More than 30% of Americans are living with some form of chronic pain, and opioid abuse has been called the deadliest drug epidemic in U.S. history. The standard of care for pain management treatment is a multidisciplinary approach comprised of medical management, physical therapy, and psychotherapy. Recent evidence reveals that mindfulness is a brain-altering, effective psychotherapy for managing pain.
I was making the final recipe for a Sunday dinner with my family (Cucumber Mint Spritzer). The recipe called for finely sliced cucumber. I decided to use a potato peeler. My plan was to get dinner on the table in the next 10-minutes, so I started peeling faster and pictured myself walking outside to grab mint from the garden. It was at that moment that I felt a sharp pain. When I looked down at my thumb, there was a pool of blood on my left knuckle. Instead of slicing the cucumber, I had sliced off my own skin.
I quickly ran my thumb under water, poured peroxide on it, and applied pressure with a napkin. I grimaced at the cutting board wondering how much of my knuckle was missing. My mother, who worked as an emergency room nurse for most of my life, told me to go to urgent care. It was open for another hour so I jumped in the car. On the drive there the word Mindfulness flashed into my mind. I took a longer breath and noticed how far away from my body, and especially my left thumb, my mind had gone. It was as if I only occupied the right side of my body and my mind was leaning over even further, hanging somewhere in space out the right window.
Turn Towards the Pain
In working with clients, people look at me aghast when I offer “turning towards the pain” as a strategy for coping with discomfort. With mindfulness— turning towards pain as opposed to ignoring it—is a pain management tool. When people gently turn towards pain, they report that they experience less of it and their resistance usually decreases. People with chronic conditions have reported reductions in pain after training in mindfulness, even if they still suffer from the illness.
I winced at the idea of turning towards the pain, but I had experience with this, so I slowly tiptoed my attention over to my left thumb, focused on it for ½ a second and then quickly returned my attention to the right side and back out the window. It took me four or five times of going back and forth before I could hold my attention on my thumb for any length of time.
And I was telling myself stories about my thumb, negative ones. “You’re thumb is going to be deformed.” “This is gross.” “You’re skin is shredded.” Negative thoughts create uncomfortable emotions that can lead to tightening of muscles, leading to more pain. All my thoughts led to feelings of revulsion and panic, and I wanted nothing to do with what might lie beneath the napkin. But I persisted, letting the thoughts drift by and continually drawing my focus back to the sensations in my thumb and staying present; and then the strangest things happened. It was as if my thumb has a voice of a small child who had been hurt, “Don’t leave me here all alone to deal with this.”
Making Pain Worse.
There are ways we can unintentionally make our pain worse.
How many times do we abandon ourselves when faced with difficult sensations or emotions? Injuring my thumb was a time for self-compassion, not rejection. As I turned towards my thumb as an ally, warmth came into my heart and my tolerance for focusing on my thumb expanded. I had more space. I noticed I was breathing shallow and holding tension in my muscles. I deepened my breath and sent some ease into my body. It was only through coming back to myself and turning towards the pain over and over again that I could tell what my body really needed. By the time I got to urgent care, the bleeding had stopped, They made me pull off the bandage which caused more pain but I could see most of my knuckle was still there and most of me was present with it.
Five Steps to Turning Towards Pain
1) Develop a Mindfulness Practice.
You wouldn’t expect to pitch in the major leagues without practice. Mindfulness is a way of being present in life, but it is also a skill. As with any skills it takes consistent practice. I conducted a 10-week Mindfulness Group for Social Workers and results showed that people got benefits when they attended 6 or more sessions. When it comes to the impact of mindfulness on pain this is no different. Mindfulness reduces chronic pain by 57 percent, and accomplished meditators can reduce it by over 90 percent, and that’s without the negative side effects that pain medication brings. In fact, there are positive side effects of Mindfulness, like a more peaceful mind, greater attention and concentration, and enhanced immune functioning.
Mindfulness takes practice. Start with 5 minute daily practice. Expand to 12 minutes, and work your way to a 30-minute daily practice.
2) Create a Functional Story About the Pain
What story you are telling yourself? Thoughts like, “I can’t take this,” “Why Me.” I can’t.” will increase depression, anxiety, or anger and lead to increased tensing and pain. Instead, use healthy coping statement, “The pain is bad now, but I know some ways of working with this.“ “This won’t last forever, it will get better eventually.” “I know this is hard, and I can be a good friend to myself.”
3) Gradually Turn Towards the Pain
Once you have established a basic mindfulness practice, turn your attention from focusing on your breath to focusing on pain sensations in your body. BUT START WITH SMALL AMOUNTS of pain. You don’t surf the north shore of Oahu in the winter when you are learning to surf, you start with smaller waves. Pick pain at a level of 3 or 4 to start with and when you can ride on those waves, then gradually expand to bigger ones.
4) Expand the area.
Instead of focusing on the bullseye of pain (your lower back), focus on a larger area (your whole back). Choosing a larger area of focus makes pain more manageable.
5) Shifting Focus
Shift your focus back and forth from an area of pain in your body to a neutral or pleasant area of your body. Focus on the quality of the sensations, the boundaries of the pain, and any movement of sensations.
Nobody wants pain, yet it is a reality of living. My 92-year-old grandmother told me, “When you get old everything hurts.” We can’t escape pain, but we can learn how to manage it, and if we do that in healthy ways, we come back to ourselves and reclaim our lives.
Click here for a brief mindfulness practice on working with pain.