Mindfulness-Based Pain Management For Chronic Pain

Chronic pain. It’s horrendous, obviously painful, often debilitating and causes a plethora of other issues when conventional treatments fail. Chronic pain sufferers commonly experience anything from anxiety and depression to pain medication side-effects and addiction.


All of this on top of excruciating pain that can’t seem to be controlled. Using the mindfulness approach for chronic pain may be just what the doctor didn’t know to order.

Mindfulness is, in a nutshell, paying close attention and maintaining direct focus. Being unafraid to gracefully embrace a moment, good or bad, and know that it’s okay to let it go.

Yes, it sounds terrifying to a chronic pain sufferer to pay more attention to the pain. Don’t stop reading! It will become clear how mindfulness for chronic pain can be highly advantageous and even help eradicate pain almost completely when practiced properly.

Practical Mindfulness Methods

A common relaxation technique over the years has been to tense up each part of the body, individually, count to 10, and then release your hold.

The object is to notice exactly how tense you were to begin with, and to physically feel the tension go away. You would typically start from head to toe and gradually work your way down each body part until your entire body is completely relaxed.

For instance, you could start with your face by crinkling your forehead, squeezing your eyes together, pursing your lips and clenching your teeth.

Inhale through your nose, hold the tension as tight as you can for 10 seconds and then slowly exhale through your mouth. Feel the muscles relax in your face and head.

Feel the tension and stress leave your body. Notice how you can feel the blood start to move again and how revitalised yet relaxed and calm it makes you feel.

How completely aware you feel.

This is the same premise as mindfulness for chronic pain.

The idea is to get closer to the pain, acknowledge it, appreciate it, and let it leave. Accept that the pain is there, without judgement, which is the hardest part really. Naturally we associate chronic pain and all that tags along with it as negative.

Focus On the Relief From Pain

But just for this exercise, try and view it neutrally. Shake hands with the pain as if it’s the first time you’re meeting a new neighbour.

Visualise the pain.

And when you exhale, let the pain move on.

Substantial pain relief may not be immediate, but if you are mindful and continue practising mindfulness for chronic pain, the decrease in pain will gradually happen.

It takes practice and focus, but it’s well worth the reward considering the damage other treatment modalities can potentially cause to your body, mind and spirit.

It also helps to alter your mindset on the pain itself. Your approach should be to understand your pain, individually describe the sensations you notice with and without the mindfulness exercises, and create a deeper awareness of balance.

If you enter this with the only idea that your pain needs to be “fixed”, if you aren’t extremely successful on your first shot of meditation, your mind will interpret that as “failure”. And mindfulness for chronic pain is so much more than simple success and/or failure.

Mindfulness will help you achieve a more accurate perception of the pain. You essentially retrain your brain to calculate pain differently.

Think about it; your mind doesn’t actually feel the pain, but it sure tells you on a scale how bad it might feel.

In order for your brain to differentiate the intensity of pain, it first had to send signals all the way down to the core of the pain, which was then interpreted as even greater pain. It’s like poking a really bad bruise. Ouch!

Mindfulness and Pain Connection

Food for thought: Mindfulness for chronic pain isn’t about eradicating pain.

Mindfulness is a phenomenal and powerful modality to help you live a full life even with the pain.

Your focus is no longer on the outside obstacles but on accepting what’s going on inside your body and having a different relationship with it.

You can choose your reactions, believe it or not, and mindfulness for chronic pain assists in just that. With practice and determination, you can and will alter your pain response.

Think of all the added benefits like less narcotic pain medication, less chance for addiction to medications, as well as decreased anxiety and depression symptoms.

What about the fact that you can begin again to live a meaningful, active life without spending most of the energy on avoiding any pain breakthrough?

Mindfulness for chronic pain has endless potential and the results can affect multiple areas of your life.

There’s really no reason not to try it. 

My name’s Vidyamala Burch and I’m the co-founder and director of Breathworks, which is a mindfulness-based organization.

We’re based in the UK, but we’ve got trainers in many other countries. I like to describe mindfulness as simply being awake, being really present to your life as it happens, not being lost in the future, worrying about the past, but just being right here, right now, in your body, aware of your thoughts, aware of your emotions and then you can make choices how you respond to your experience.

So it’s that moment of choice that comes out mindfulness, that’s so life-changing.

Mindfulness as a treatment, for example, in Mindfulness-Based Pain Management, which is the program that I’ve developed.

It’s really very, very simple. Hard to do, but very simple conceptually, and it is this idea of being really present to your experience. If you’ve got discomfort in the body, if you’ve got pain in the body, it’s learning to turn towards that experience and to come into a relationship with it, because usually, we’re pushing it away, which is the last thing we want to acknowledge.

And because we’re resisting and pushing it away. Paradoxically, we’re dominated by it, through omission.

It’s like having a monster in the room. So, you turn towards it and you think, OK, what is going on here…

And we have lots of methods to train in that, we’ve got meditation practices, body scanning, breath awareness, learning to work with your thoughts, learning to work with your emotions, and when you come into a relationship with it, you can make choices about what is the appropriate next step.

If you’re in a lot of pain, it might be to take a break, it might be to have a lie-down, if you’re feeling stiff, it might be to go for a little walk, if you’re hungry, it’ll be to eat.

If you’re feeling very distressing thoughts, you note those, and to look at your thoughts rather than from your thoughts is a very different experience. If you’re very, very, angry and you think, Ohh, I’m really angry, that’s different from being lost in anger because you step back a little bit and you’re turning awareness back in on your own mental, emotional, and physical experiences.

So, the treatment process is you really just training in that again, and again, and again. We call it practice.

It’s a little bit like learning a musical instrument. You have to do the scales to become proficient. So we do meditation practice to become proficient, and skilled at coming into relationship with our own direct experience and then learning how to respond more and more creatively and helpfully over time.

I’ve lived with chronic pain since 1976 when I injured my spine in a lifting accident, and then I had a car accident about five years later, and I’ve had three major surgeries over that period between now and then. The pain’s been constant and pretty severe most of that time.

I’ve got partial paraplegia, so I’ve got paralyzed bowel, paralyzed bladder, and mobility impairment, and of course, I’ve got the normal degeneration that comes with age, joint problems and so on In terms of how I’ve lived with that pain, initially, I was just in denial.

I pretended that there was nothing wrong with me, I was angry with my body, I pushed my body and then, eventually, I had a crisis about ten years after my original injury. Then I started to learn how to work with my body, rather than fighting my body and move more towards accepting my situation.

And I would say now that I’ve got a very good quality of life, I’ve got a very rich life and I like to say that I feel I’m flourishing now.

I’ve still got pain, but my life is no longer dominated by it, and I’ve, in a sense, befriended my situation and I have a good life with my pain as part of it.

The sort of pain I get each day is a combination of neuropathic pain, which is a bit like a toothache in my spine and down my legs, and then I also get joint pain which is a kind of grinding bone pain in my back and mainly my legs and my feet. In terms of the intensity of that pain, I would say it’s normally between 5 and 8 out of 10, on a pain scale.

It tends to get worse as the day goes on because it’s worse with being upright and with activity, so I’m better in the mornings and I’m more tired and achy in the evenings.

Through my life journey of learning to live as well as I can with my painful body, I’ve done a lot of reading and a lot of research about what pain is, and I’ve learned that pain is an experience that’s subjective. Everyone pain differently, and it’s in the nervous system of the body and, in a sense in the mind.

So, I used to think it was, my, my… I felt pain because my back was damaged, but now I’ve learned that my back is damaged.

There are certain signals that go into my nervous system, and then my mind has become conditioned, if you like, to feel pain.

So, what I’ve learned is that when you live with chronic pain, your nervous system becomes very good at feeling pain, so in a sense it’s a bit like, if you turn, a bit like turning up the internal amplifier, so you become better and better at experiencing pain, which is hardly a skill that we want to develop.

But that seems to be what happens, that we get more and more of our nervous system devoted to the pain experience, and that’s definitely my experience. I’ve got these spinal injuries and back pain and joint problems, but the pain itself is also something that I’ve needed to learn how to manage.

I found it very interesting learning how to use my mind to manage my pain, which wasn’t something that would have occurred to me 38 years ago when I injured my spine. But, I was lucky enough to be taught a meditation practice when I was in a hospital when I was 25, and it was quite a revelation for me.

I was a young girl lying in a hospital bed, loads and loads of pain, and then this person taught me or asked me to place my mind on a certain image.

He asked me to remember a time I’d been happy and a place I’d been happy. I took my mind back to the Southern Alps of New Zealand, where I’d done loads of climbing and been extremely happy as a teenager.

I did that with the teacher. He brought me back to the present. I was still the same girl, still lying in the same hospital bed, and yet my experience had profoundly changed, through what I’d done with my mind, and that was a complete revelation to me, and I got the bug for mind-training, or I got hooked into training my mind, because I realized that what I did with my mind changed my experience of the pain in my body.

Now it’s very important not to think, therefore, if you’re experiencing pain, it’s all in the mind and it’s your fault.

We experience pain because there’s an injury, the nervous system’s become sensitized, as I said earlier.

However, we can use our minds to unwind that sensitivity. We can use our minds to turn down the volume control in the nervous system. We can use our minds to calm everything down using meditation techniques, and so on, and I found that extremely effective for myself, very, very, empowering.

So, if anyone had ever told me it’s all in the mind, I would have felt very, very, angry, because I would have said, but my body is damaged, how can you say that it’s all in my mind.

So, it’s quite a subtle distinction. I have pain because my body is damaged and my nervous system experiences pain, and my mind can either make it worse, or it can make it better. depending on what I do with my mind.

So, the model that I’ve developed at Breathworks works is to divide the experience of pain or discomfort into two components, and we call that primary pain and secondary suffering. The primary pain or the primary suffering is the actual unpleasant sensations that I’m feeling in my back at any given moment.

The secondary suffering, which is often much much more distressing, is all the ways I make that pain worse, through my unconscious resistance, through the internal “I don’t want this experience.

I don’t want it”, going on. And that can happen mentally, with things like catastrophic thinking, allowing my mind to just go over and over the kind of “Oh, my god, it’s ruined my life, why me, poor me, it’s not fair, how I am I going to cope with how am I going to earn a living”, etc.

I can allow my mind to do that, or I can train my mind not to do that. Emotionally, it’s things like fear, anxiety, depression, despair…

all, very, very understandable emotions and yet we can learn to have a sense of choice around whether we fall into those emotions or whether we simply note the presence of them, and they may just allow being there, just let them go.

And then, physically, secondary suffering is secondary tension, so you’ve got, I’ve got pain in my back.

I don’t want it, I tense against it and then guess what, I get more pain, so I have pain plus tension equals more pain.

So, if I use my mind to learn how to soften into my body, soften into my breath, then I don’t get the secondary tension, so I’m just left with the primary sensations.

And what I’ve learned through all the years of practice, of mindfulness practice, is two important things. One is, you only experience pain one moment at a time, because, of course, a lot of the distress is thinking, oh, my god, how am I going to get through the day, or the week, or my life…

But, you only experience it one moment at a time, and the other is that the present moment is bearable.

Because when you allow the mind to run away with itself, you could think I can’t stand it, it’s going to kill me.

When it’s just in the moment, and you’re just staying with the basic experience without adding on all the secondary things, then it is bearable. It’s not nearly as bad as I fear it will be, and that’s a tremendous relief, just to live with it moment by moment by moment, breathing with it, and accepting it as it is, without adding anything.

If I think of my own experience of back pain, there’s definitely a component which is just the raw physical sensations, and then there’s a component which is my mental and emotional reactions to that discomfort, the kind of “I don’t like it” reactions.

Before I would say most of the pain I experienced was the mental and emotional aspect of it, which is quite a shocking thing to acknowledge, because….. I wouldn’t have agreed with that then, obviously, no, no, no, it’s just my back pain.

But now that I’ve become much more aware of my inner processes, I can see how the mental and emotional side was very intense and very strong. Now that I’ve got more agility with my own mind, let’s call it that, more of mind training, mindfulness has helped me get to know my own mind better, get to know my reactions. The mental and emotional aspect has calmed down massively.

So, my overall experience of pain has diminished, so I don’t suffer anything like the way I used to, even though the painful sensations are still there.

And, there’s a very important distinction, I think, between pain suffering. It’s interesting. Pain, you can live with, suffering is where you are kind of tormented by the pain. So, you can have pain without suffering, and that’s very much what we teach in mindfulness training, how to accept the pain and reduce or overcome the suffering dimensions to that pain.

There’s a nice quote that I think came from Christopher Reeve, who was the guy who broke his neck, who’d been Superman, and he said pain is inevitable, misery is a choice, and I think that’s very good, actually.

That we’re all gonna have pain in life, but misery is not compulsory. We can learn to tone down the reactive aspect to our pain, our discomfort in life. When we talk about the mental and emotional aspect of working with pain or learning how to train one’s mind to turn down the reactive distress around pain.

That might sound a bit esoteric, complicated, even religious. But I’ve got a really good little exercise that will help you get a sense of that in a very, very, simple way. And it’s using the breath, how we use the breath.

You remember that earlier on I said that you can divide pain into primary secondary suffering. Primary is your basic sensations, and secondary is all the ways you react to those sensations, and usually that’s caused by resistance, the kind of, “I don’t want this”, and when we resist, we almost always hold the breath, as well, and when we hold the breath, we get more tension.

So, I’d just like you to make a fist with one hand.

and what’s happened to your breath?

and you’re probably finding that you’re holding the breath, that’s what almost everybody does.

You make a fist, and you stop breathing.

The fist is a metaphor for the pain in the body. So, I’ve got back pain and it’s like I’ve got a fist in my body.

Then, if I’m not careful, I’ve got back pain plus breath holding, more tension, more pain.

If I have my fist and I imagine directing my breathing into the fist, if you do that at home, imagine directing your breath into the fist.

What does the fist want to do?.

and you’ll probably find that the fist wants to open. It’s quite natural, when we direct breath into an area of contraction in the body, it wants to soften, and then we’re just left with the basic sensations of pain, plus healthy, free-flowing breath.

And, of course, we breathe to deliver oxygen to the cells, which is energy, which is life force and to get rid of carbon dioxide, which is the waste product.

So, if you’re breathing optimally, then that’s going to be better for energy, better for your health. If you’ve got tension in the body, contraction in the body, discomfort in the body, plus breath- holding, inhibited breath, that’s a recipe for a lot more distress and suffering.

So, really, learning to bring awareness to our experience of the body, awareness of how we live with pain can be as simple as coming into the breath and the body, and allowing the breath to soften towards, soften towards, soften towards the areas of discomfort, and to let them settle, and unwind that cycle of tension and breath-holding, and tension and breath-holding that can become very, very intense.

I feel that I now, finally, after 38 years, I’ve learned how to manage my pain well and I’ve learned how to create the conditions in my life to support what I want to do with my life and to bring my pain with me in such a way that it doesn’t dominate.

And the things I do are very, very simple. It’s not fantastic rocket science, it’s breath awareness, being as aware as I can of my breath, as often as I can in my life, and noticing the breath-holding, and dropping back into my body, dropping back into my breath.

That has changed my life, that’s changed my life enormously.

Meditation practice has been extremely important to my journey, so I do a meditation practice in the morning, every day, where I settle into my body, I come into relationship with my discomfort in a way that’s gentle, tender, caring. I look at my mind, what are my thoughts doing, how can I manage my thoughts.

I look at my emotional states, and I spend some time trying to cultivate a more positive and supportive emotional state.

So, I do that in the morning, and then after lunch every day, I do a body scan, which is where I lie down on my bed, or on the floor, and I scan through my whole body with my awareness, and I soften my whole body with the breath.

And that’s been enormously important as well, those two things, the morning’s meditation practice, and body scan after lunch. The other thing that’s changed my life, very much for the better is pacing, and the phrase that I use there, is, take a break before you need it.

Take a break before you need it, and that’s been a very difficult thing for me to learn as a person because I’m a person who pushes the envelope.

That’s my character. So, the idea of stopping something before I was in a state of complete exhaustion, was odd. I thought you just keep doing something until you can’t do it anymore, and then you collapse.

That’s what I thought was an intelligent way of living. So that’s what I used to do, day after day, after day, pushed myself to complete exhaustion.

So, what I use now, what I do now is use a timer, when I’m at my computer, I work for twenty minutes, the timer will go off and then I have a rest for 10 or 15 minutes, then I go back to my computer.

And I’ve written two books in this method, so you can get a lot done in twenty minutes spells. What I used to do, as I would sit at my computer for maybe two or three hours in the morning until I was in agony.

I’d have sweat dripping off me, my breathing would be incredibly contracted, I’d be in very tired mental states, and then I’ll be completely wiped out for the rest of the day. So, I might have two or three hours of relative productivity, then I’d be just shattered.

This method of taking a break before I need it, means I can keep going all day long, so I can get much more done in a day, and it means I never get to that point of complete exhaustion.

So, if you think of it as energy is money in the bank, I never completely drain the account, I never go into debt. So, you just always had a little buffer in there. So, that’s been really, really important, learning how to pace my activities.

And I’d just like to repeat that, for my character and my personality type, that did not come easily. So, I always say, if I can do it, anyone can do it, yeah.

And once I started to experience the benefits, then it became easier, and that was quite soon, quite early on. So, breathing meditation, pacing, taking a break before I need it, and then it’s very simple things like three meals a day.

That’s very important. And, I think that when we’re on medication, we wake up in the morning, we take our drugs, we feel sick, we don’t eat, we feel wiped out, and then the whole day is in ruin already.

So, having a good breakfast, a good lunch, a good dinner, that’s been very very important.

Living a routine life. Again, that’s not my nature, but I’m a great fan of routine these days, going to bed at the same time, getting a decent night’s sleep. That’s been important. And, then lastly, exercise. So, I do stretch every day, just very, very, gentle stretches.

If I didn’t do my stretches every day, my back will be much, much, worse. I know that, because every day, I spend the time kind of unlocking my back, because of the condition, I spend the time just limbering up, and then I can manage through the day.

So, I do stretches and I also swim, so aerobic exercise is also important. And, again, you know, I’m not talking about swimming a mile or anything, it’s just a few lengths, three times a week, makes a big difference.

So, these are the ways I’ve learned to manage my pain. And another point about that actually is, I used to think that a miracle was like one big thing that happened, you know, blinding light, and your life’s changed. If I look at the way I am now compared with twenty years ago, it is a bit like a miracle. I’m so much better, my quality of life is so much better, but that’s come about through little changes across a very broad front.

So, lots and lots of little changes across a broad front adds up to very, very, significant and profound change, and that’s been a really great thing for me to realize as well.