Chapter 15
Nurturing Hope While Living with Pain
In This Chapter
Understanding the nature and effects of pain
Putting your pain into perspective
Discovering how to accept the reality of pain
Coping with pain on a day-to-day basis
Research shows that traditional medical pain management can be highly effective for acute (short-term) pain relief. For chronic (long-term) pain management, however, some medical interventions may cause more problems than they alleviate.
In this chapter I describe how you can use mindful interventions to deal with chronic pain and illness: mindfulness-based cognitive therapy (MBCT) can inspire confidence and improvement while you’re coping with pain. I also suggest that living with an incurable or long-term condition can become much more manageable if you can accept it before looking at solutions for improvement. This statement may sound incredibly difficult to believe, but as you discover in this chapter, the saying ‘what we resist, persists’ unfortunately contains a lot of truth.
Your key aim is to find out how to be with and around pain while not letting it corrode your experience of life. As so often throughout this book, I invite you to be open, curious and adventurous. For this reason, I include a number of inspiring anecdotes for you to consider. Remember that your life is happening now: try to be aware of this fact as much as possible.
Be sure to consult your GP prior to making any change to your use of pain medication, whether prescribed or otherwise. Your GP will be able to guide you. Don’t try and go ‘cold turkey’ or put too much pressure on yourself to suddenly deal with more pain than you can cope with.
Grinding to a Halt: When Pain Stops You from Living Life
Pain can appear in many different guises: you may feel heat and burning, cold and numbness, stabbing, throbbing or cutting sensations, tightness, pulling or twisting. Or what you’re feeling may be completely different or cover several of these descriptions.
Pain describes a state of physical and psychological suffering or discomfort that’s caused by an illness or injury. Many experts view constant pain as an unspoken epidemic. A study about pain conducted in 2004 claims that one in five Europeans suffer from chronic (that is, long-lasting) pain.
Here’s a list of some of the costs of pain to the individual and society:
Dependency on drugs and other people
Dependency on self-medication (alcohol, cannabis, overeating, and so on)
Depression and suicidal thoughts
Financial difficulties
High medical costs (if using private healthcare)
Isolation
Loss of ability to work
Loss of purpose
Understanding the nature of pain
You can sense pain as an acute or chronic experience:
Acute pain: Follows an injury, onset of disease or natural event such as childbirth immediately, and relatively speaking is short term. Acute pain can be useful because it warns you not to do certain things that may lead to deeper or lasting damage. You can see acute, short-term pain as a physical alarm bell. If you break a limb, burn your finger or have a hernia operation, pain is your guide as to what you can do while healing and what to avoid. You therefore take good care of the impaired area so that it can repair itself (which usually takes around six weeks to six months to heal completely).
Most of the repairing happens during sleep, which is one of the reasons why sleep is so important.
Chronic pain: Continual and long term, perhaps lasting for years and decades, chronic pain isn’t necessarily severe or always intense but it is regularly experienced. Chronic pain can cause almost unbearable discomfort, but pain alone doesn’t cause this kind of hell. The extreme struggle can arise from your desire to stop or get rid of the pain, which somehow leads to even deeper pain: you can therefore see this experience as suffering. Chronic pain is my main focus in this chapter.
As well as physical pain, humans also experience mental suffering. Physical pain is caused by external triggers whereas mental suffering is caused by worrying, non-acceptance, frustration, anger and other destructive emotions.
You can benefit from accepting this fact of life (which is no different from accepting birth and death, day and night, the seasons, and so on). Particularly with chronic pain, the dislike, the fear for the future (‘how long will I suffer?’, ‘will it get even worse?’, and so on), non-acceptance of the situation, and ‘why me’ and ‘why now’ mindsets are self-created and self-perpetuated. These sensations are referred to as suffering. The discomfort caused by suffering can become habitual and create so much tension that you experience yet more physical pain due to tightness, stress chemicals floating around your system and bad body posture. This discomfort can appear worse than the pain you originally experienced from an injury or illness. If you routinely trigger your stress response and inadvertently flood your body with chemicals such as cortisol and adrenaline, your experience of suffering and stress shoots through the roof (check out Chapter 14 for more details).
If suffering takes over your every waking minute in a vicious cycle, like a nightmarish merry-go-round, it can become a hated companion and account for approximately up to two-thirds of your whole chronic pain experience.
Looking at different types of pain
Research over the last 50 years or so has completely revolutionised the conception of pain in medicine. Previously, physicians didn’t realise that people have different experiences of pain, even when suffering from the same injury or illness.
Now people understand that pain involves body and mind. For instance, pain
Is subjective – each individual experiences and processes it differently.
Is a disagreeable sensation.
Is an uncomfortable emotion.
Can be caused by real or possible tissue damage.
Can be caused by changes to the nervous system even without obvious physical injury or disease.
In many cases certain diseases, such as arthritis, gout and cancer, cause the pain experience directly. Tissue is inflamed, joints are degenerated, and tumours are growing and pressing on other sensitive areas; any such pain you experience is linked directly to the illness. This is known as physiological pain.
In contrast, neuropathic pain is experienced by your nervous system. Medical examinations usually can’t ‘see’ this type of pain. Its causes are manifold: damage to nerves or the spinal cord and even the brain. The problem occurs when medicine can’t detect anything and yet the pain is still very much present.
Research indicates that the central nervous system can become so hypersensitive that a little pain feels like a huge invasion. Often neuropathic pain is disguised in sensations that you don’t normally see as being a symptom of pain, but nonetheless pain of this nature is horribly real:
Burning sensations
Coldness
Electric-shock type feelings
Itching
Numbness
Phantom limb pain (when an extremity is lost or paralysed and yet causes you terrible pain)
Pins and needles
Studying the effects of pain on memory
Intense and long-term pain alters the way that the brain remembers and recognises experiences and events. When pain is perceived, in an instant the mind produces a memory pathway. These pathways include the following:
What caused the pain
Which rules you need to follow to avoid further pain in the future
Fear of returning to work, because you may exacerbate your condition or be seen as weak
Avoiding exercise because it may increase or prolong the pain
Avoiding challenges or adventures until you’re well again
You can see that these rules lead to a restricted mindset. Your life can quickly become limited, lonely and without purpose. This change leads to two further problems: low mood and avoidant, anxious behaviour.
Pain may cause you to lose many things, but you still have a basic choice about how to proceed. Having withdrawn from the outside world, you can:
Spend time focusing on the pain and undoubtedly increase your suffering.
Wake up to the realisation that this is your life; however restricted, this is it. So perhaps the time is right to try and do things differently.
MBCT can help you change your mind, get you back in touch with your body and unearth a new relationship with pain. As a result, even if the pain is still present, you can discover how to look at it, experience it as an observer, dance creatively with it and start having a life around it, instead of the pain being your entire life.
Hurting mentally
Mental pain can occur for a whole range of different reasons, including:
Biochemical imbalances of the brain
Feeling that you can no longer live with the ongoing physical pain
Other triggers, such as not feeling successful or attractive enough or being unsure about your sexuality
Mental pain can sometimes be so severe that it leads to self-harm (cutting and burning oneself), because sufferers tend to tolerate physical pain better than emotional pain. (Kindly refer to Chapter 12 for more information on dealing with emotional pain.)
Maintaining Perspective
Long-term pain can eat away all your desire to feel alive, which has repercussions on your relationships with others. Talking about your pain in public is frowned upon. When people ask how you are, you rarely answer, ‘Well, I have this ongoing pain . . . and it makes me feel really miserable and alone.’ You don’t want to drive people away, be seen as weak or feel as if your pain is serious enough to mention.
Therefore, blocking your pain can seem like a wonderful temporary solution, like creating an online alter ego who’s strong, successful, admired, and so on. But people who fall into this trap sometimes neglect their real life and real-life needs: relationships fall apart, jobs are lost and chronic diseases get even worse.
Please consider writing down in your diary what you tend to use to suppress the pain and fear you feel in relation to your illness, injury or disability.
Then endeavour to take the power back into your own hands to help yourself, refusing to listen when others or even yourself tell you to just ‘man up and deal with it’. You have the right to feel free of pain and suffering and to live at ease, or to at least have an element of control when you’re affected by pain.
Of course, everybody has struggles, but life can be so adventurous and beautiful too. Help yourself not to forget this fact by writing down in your diary moments of pleasure, gratitude and satisfaction you’ve noticed recently through your mindful observation of all aspects of your life.
Being mindful can help you to see the larger picture of life, because unsurprisingly people enduring intense pain can sometimes only think about the pain and not beyond it. This statement isn’t to blame anybody, but is just an observation. If you sit with your pain for a while and allow it just to be present, perhaps you can experiment with looking at the larger picture.
Here are a few examples, but please create your own in your diary. See if you can apply any of the following to your own life:
Staying positive: For example, even though you’re in pain, you may be recovering from an injury/illness and that can be a moment of triumph.
Show appreciation: For example, if people are caring for you, or you meet fellow patients in a clinic or support group, appreciate the bonds that you form in spite of, or even because of, the pain.
Being grateful: For example, have you recently been helped or assisted by a total stranger who gave you kindness because he saw your difficulty?
Sometimes immense suffering can cause people to feel envious, become self-centred or lack compassion. But if you open your heart to the suffering of other people, you may find that you can let go of your own story. Consider experimenting with what it feels like putting your pain in a box for a little while and doing something out of the ordinary for somebody else.
Waking Up to Life: Accepting Pain
You can view pain and illness as a wake-up call to make positive changes in your life; if you’re often in discomfort, maybe you need to change your routine, engage in gentle mindful movement or go for a mindful walk (see the suggestions in Chapter 6), go swimming, do stretches in the morning, and so on.
Perhaps consider looking at other habits and aspects of your lifestyle that may improve your wellbeing, such as adjusting your food choices and including fresh groceries that strengthen your immune system. Omega 3, for example (contained in linseed oils and oily fish), can help to prevent or improve osteoporosis, improve your heart muscle, de-clog arteries and reduce inflammation in the brain which, in turn, reduces depression. Alternatively, invest in seeing a holistic nutritionist who may know what food or plant can possibly improve your condition.
Finding new ways to enjoy life, including outlets for your creativity and passion, means that you’ve less time to focus on pain and less space for it in your life.
Kindly explore a way forward by meditating on this issue. Take a seat in your meditation corner (see Chapter 4) and start this sitting by asking yourself one simple question: ‘The adventure of life – where can I find it?’ Of course, reword this question so that it sits well with you.
After placing this question in your awareness, sit and begin by grounding yourself and focusing on your breathing. Perhaps, sooner or later, ideas, words, colours and images appear in your mind. Allow them to visit briefly and then let them pass by. As best as you can, don’t engage in a whole story or plan at this point; simply notice the ideas that come up and allow them to pass.
When you’ve finished this explorative meditation, please write down in your diary everything you remember. Practise this exercise a number of times and continue to collect new insights. Eventually, when you feel ready, write down your action plan.
Here’s an example:
1. Join the local book/reading club.
2. Find out when the group is meeting.
3. Call them and ask whether I can join and how to go about it.
4. Make them aware of my needs (disability access, for example).
Human beings are social animals. Finding interesting pastimes not only gives you more purpose, but also connects you to people and enables you to befriend others.
Accepting and then responding
Whenever you feel pain, the first sensible action is to accept its presence. The pain isn’t going to leave just because you growl, scream, cry or deny it. By opening up to and exploring it, you may be able to work around it better and also feel more compassion for others who hurt and suffer.
The Buddha said that a wise person experiences pain in the body and does his best not to worry, wrestle and torture himself with ‘why me’. As a result, the wise person feels the physical pain but is spared the additional mental pain (the suffering). The physical pain is like a single arrow that inflicts an open painful wound. Non-acceptance, suppression, ill will and other destructive emotions about the first arrow consequentially hit the wounded person like a second arrow, which penetrates the already painful wound, ripping it open even more.
Think about where you see yourself right now. Are you reacting unwisely to your pain or responding with patience and acceptance?
The practice of mindfulness (formal meditations and informal everyday exercises) explores and expands your ability to respond wisely. With time and practice, you discover more and more about how to pay attention to your body and the pain you’re feeling. You become the investigative journalist who uncovers the little details that make a day more enjoyable and create less suffering.
Please sit down and ponder on how you can create less suffering and more adventure in your life. For this is your life and every second counts; every moment offers an experience in which you may find deep delight. But in order to experience anything, you need to open up to life and change your attitude.
Recognising what your body can still do
Even if you feel a lot of physical pain, your body isn’t useless; perhaps start small and work up to doing more.
Consider coming up with your own action plan built on acceptance and compassion, wisdom and patience. Kindly use your diary and note down a few ideas.
Creating a new relationship with pain
Discover as much as you can about your pain. Discern what it’s trying to tell you and how you can prepare yourself for it and help your body to respond to it.
See your pain as an indicator for your body to change something or your mind to respond in a different way, instead of seeing pain simply as an enemy. Notice the difference between the pain itself compared with tension, angry thoughts, fearful beliefs – feelings that can manifest physically. For instance, think about feeling restless, tired, exhausted, frustrated or tearful: how do these emotions register as sensations in your body?
Using Regular Coping Skills
In this section, I suggest several ways in which MBCT can be extremely helpful when you’re coping with chronic pain.
Engaging in breathing practices
I suggest three mindfulness exercises that you may find helpful in dealing with pain.
You can carry out these exercises while sitting or lying down (Chapter 4 gives suggestions on being comfortable during your exercises). The more you focus on the breath, the less likely you are to focus on pain. The more your lungs fill with air and expand, the slower your heart beats, helping you to return from fear and anxiety to calmness and acceptance.
Whenever you engage in mindful movement, even the gentlest one, really listen to your body. If you feel any pain or tension, reduce the movement or don’t do it at all. You can always just imagine doing it (some research suggests that even imagining a move can have a positive outcome for the body).
Breaths and movement
Please consider carrying out the following exercise, which involves breathing in and out and includes mindful movement:
1. Lie on your back with legs stretched out, allowing yourself to be totally relaxed. Alternatively, sit in a comfortable position, using pillows to feel supported.
2. Inhale, and while doing so, open your toes. Think of this action like a flower opening to the sunshine.
3. Exhale, and while doing so, scrunch your toes as if the flower is closing. If you tend to get cramps, perform the closing action gently.
4. Inhale. This time, softly point your toes away from you.
5. Exhale. This time, straighten your feet to bring them parallel to the floor. Roll your ankles in each direction, clockwise and anti-clockwise.
6. Carry out six to nine repetitions of the above sequence (Steps 1 to 5).
Knee folds
Please only do this exercise if you don’t suffer from any back or leg injury:
1. Lie on your back, legs stretched out, totally relaxed. You cannot do this exercise in a sitting position – if you have trouble lying down at this point, skip this exercise until such a time as you find it easier to do so.
2. Slide your feet in. Bring them closer to the buttocks one after the other, and rest your feet on the floor, hip distance apart.
3. Inhale. Drop or open the knees to the side.
4. Exhale. Bring the knees back up.
Hip rolls
This exercise involves gentle hip rolls. Please:
1. Lie on the floor. You can also do the hand movements sitting down or even standing.
2. Open your arms to the side. Form a V-shape or T-shape.
3. Exhale, dropping both your knees to the right. The hips, pelvis and lower back and spine follow this movement, while the head stays soft in the centre or turns slightly to the left. During the inhalation, hold this position.
4. Return the spine, pelvis, hips and knees back to the starting position when the next exhalation begins. Please repeat on the other side.
Move while exhaling and stay in position while inhaling.
5. Relax your legs by stretching them away from you. If doing so is uncomfortable, stay in the previous position.
6. Lay your arms along the side of your body, bending them at your elbows to bring the forearms parallel to the floor. Turn the palms to face the front (same direction as your toes).
7. Inhale, opening and gently spreading your fingers wide. While exhaling, tuck the thumb into the palm first and squeeze the other four fingers into a fist. Repeat to the rhythm of your breathing six to nine more times.
8. Lay your arms and palms of your hands in the same position as Step 6. Move from the wrist and with the inhalation point the hand and fingers forward and then down to the floor. When exhaling, change the direction, flexing at the wrist and hand – your fingers pointing towards your head.
9. Make a fist, thumb in the palm, with the other four fingers gently squeezing it, and make circles with your fist. After six to nine repetitions, change direction.
The simple co-ordination of breath and movement slowly brings back energy and may help you to start moving again. When you get up, slowly and gently, you can incorporate simple tasks such as going to the loo, getting dressed and making a cup of tea mindfully (not all at the same time, of course!).
Other suggestions
Many of the exercises throughout this book can help you cope with pain. For example, mindful walking can come naturally to you, even when you’re unwell. Each step at a time brings back the wondrous gift of walking. Focus on your feet only and imprint them onto the floor as if you’re making impressions of them in sand. Turn to Chapter 6 for much more on mindful walking.
In addition, try the sitting with difficult thoughts exercise in Chapter 7, where you choose one particular aspect of your pain experience – for example, the physical manifestation of pain – as your anchor of awareness. The whole exercise helps you to check out all the different feelings and subtle changes that occur throughout the practice.
When thinking about mindfulness exercises to help with your pain, check out the body scan (from Chapter 4). Kindly engage fully in the exercise and try as best as you can to find a posture that feels comfortable to you, changing position whenever necessary. Also, please be aware that you’ll travel through parts of your body that are free from pain and other parts where pain is present. Wherever you are, stay only briefly and notice that many different shades of comfort and discomfort exist on this journey.
Achieving wholeness
When you think about wholeness, you may have a picture in your imagination of how you once were or possibly how you really wanted to be: strong, beautiful, fearless and loved. But no guarantee exists that you’d be happier if you resembled that perfect person. Recall that plenty of seemingly enviable humans have experienced a lot of suffering in their lives, despite their beauty, fame and wealth.
The idea of wholeness refers to something else entirely: you can only be whole and at peace in the present moment, because it’s only in the here and now that your life is happening. Vidyamala of Breathworks (see the nearby sidebar ‘Moving towards wholeness in four steps’) points out that, by definition, wholeness has to include everything: pain and pleasure, wanted and unwanted. If you exclude even a tiny aspect of yourself or your life, you can’t experience wholeness.
Moving towards wholeness in four steps
Breathworks founder, Vidyamala Burch, created her own formulation of mindfulness-based interventions in 2001. It’s similar to MBCT and offers programmes to people living with pain, stress and illness. Her goal is to assist you to take control of your own wellbeing and live with self-reliance.
You may not necessarily alleviate all discomfort and restrictions, but you can discover how to become more aware, kind and accepting. In Vidyamala’s view, mindfulness is ‘not so much a technique as a particular attitude to life (and therefore to suffering)’. Anybody can become more mindful and more accepting. You aren’t your condition; just somebody who lives with a difficulty and yet still has a life around it.
She identifies four stages of acceptance:
Denial: First, you probably deny your pain and try to pretend that the pain isn’t really happening, and don’t admit that you may have a long struggle ahead.
Bargaining: Second, you may admit that you have pain, but bargain with yourself and the universe to try to make it go away (for example, ‘if I meditate my pain will disappear’, or ‘if I exercise I’ll be cured’).
Acceptance: Third, you come to accept that you have to live with the problem but also that you can learn strategies and change your outlook. Your life includes pain, but that’s only one part of it. Your wellbeing is no longer dependent on trying to have a perfect, fantasy life that’s free of pain.
Flourishing: Fourth, by accepting what is, you transform the energy of resistance into power for new adventures. You can even flourish, despite having an incurable illness or chronic pain.
Breathwork’s prescription (just like MBCT) is to turn kindly towards the discomfort and search for enjoyment, because both experiences are part of life.