our brain’s processing centres. Pain is a subjective experience; it’s different for everyone. You’ve seen this: some people may stub their toe against a desk and laugh it off while others are nearly brought to tears. I once had one patient with a fractured vertebra who seemed to laugh through his exercise program while I’ve seen others with the same injury who have struggled immensely just to get through the day. Yes, some of this is due to our overall health and fitness, however, this is also because our experience of pain is not 100% a direct result of the amount of damage or degeneration at the area of injury. A big factor is also how our brain decides to process the information it receives from the nerve fibres at the area of pain. As time goes on and the tissues heal, pain actually becomes much more of a brain processing issue. You’ve probably heard of the term ‘neuroplasticity,’ either on the internet or on television ads for ‘brain training’ programs. Neuroplasticity is a term that describes how our brains and nervous systems grow, morph, and adapt in response to our thoughts, actions, beliefs and environment– even as adults. It plays a major role in the development chronic pain. Let’s first consider what happens when you first get injured.
A lot of factors affect how severely your brain initially interprets pain. As a clinician with several years of experience, I can now often pick out who is going to have a more challenging recovery within the first one or two visits by looking out for these signs: the amount of stress we were under during or after the injury, being fearful and doubtful of a full recovery, having anxious thoughts about the severity of the problem, or feeling like a victim. As well, actions like being hypervigilant over every sensation can train your nerves to become more sensitive to sensing potentially painful sensations. Furthermore, some of our defense mechanisms, like altered patterns of movement to avoid pain and being overly protective of the injured area, may help in the short term, but if continued for too long can make things feel worse as well. Negative perceptions towards our bodies can also make our processing centres more sensitive to pain. For example, middle-aged individuals, after having an episode of back pain and some x-rays or MRIs showing degenerative changes, are often told by their doctor that they have the back of an elderly person—this has been shown in studies to have a ‘nocebo’ effect; they report worse pain than those with the same conditions who do not get x-rays or MRIs. As you can see, there are a lot of possible players in the development of pain. Sometimes one of these may be present, sometimes it may even be all of them.
This is where neuroplasticity comes into play. When these issues aren’t properly addressed and persist over time, our brain and nervous system start to adapt to them and they become hard-wired. This is how chronic pain develops—the painful messages continue get fired to your conscious mind even after damaged tissue heals. The fire goes out, but the alarm keeps going off. This is because your brain wants to protect your body. If it continues to sense a great deal of threat after an injury, it leaves the pain volume turned up in its pain processing centres and tells your conscious mind that even something that has healed still feels really, really bad. Worse yet, the more things hurt, the more we tend to double down on our poor-coping strategies and negative attitudes. We get trapped in a negative feedback loop of feeling pain, coping poorly, feeling more pain, and so on.
People with chronic pain are not faking it. The pain they feel is very real. Furthermore, chronic pain is nobody’s fault, and people who suffer from chronic pain are not ‘weak’. Things like being overly stressed at work or home, even when totally unrelated to the injury, can influence pain processing too. Although chronic pain is more common in those with underlying anxiety and depression, it can still happen to even the people who we consider the most optimistic, strong-willed, resilient and outgoing. As bleak as this sounds, it doesn’t have to go on forever. While neuroplasticity can crank up the pain volume, we can also use it to turn it back down. Enter a very simple, but very powerful tool: mindfulness meditation. Thousands of thoughts run through our minds every day, distracting us from the present moment. Our actions and daily habits, intentionally or not, are often the result of these thoughts. Mindfulness meditation directs our attention to the present moment and helps us to realize that as humans we are more than just our thoughts. It helps us to take a step back from all the chatter running through our minds every day, assess it accordingly, and take more control over how we respond to it. It can train us to be less judgemental and negative towards ourselves. When we become more aware of how we are thinking, feeling, and responding, and we can start to adopt better coping strategies when it comes to pain.
As mindfulness meditation makes us more aware of the present moment, we can also more easily check in on our bodies. Are we unnecessarily tense? A simple example of this is clenching your jaw (at least for me); it happens when we are stressed, and we are often too busy and caught up in the bustle of life to even realize we are doing it. Furthermore, with regular meditation and increasing our focus on the present moment, there comes a sense of calm. Our bodies also begin to produce less stress-related hormones like cortisol, which is known to be higher than usual in people with chronic pain. Sleep improves. We can start to allow more pleasant messages to make it to the front of our conscious mind, while the painful ones get shuffled to the back. Our entire nervous system can start to relax and reset, and the positive messages become more hard-wired again. Our brain starts to turn down the volume on pain, and with practice the effect becomes stronger.
Don’t get me wrong; chronic pain varies tremendously in its complexity and severity, and results vary. However, even if the pain isn’t always 100% gone, we can still gradually begin to reduce our sense of fear and anxiety, take greater charge of our lives, and eventually get back to our normal activities. Gradually increasing our activity with a sense of security over time also contributes to turning down the pain volume in our brain. Our quality of life and sense well-being eventually begins to return. We continue to feel better and do more. The negative feedback cycle becomes a positive one.
This isn’t junk science; there are numerous good quality research studies that demonstrate these effects, and the evidence is continuing to grow stronger. One study intervention was effective in significantly reducing chronic pain in eight weeks just by meditating for about 30 minutes a day, four days a week. Research shows that these benefits can hold up in the long term with a continued practice.
So, how do we start practicing mindfulness meditation? There are endless resources out there in the form of books, internet articles and blog posts, youtube videos, etc. Get out there and check it out. Do you just want to cut to the chase? The following is one simple way of starting:
1. Sit upright in a comfortable position in an environment where you won’t be distracted.
2. Begin to focus on breathing in and out, using your diaphragm, at a pace that is slow but comfortable for you.
3. Close your eyes and in begin to focus on your breath as it flows in and out. You may count 1, 2, 3, as you breathe in and 1, 2, 3, as you breathe out.
4. Continue to focus on your breath in this way for as long as you are comfortable.
This is a simple method to bring to direct your attention away from scattered thoughts and into the present moment. Do not get frustrated if you mind wanders away from your breath. This is going to happen no matter what– none of us can just turn off our thoughts at will. At first it might even happen every five seconds. When you realize that you’ve lost focus, even if it went on for a long time, do not judge or be hard on yourself, just return to your attention to your breathing. Start with an amount of time that you are at least 95% confident you can make a regular habit out of. For now, it may even just be for 30 seconds a couple of times a day. Once you’ve made it a consistent part of your life for a few weeks, start to gradually increase the amount of time you spend practicing. Work it up to perhaps a 5-minute daily practice, 10 minutes, or even thirty. Most importantly, give it lots of time. Our brains don’t re-wire overnight. The process can take weeks, months, or even years depending on the severity and duration of your condition. In reducing chronic pain, mindfulness meditation can serve as a powerful tool, but think of it as one component of a larger tool box of resources. Find a healthcare professional who is up-to-date and educated on pain science who can be there to help you in navigating the road to recovery. That said, they should also be skilled in assessing and rehabilitating damaged tissue and ruling out more serious problems that might be causing your pain.
As a clinician I don’t believe in immediately jumping on the pain/brain science train; possible long-term orthopedic contributors to your pain must also be assessed for and dealt with if found. A health professional can also educate you on which activities are safe and okay and which ones are not, improve your overall understanding of pain, give you a greater sense of security and control, and provide guidance in returning to your normal activities. Be wary of any practitioner who has you leaving their clinic feeling more scared than when you came in.
Beginning an exercise or activity program with graduated increases in duration and intensity is crucial. Your nervous system needs to re-learn what safe movement is. This might be something as simple as going for a walk, doing a little more work around your home, or starting a gentle gym program or yoga routine (I’m biased towards this one!). Build it around what feels right for you.
Surround yourself with supportive people who offer encouragement instead of judgement, whether it is a friend, family member, or co-worker. Even if it is just one person, find them and keep them close– just don’t rely on them to do the work for you. Take charge and accept personal responsibility for improving your current situation, no matter what’s happened in the past or how you got to your present situation, even if the initial injury was someone else’s fault. No one is helpless when it comes to chronic pain, and at the end of the day you must be accountable for your own health. Most importantly, believe in yourself, your bodies’ innate ability to recover, and never give up.