Mindfulness and pain

Mindfulness is about being here, now. It’s about being ‘present’ or in the moment. While the idea is really very simple, embodying mindfulness is not always easy. We’ve all had experiences of being completely absorbed in what we are doing – perhaps walking on the beach, playing with a child, looking up at a magnificent sunset, or enjoying the first mouthful of a delicious meal. These moments are moments of mindful awareness and we have them all the time. It’s just that they are brief and fleeting.

Soon enough our minds wander off into streams of consciousness – analysis, remembering, planning and other distractions. We might pull into the driveway and suddenly come to our senses, unable to remember the drive home because we were replaying the day’s events in our minds.

The practice of mindfulness meditation is really just about stretching out these moments of present-focused awareness by training our minds to keep coming back to what is happening right now. Some people describe it as shifting out of the ‘doing’ mode and into the ‘being’ mode, or switching out of autopilot.

At first this involves picking something to pay attention to – like the flow of your breathing, the shifting sensations in your body, or the many sounds around you – and noticing each time you end up distracted so that you can gently coax your attention back. This returning to the now, over and over, becomes a habit, just as practising scales on a piano or kicking the footy or learning to knit develops muscle memory. We stop ‘missing precious moments’ and start being more fully engaged with what is happening as it unfolds.

Chronic pain can have a devastating impact when you live with persisting pain, as well as impacting your family and friends.

• Maybe you can’t do all the things you love the way you used to before you had pain.
• You might feel shut off from the rest of the world, even shut off from yourself.
• Your mind might race with lots of worries or self-critical thoughts.
• Maybe you feel anxious without knowing why.

This is a really common, valid and understandable reaction to having ongoing pain. And because your mind and body are connected, mental anguish can make your body feel worse. Your pain alarm system gets really sensitive, and you might get more physically tense, as you feel more distressed. You can read more about pain here.

Practising mindfulness meditation helps bypass some of the worries and frustrations that creep in when you’re in pain. Think of it like learning how to duck-dive under a wave at the beach. Or even better, learning to surf that wave.

Meditation teaches us to ride the waves of pain, anxiety, stress, and fatigue. This helps to build our confidence and gets us in position to ride the positive waves too, like feelings of enjoyment, connection, pleasure, and achievement.

Mindfulness is no magic pill. Like any skill worth learning, it takes practice and patience. But millions of people have experienced the life-changing benefits of meditation for everything from pain to better relationships, creativity, mental focus, and greater peace of mind. And so can you.

Research shows that practising mindfulness meditation can be helpful for people with persistent pain, with a moderate effect in reducing pain intensity.¹. Compared to normal medical care for pain, meditation also seems to improve other important aspects of life, such as depression, coping ability, quality of life, acceptance, and sleep quality ². Importantly, mindfulness meditation has significant and lasting effects on reducing the functional impact of pain ³.

When it comes to acute or short term pain, people can tolerate more pain after receiving meditation training ⁴. Neuroimaging studies show that meditation engages multiple brain mechanisms that change the sensory experience of pain to make it less bothersome and unpleasant ^6,7.

Overall, the current evidence suggests that mindfulness-based treatments are about as good as well-established psychological treatments for persistent pain, like Cognitive Behaviour Therapy (CBT) ⁵. However, since the research on meditation is newer, it is not yet as strong and convincing as the research on CBT. We still need to do more high quality studies to figure out which types of meditation helps most with pain, what doses of meditation work best, and what the essential ingredients are that make meditation helpful.

Researchers are still exploring why meditation can be helpful in coping with pain, but this is what we think so far, along with some tips on how to apply mindfulness in your own way.

Use these tips, along with the resources at the end to get started or continue your meditation journey. Look for professional help if you get stuck or want to go deeper.

Although meditation is not simply a relaxation technique, relaxation is often a helpful side effect. Relaxation is very important for coping with pain because pain is not only stressful in itself, but stress can fuel pain.

Relaxation helps calm down your nervous system and boosts your body’s pain killing “feel good” hormones, called endorphins.

We sometimes feel locked in a fierce battle with our pain and just want to get rid of it. While this is completely understandable, it can make us more frustrated, anxious or depressed.

Mindfulness is about accepting what is here, right now, as best we can. This doesn’t mean we’re resigned to being in pain, because that would be predicting the future. Acceptance is all about what’s happening here and now.

Surfing the wave we’re on, rather than thinking about the next wave

Research shows that people who are better at accepting their pain respond better to various treatments and have better overall pain outcomes . Of course, acceptance is just one of many things we call psychological ‘resilience factors’ (others include things like positive emotion, hope, optimism, social support, effective problem solving), so it’s not all about acceptance.

Meditation helps us to avoid ‘buying into’ into any negative story around our pain. This frees up our attention to savour the positive things that are happening and come up with creative solutions for the problems we face.

Exciting research using brain scanning technology, shows us how the brain lights up when people with pain are meditating. It looks like while people are still aware of the sensory aspects of pain, they experience pain as less unpleasant. This is probably because it doesn’t activate as many of the brain networks related to memory, emotion and self-referential thought.  Shifting these brain states through meditation involves calming our emotional response to pain, practising struggling against it less, even ‘befriending’ it, as strange as that might sound.

Meditation trains your brain to experience pain with less distress

One of the most powerful things that meditation can teach us is how to be a better friend to ourselves. We can all be pretty hard on ourselves, sometimes downright mean. In fact most of us would never speak to others the way we sometimes speak to ourselves.

Meditation helps us tune out from this and tune in to a kinder, more friendly way to relate to ourselves. Research shows that stoking the fire of self-compassion not only warms the heart, it helps with pain. One study found that an 8-week Mindful Self Compassion (MSC) group reduced anxiety and pain interference even more than group CBT for pain ⁸.

Mindfulness means paying attention to what’s happening in each moment as it unfolds. Often this happens through meditation, but it doesn’t have to. Mindfulness and meditation are closely related. Usually the word ‘mindfulness’ means the state of mind you’re in when you’re present, accepting and compassionate. Some people call it kind, connected presence.

‘Meditation’ on the other hand is an activity, a way to practice dropping into that state of mindfulness. So you can be mindful without meditating. Sometimes we call meditation a ‘formal’ mindfulness practice, while ‘informal’ mindfulness practice involves trying to be more aware and present in your daily routine. Both are helpful and reinforce each other.

No, but sometimes it helps to have a regular space in your home or garden where you can be undisturbed for a while so you start to associate that place with mindfulness.

You don’t need any special equipment, just a comfortable chair or cushion or mat on the floor if your prefer to lie down. Your bed is OK, but it might put you to sleep and meditation is actually about ‘falling awake’ rather than falling asleep.

Some people find it hard to carve out a quiet spot so they do things like park their car in front of a park or beach, which can give them some alone time to meditate. Find a creative way to make meditation work for you.

Yes, mindfulness practice is an ‘inside job’, although it’s great if you find others who are into it too so you can motivate each other.

You might like to join a meditation group and do a structured meditation course. These days you can even do these online or use a smart phone app like Insight Timer to keep your practice going. There are additional resources listed below to support your practice.

It’s always worth discussing trying any new care or practice with your trusted health professionals, and to use meditation as a complementary therapy rather than abandoning your usual care. It’s often helpful to only have these types of conversations with the health professionals you feel comfortable with.

Meditation is generally safe and effective. But if you’re not used to paying much attention to your feelings and body, it can sometimes feel uncomfortable to really tune in at first.

Some people may get a temporary increase in anxiety which then gets better with practice. It’s a bit like how starting a new exercise program can make you a bit sore at first as your muscles get used to it.

If the anxiety doesn’t start to improve after a few weeks, it’s worth getting some guidance from a meditation teacher or health professional with a strong background in mindfulness.

If you have a history of trauma, then it’s best to learn meditation from an experienced psychologist or mental health professional with expertise in this area so they can tailor it to your needs.

Paying attention to pain in a kind and accepting way is harder than paying attention to pleasant feelings. So it’s best to get a bit familiar with mindfulness meditation before delving right into pain. Consider doing some mindful park walking, general body scans, and self-compassion meditations for a while before zooming right in on pain.

When you do start meditating on pain more intentionally, for example using the ‘Working with pain’ recording below, it’s best to choose times when you have more moderate or mild pain. It will be hard to get much traction if you start with 10/10 pain. Like most things, start easy, start slowly and dial up the difficulty as you gain confidence.

No! You don’t have to shave your head and give away all your money to meditate. You don’t have to take on any religious or spiritual beliefs either. Mindfulness meditation is a practice that helps you to become more in touch with yourself.

At the same time, some people who are religious find that meditation makes them feel more connected to their faith or spirituality. It’s up to you how you use it.

You don’t have to be in pain to benefit from meditation. There are so many physical and mental health benefits – improved work productivity, sleep, creativity, sporting performance, cardiovascular health, relationship satisfaction, general quality of life – that mindfulness is being practised by people from all walks of life. It’s being used in schools, prisons, parliaments, multinational corporations, gyms, and hospitals.

Why not ask a friend or family member to learn meditation with you?

Mindfulness practice at home is free!

Attending a structured 8-week meditation course like Mindfulness-Based Stress Reduction will cost around $AUD500.

Teaching yourself at home with a book and CD like ‘You Are Not Your Pain’ (listed in our resource section below) will cost about $AUD25.

There are sometimes free online mindfulness courses, or you can get a brief taste of meditation through the free smartphone apps such as Insight Timer.

A good way to start mindfulness meditation is by choosing a time and place to practice, where you can be undisturbed for a while (e.g. 15 mins).

You could start by trying the body scan meditation or find one online that you connect with.

Try to commit to it every day for a few weeks and before deciding on whether it’s helping you.

Approach this experiment with balance and kindness, so if it feels better to go slowly and take bigger breaks between practices, then go for it. Explore what works for you.

It’s normal to feel restless and distracted at times. While this can be a great opportunity to work with another kind of uncomfortable feeling and build your confidence, you don’t have to. Experiment with different ways of cultivating mindfulness. If you’re really restless, a great practice is a walking meditation.

Go for a walk outside and focus on the wind on your face, the pressure in your feet, the breath in your belly, the sounds of nature. Practice just feeling into your senses rather than analysing what you’re feeling.

Another ‘dynamic’ meditation practice like walking is yoga.  Check out our Yoga with Pain module. If you have your own stretching routine that helps, trying using this as a mindfulness exercise, focusing on the sensations and your breathing as you stretch.

Something is better than nothing, so don’t get too rules-based.

If you can do at least a bit of meditation everyday you’ll really notice the benefits. Meditation seems to work on ‘dose’, so if you can do more, that’s great.

And remember you can do ‘informal’ practice throughout the rest of the day. For example, eat slowly and mindfully, tasting each mouthful completely. Or try really listening and focusing on what your friend is saying when you’re spending time together, rather than thinking of the next thing to say or checking your phone.

A great starting point is also to focus on pleasant experiences. Notice when you’re enjoying yourself and scan how your body feels, notice the thoughts that come up, observe how you interact with others. Put on a song that you love and really try to listen to it while noticing your physical and emotional reactions.

Another good regular practice is to do a short 5 minute meditation by listening to the breathing space meditation whenever you feel you need it .

After a while you might enjoy doing your own meditation without any audio guiding you. ‘Owning’ your own meditation practice can be really empowering.

Lots of health professionals use mindfulness in their clinical practice these days, especially psychologists, occupational therapists and social workers.

Many will be able to get you started on a meditation practice and help you overcome common obstacles. Going it alone can be really tough so it’s great to have someone to talk to and keep you motivated. Of course, not all health professionals will be encouraging or have any experience with meditation, so focus on the people you trust and feel comfortable with. Also be prepared to ‘road test’ a few meditation facilitators to find someone you connect with.

Working with a professional is also recommended if you have a history of trauma.

For more information about mindfulness and pain, visit the Mindfulness Based Stress Reduction Program or the Mindfulness Based Cognitive Therapy website.

For consumer summaries go to Cochrane Summaries. Alternatively, if you need to speak to your GP or health care professional, please seek further assistance.