Mindfulness and Pain, Part 3: Untangling the threads
In the first part of this series, I raised the possibility of mindfulness helping with management of pain and sensory issues, focusing on Shinzen Young’s Break Through Pain. In the second part, I described how developing greater body awareness–and learning to be mindful of sensations before they get too overwhelming–is an important foundation.
One thing I forgot to mention explicitly in the last post was the way trying to ignore or block out pain and other bothersome sensations can backfire, and actually make the situation worse.
These sensations are kind of like little kids or animals: if they are trying to get your attention and you keep ignoring them, they will just keep trying harder!
Thinking of the potentially overwhelming sensations as little animals has helped me react less harshly to them! Try to cope with these sensations by ignoring them, and before you know it you may be in full meltdown or shutdown. In the case of physical pain, you may still mostly not register it as pain but find yourself suddenly throwing up, or the body part in question completely seizing up so that you can’t use it. (Yes, I had a problem with both for a while. In public, when I was really trying to clamp down on it to function.)
Even before I figured out that working on body awareness was necessary, I learned that just acknowledging the sensations helped a lot. “Hello, I know you’re there. Can’t do much for you until we get home, but I do hear you!” That can be enough to get the sensations to stop escalating to get your attention.
Moving on, in this post I would like to describe some ways of dealing with the sensations once you’ve developed enough body awareness to consistently recognize them for what they are.
The first thing I tried, since tight/spasming muscles were giving me fits, was just lying down and trying progressive relaxation. In my case, deliberately tightening them first was not a good idea at all, and I had already developed a decent sense for what they felt like when they were tight. Though I’ve been using it primarily for muscle tension itself, this technique does help with anxiety (along with a lot of headaches, etc.); the physical tension will only make you feel more anxious, and so on. After a while, I could relax muscles as far as they would relax that way, if I noticed they were tight while I was going about my business.
One crucial point: thinking in terms of forcing your muscles to relax does not work nearly as well as letting them know that they do not need to be tense. This may seem like a fine distinction, especially if you’ve gotten used to bulling through and trying to make your body do things it doesn’t want to, but it made a huge difference for me. Demand resistance probably plays in there, too.
While that helped quite a bit, it did not completely do the job for me. Sometimes muscles are in such a state that they cannot relax, or they go into rebound spasm as soon as you start using them again. Sometimes you have types of pain which aren’t strongly mediated by muscle tension (though I have been surprised at how few I’ve run into, from an arthritic knee to migraines–more on the weird medical neglect of muscular causes of pain later!). Simple relaxation also does not directly address the way pain signals and other sensory signals will gang up and amplify any discomfort you’re experiencing.
When I was younger, I studied Buddhism pretty seriously for several years. (How I got away from that is a story of its own; in a way, it boils down to spending a number of years overwhelmed by dark night of the soul experiences.) I’m more than a little perplexed by the way I seemingly forgot that old Siddhartha’s teachings were all about suffering, and not having to suffer–more like, didn’t see them as relevant for a number of years there, being too caught up in suffering! A lot of other things have been built up around his teachings since then, but the very core is practical advice for dealing with suffering. At base, it’s more about pragmatism than religion as most people think of the term. Stephen Batchelor’s Buddhism Without Beliefs piqued my interest again (and helped work around the demand resistance!), though I can certainly see the point of some criticisms.
I got some obstacles out of the way, and–without calling it that–had been trying to apply mindfulness to my emotional states, which has helped me develop better emotional regulation and actually reversed some of the PTSD-related hyperarousal*. Becoming more mindful of your emotional reactions is another important prerequisite here. I had not been thinking of the body awareness thing explicitly in terms of mindfulness, either, though that was what I was doing. It finally occurred to me that explicit mindfulness might help with the physical pain I’d been unsuccessfully fighting; at least it couldn’t hurt!
With that in mind, I started doing more sitting/lying vipassana meditation, which has been helpful in multiple ways on its own. Once I felt secure in my ability to maintain concentration, I started focusing on the actual physical sensations, and the emotional reactions that wanted to go along with them. Just experiencing the sensations without overlaying all sorts of interpretations can make the pain and/or sensory weirdness easier to deal with.
Once you become aware that what you’ve been experiencing as pain and suffering is really made up of a lot of different sensations and reactions, it becomes harder for them all on to gang up you anymore. You can recognize when the fear, frustration, etc. kicks in, and see that it’s not an inherent part of the pain.
For more information on how this can work–and specific techniques–I would strongly recommend Shinzen Young’s Break Through Pain, which I mentioned and quoted from in the first post. C4Chaos also offers an excellent example in Open Practice: How Vipassana Meditation Relieves My Migraine Headaches.
As with the purposeful relaxation, it helped to stop and pay attention at first. If the sensations are overwhelming enough, or I’ve fallen back into trying to ignore them, sitting or lying down is still necessary. For dealing with a lot of pains and bits of sensory weirdness, though, after some practice I could deal with them better on the go. Just recognizing that your feelings of panic and frustration are reactions to these sensations–and can be separated–can help you get less overwhelmed.
Particularly where sensory issues or combinations of sensory issues and pain sensations are involved, this approach has worked a lot better for me than trying to stay semi-functional through taking a lot of Xanax or Klonopin, with very little understanding of what’s causing the problem! Or, as Bev points out in her recent Curing Autism post, the very common attempts at coping through alcohol or nonprescription drugs: “Sometimes the cure is worse than what one is seeking to alleviate.”
Learning to deal with these things better has meant that I don’t have to avoid as many stimuli, and it has also freed up more physical and emotional energy to do things. Recognizing the difference between sensory input and reactions to it–along with how the reactions can help further scramble sensory processing–I have been able to deal with more stimuli. Just gaining some awareness of how these things work together has made a big difference. If my back is acting up, I know that things are likely to get ugly if I also try to deal with noise and crowds; I am also better able to recognize when things are starting to get ugly before it turns into a full-out shutdown or meltdown. It’s been a relief, and it’s still early days.
Similarly, I have been able to cut back on pain medication after only a few months working with the pain this way, though it still comes in handy sometimes. Starting to figure out how to crack the pain amplification problem has helped a lot with this. There’s still a long way to go there, but again it’s a relief to know I’m not just interestingly “broken” in a way that I can’t do anything about.
Another point I didn’t address earlier: the “purification” aspect of Shinzen Young’s approach, which initially put me off reading the book! Even though he draws a fairly reasonable-sounding distinction between the potentially very harmful kind of asceticism and what he is suggesting, I am still very wary indeed. Especially if you’ve got a history of the harmful kind of ascetic behavior–which sure helped me get into such a painful state!–this may not be for you. Ignoring this aspect, which is not too intrusive anyway, it’s still a very useful book.
Incidentally, this is one of the reasons I was drawn to look into Taoist Water Method meditation, with its gentler Dissolving approach. (Thanks to Jane at Bipolar Recovery–which now seems to be protected–for mentioning this option!) This is an option for directly dealing with the connections between emotional and physical tension, and some of the patterns this can form after a while. The bit that seems perfect for me? Its emphasis on not forcing things. Given the habit energy I have behind forcing things–and the amount of damage I’ve done that way–it seems like a beneficial balancing approach.
I can’t think of much else to say on this subject right now, so I think this is the end of the post (and the series). I hope someone can get some good out of it.
* It’s easy to see the way physical/emotional factors are all tied together in hyperarousal! It can also cause pain amplification. One fairly good article on PTSD and Childhood Trauma describes part of this:
One last point to be born in mind in treating all victims of traumatic stress, whether the result is depression, anxiety attacks, or PTSD, is that the trauma is perpetuated in the body as well as in the brain. It is as if the body of the victim is perpetually on alert for the next blow, critical remark or sexual attack and is therefor held very rigidly. This is true even of depressed or anxious ballet dancers or athletes which Alicia and I have treated. These people are more prone to injury because of this ‘emotional holding pattern’ as I call it. They are also less likely to let go of the emotional impact of the trauma while this somatic pattern persists…
PTSD, like depression, can also be somatized. In an individual who was not allowed to express negative emotions as a child these emotions can be expressed as physical illness such as chronic fatigue syndrome or fibromyalgia
Hyperarousal is really hard on your body after a while, and the way it affects your nervous system can directly cause the fibromyalgia-type pain amplification. You can’t untangle one part of it without untangling the others. These are usually treated as unrelated problems in our society.
As the other article linked to earlier describes hyperarousal:
In the hyperarousal state there is a large increase of activity of the sympathetic nervous system resulting in increased blood pressure, heart rate, respiration, muscle tone, with a release of stored sugars, and a reduction of attention to non-critical information (Perry et al. 1995 ). This in turn triggers a release of adrenocorticotrophic hormones, cortisol and other stress-responses in the brain. The child may reactivate these responses according to Perry (1995) and his colleagues research, by simply thinking or dreaming about the trauma. Specific reminders (gunshots, loud noises or a stranger) may trigger the stress-response in the brain over and over again, even if the child is a distance from the original trauma. Over time the response, now may elicit an exaggerated response, causing a state of hyperarousal. Perry (1995) reports, in the long run these children learn a set of maladaptive emotional, behavioral and cognitive responses to perceived threats. Because physiological arousal becomes associated with traumatic memories in trauma survivors, any stimulus whether related to the trauma or not, can cause a flashback or reliving of the trauma. This can trigger an emotional overload, especially in adolescents with lower levels of serotonin or catecholamines, which interferes with a persons ability to regulate emotion, and can make a minor event into a major crisis to the individual (Wilson, 1986).