By Dr. Mara Karpel

“Pain is inevitable. Suffering is optional.” ~ Buddha

©M. Karpel, 2015

©M. Karpel, 2015

As I write this blog, I have had pain in my left wrist for over three months. Sometimes, it’s a sharp pain that wakes me up in the middle of the night. And sometimes it’s a dull achy pain that is the first thing I think about when I wake up in the morning. I’m doing what I’ve been told to do to help it heal, but I’ve been advised that it will take time. There are times when it really “gets” to me, becoming the primary focus of my attention, taking away my energy from the things that make me feel good and interrupting my momentum toward the goals that I want to achieve. When I have these reactions, I feel emotionally drained. And then I remember that I have a choice in how I deal with the pain. That’s when I choose a different path.


The Pain Cycle

We’ve all experienced pain from time to time––a wrenched back, a sprained ankle, tooth pain, even a headache. Yet when pain becomes chronic–– lasting for longer than three months with little or no relief––it often leads to the pain cycle: Pain causes lowered activity and increased use of medications with side-effects of drowsiness and fatigue; this leads to further decreased activity and, subsequently, social isolation, boredom, less flexibility, less strength and stamina, and lowered ability to cope with daily stressors of life; this, then, spirals down to depression and anxiety; leading to a lower tolerance to pain, greater sleep disturbance, and increased fatigue and muscle tension; and all of this cycles around to increased pain and a repeat of this pain cycle, with even greater intensity, as well as physical and emotional suffering.

Adding to this downward spiral is what the mind does when the body is experiencing pain that doesn’t go away. In his book, Full Catastrophe Living, Dr. Jon Kabat-Zinn writes, “If you have a chronic illness or a disability that prevents you from doing what you used to be able to do, whole areas of control may go up in smoke. And if your condition causes you physical pain that has not responded well to medical treatment, the distress you might be feeling can be compounded by emotional turmoil caused by knowing that your condition seems to be beyond even your doctor’s control.” You may notice thoughts such as, “My body is broken,” “I will never feel better,” “I will never feel happy,” or “This will never end.” When we struggle like this in the face of pain, although it may be the “natural” thing to do, we are creating more emotional suffering, subsequently leading to greater physical pain and suffering.


Breaking the Pain Cycle

In order to break this pain cycle, we need to approach it from several different angles. First, relaxation techniques can be extremely beneficial, as they can reduce the stress caused by the pain. Relaxation can also reduce pain by releasing endorphins, which are those wonderful natural pain-relievers and mood elevators in the brain. Furthermore, relaxation decreases symptoms caused by stress, such as sleep disturbance, fatigue, and muscle tension, which all tend to aggravate pain. Mindfulness meditation, consisting of actually fully noticing the sensations of pain and illness as they rise and fall, without judgment, as strange as it sounds, has been found to be more powerful in relieving pain than medication. In fact, this type of meditation has been found to reduce chronic pain by as much as 57% in newcomers to this technique and by more than 90% in seasoned mindfulness meditators, says Dr. Danny Penman, author of the book, Mindfulness: A Practical Guide for Relieving Pain, Reducing Stress, and Restoring Well-Being.

Brain-imaging studies have found that mindfulness meditation can actually change the structure of the brain so that meditators experience less intense pain over time, sometimes to the point of barely feeling the pain at all. These findings have inspired hospital clinics to prescribe mindfulness meditation for pain and discomfort stemming from a variety of conditions, instead of overprescribing pain medications with their myriad of side effects. It has been prescribed for coping with the pain of cancer and the physical side-effects of chemotherapy, for heart disease symptoms, symptoms of diabetes and arthritis, as well as chronic back pain, migraine headaches, fibromyalgia, coeliac disease, chronic fatigue, irritable bowel syndrome, and even multiple sclerosis. In addition, the research has consistently found that it’s also a powerful reliever of stress, anxiety, and depression and that it can improve memory, focus, and physical stamina, helping our overall sense of well-being and happiness. A recent study published in the journal, Psychiatry Research: Neuroimaging, found that brain imaging studies of people who participated in a Mindfulness-Based Stress Reduction showed changes in the gray matter density in those regions of the brain that are important for new learning, memory, emotional regulation, and problem-solving.


The Body Scan

One technique of mindfulness meditation that is frequently used for coping with physical pain and is also powerful for reducing anxiety and stress is called the Body Scan Meditation. According to Dr. Penman, the Body Scan “allows you to see your mind and body in action, to observe painful sensations as they rise, and to let go of struggling with them. When you do this, something remarkable happens: your suffering begins to melt away of its own accord.”

Here’s a quick summary of the Body Scan:

Lie on your back, close your eyes, and feel your body sinking into the surface beneath you. Then, focus your attention on your breathing, without trying to change or control it. Just feel your breath as you inhale and exhale, your belly rising and falling, the sensation of your breath as it moves through your body. Sense if your breath is deep or shallow, smooth or ragged. Then gently bring your awareness to each region of your body, one by one, without judgment. Notice the sensations in each part of your body without judging, without telling yourself that this is good or bad. Just be aware. Move very slowly, starting at the top of your head, moving through your face, your neck, your shoulders, your arms, each of your hands, your upper back, your middle back, your lower back, each of your hips, each of your legs, all the way down to your feet and toes. Take note: Is this body-part warm or cold, pain-free or achy? If there is pain, is it sharp or dull, is it tingly, is it intense? For example, my left wrist has a dull achy pain at this moment, while my right wrist is pain-free. After you’ve scanned each part of your body, separately, become aware of your whole body and again focus attention on your breathing. When you’re ready, open your eyes slowly and gently bring your awareness back to your surroundings.


Engaging in Pleasurable Activities

Now, for the rest of the day, increasing your pleasurable activities, in spite of the pain, is also important for breaking this cycle. Enjoyable activity can serve as a distraction from your pain and it can decrease your social isolation. Therefore, it will help improve your mood.  Recently, I met a friend for an inspiring conversation over a cup of coffee. I was so intrigued by our conversation and enjoyed the connection with my friend so much, that I forgot about the pain in my wrist. When I returned home, I hardly felt any pain at all.

Remember to pace yourself so that you can increase your activity level without causing you to pay for it with an increase of pain. Pacing yourself involves being careful to alternate between activities that are more physically demanding and those activities that are less demanding. Also, schedule enough time to recuperate after being active. And don’t be afraid to ask for help when you need it. Now, since my pain is just in one wrist, pacing myself means, for me, that I will take breaks from the computer, even though writing is an enjoyable activity for me, because I’ve noticed that using the computer aggravates the pain –– and might actually be one of the main causes of this pain, in the first place.


Changing Your Beliefs

Finally, changing your beliefs about yourself and your pain is critical for breaking the cycle of pain and depression. There are two forms of pain, according to Dr. Penman. There is primary pain, which is that pain which is caused directly from the illness or injury. Then there is secondary pain, which is how the mind reacts to the pain and this actually amplifies it. By becoming mindful, we can actually turn down the volume of this amplifier.

Dr. Kabat-Zinn writes, “Statements such as, ‘This is killing me,’ ‘I can’t stand it any longer,’ ‘How long will this go on?’ ‘My whole life is a mess,’ ‘There is no hope for me,’ ‘I’ll never master this pain,’ may all move through your mind at one time or another. You may find such thoughts coming and going constantly….Not only are these thoughts not the pain itself, they are not you either! Nor, in all likelihood, are they particularly true or accurate.”  As I mentioned earlier, I am aware that when I let myself go down that path of negative self-statements about my pain, I feel emotionally upset, exhausted, and even an increase of pain. However, when I can notice the pain without judgment, maybe even a little bit of curiosity, I come to see that it’s not “terrible,” that I can live with it, and I’m able to move forward with my life, doing things that I enjoy and that are emotionally fulfilling. After some time, the pain begins to subside.

Dr. Kabat-Zinn offers an invitation. “What about letting go of those thoughts on purpose, as a little experiment, when you are in a lot of pain?…What about accepting things just as they are right now, in this very moment, even if you hate them, even if you hate the pain? What about purposefully stepping back from the hatred and the anger and not judging things at all, just accepting them?”  When you let go of trying to control something that you cannot control, when you begin to allow yourself to go with the flow rather than fighting, you will begin to feel more in control of your life, instead of feeling ruled by your pain. This will ultimately break the cycle of pain and help you, once again, to have joy in your life.

©M. Karpel, 2015

©M. Karpel, 2015

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