You Are Not Your Pain: Using Mindfulness to Relieve Pain, Reduce Stress, and Restore Well-Being---An Eight-Week Program

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You are Not Your Pain

Using Mindfulness to Relieve Pain, Reduce Stress, and Restore Well-Beingâ"an Eight-Week Program

Flatiron Books

Every Moment Is a New Chance

Pain always seems worse at night. Something about the silence amplifies the suffering. Even after you've taken the maximum dose of painkillers, the aching soon returns with a vengeance. You want to do something, anything, to stop the pain, but whatever you try seems to fail. Moving hurts. Doing nothing hurts. Ignoring it hurts. But it's not just the pain that hurts; your mind can start to suffer as you desperately try to find a way of escaping. Pointed and bitter questions can begin nagging at your soul: What will happen if I don't recover? What if it gets worse? I can't cope with this. Please, I just want it to stop. ...

We wrote this book to help you cope with pain, illness, and stress in times such as these. It will teach you how to reduce your suffering progressively, so that you can begin living life to the fullest once again. It may not completely eliminate your suffering, but it will ensure that it no longer dominates your life. You'll discover that it is possible to be at peace, even if illness and pain are unavoidable, and to enjoy a fulfilling life.

We know this to be true because we have both experienced terrible injuries and used an ancient form of meditation known as mindfulness to ease our suffering. The techniques in this book have been proven to work by doctors and scientists in universities around the world. Mindfulness is so effective that doctors and specialist pain clinics now refer their patients to our Breathworks center in Manchester, UK, and to courses run by our affiliated trainers around the world. Every day we help people find peace amid their suffering.

This book and the accompanying CD reveal a series of simple practices that you can incorporate into daily life to significantly reduce your pain, anguish, and stress. They are built on Mindfulness-Based Pain Management (MBPM), which has its roots in the groundbreaking work of Dr. Jon Kabat-Zinn of the University of Massachusetts Medical Center. The MBPM program itself was developed by Vidyamala Burch (coauthor of this book) as a means of coping with the aftereffects of two serious accidents. Although originally designed to reduce physical pain and suffering, it has proven to be an effective stress-reduction technique as well. The core mindfulness meditation techniques have been shown in many clinical trials to be at least as effective as drugs or counseling for relieving anxiety, stress, and depression. When it comes to pain, clinical trials show that mindfulness can be as effective as the most commonly prescribed painkillers, and some studies have shown it to be as powerful as morphine. Imaging studies show that it soothes the brain patterns underlying pain, and over time, these changes take root and alter the structure of the brain itself so that you no longer feel pain with the same intensity. And when it does arise, the pain no longer dominates your life. Many people report that their pain declines to such a degree that they barely notice it at all.

Many hospital pain clinics now prescribe mindfulness meditation to help patients cope with the suffering arising from a wide range of diseases, such as cancer (and the side effects of chemotherapy), heart disease, diabetes, and arthritis. It is also used for back problems, migraines, fibromyalgia, celiac disease, and a range of autoimmune diseases such as lupus and multiple sclerosis, as well as for such long-term conditions as chronic fatigue syndrome and irritable bowel syndrome. It's also useful for coping with labor pain. In addition to all these uses, clinical trials also show that mindfulness significantly reduces the anxiety, stress, depression, irritability, and insomnia that can arise from chronic pain and illness. Researchers are continually finding new conditions that can be eased with mindfulness.

MINDFULNESS DISSOLVES PAIN AND SUFFERING

Mindfulness-Based Pain Management uses ancient meditations that were largely unknown in the West until recently. In one typical meditation, you focus on the breath as it flows into and out of the body (see box here). This allows you to see your mind and body in action, to observe painful sensations as they arise, and to let go of struggling with them. Mindfulness teaches you that pain naturally waxes and wanes. You learn to gently observe it, rather than be caught up in it, and when you do so, something remarkable happens: it begins to melt away of its own accord. After a while, you come to the profound realization that pain comes in two forms: primary and secondary. Each of these has very different causes—and understanding this gives you far greater control over your suffering.

Primary pain tends to arise from illness, injury, or damage to the body or nervous system. You could see it as raw information being sent by the body to the brain. Secondary pain follows close behind, but is often far more powerful and distressing. Secondary pain can be seen as the mind's reaction to primary pain.

Pain's Volume Control

The mind has tremendous control over the sensations of pain that you consciously feel and how unpleasant they are. It has a "volume" control that governs both the intensity and the duration of the sensations of pain. This is because your mind does not simply feel pain, it also processes the information that it contains. It teases apart all of the different sensations to try to find their underlying causes so that you can avoid further pain or damage to the body. In effect, your mind zooms in on your pain for a closer look as it tries to find a solution to your suffering. This zooming-in amplifies your pain. As your mind analyzes the pain, it also sifts through your memories for occasions when you have suffered similarly. It is searching for a pattern, some clues, that will lead to a solution. Trouble is, if you have suffered from pain or illness for months or years, then the mind will have a rich tapestry of painful memories on which to draw—but few solutions. So before you know it, your mind can become flooded with unsettling memories. You can become enmeshed in thoughts about your suffering. It can seem as if you've always been ill and in pain, that you've never found a solution and that you never will. So you can end up being consumed by anxieties, stresses, and worries about the future as well as physical pain: What will happen if I can't stop this pain? Am I going to spend my life suffering like this? Is it going to keep on getting worse?

This process happens in an instant, before you're consciously aware of it. Each thought builds on the last and quickly turns into a vicious cycle that ends up amplifying your pain. And it can be worse than this because such stresses and fears feed back into the body to create even more tension and stress. This can aggravate illnesses and injuries, leading to even more pain. It also dampens down the immune system, impairing healing. So you can all too easily become trapped in a vicious downward spiral that leads to ever-greater suffering.

But even worse, such negative spirals can begin wearing tracks in the mind so that you become primed to suffer. Your brain begins fine-tuning itself to sense pain more quickly—and with greater intensity—in a futile bid to try to avoid the worst of it. Over time, the brain actually becomes better at sensing pain. Brain scans confirm that people who suffer from chronic pain have more brain tissue dedicated to feeling the conscious sensations of pain. It's almost as if the brain has turned up the volume to maximum and doesn't know how to turn it down again.

It's important to emphasize that secondary pain is real. You do genuinely feel it. It's only called secondary pain because it is the mind's reaction to primary pain and has been heavily processed before you consciously feel it. But this same processing also gives you a way out; it means you can learn to control your pain. For this reason, secondary pain is best described as suffering.

In practice, you can be in pain but you need not suffer.

Once you realize this, deep in your heart, then you can learn to step aside from your suffering and begin to handle pain very differently indeed. In effect, mindfulness hands back to you the volume control for your pain.

The benefits of mindfulness on overall mental and physical health have been demonstrated in a wide range of scientific studies. Despite this, you might still be a little skeptical about meditation. When the word is mentioned, a whole cascade of stereotypes can spring to mind: Buddhist monks, yoga classes, lentils, brown rice ... So, before we proceed, we'd like to dispel some myths:

• Meditation is not a religion. It is simply a form of mental training that has been proven in countless scientific trials to help people cope with pain, illness, anxiety, stress, depression, irritability, and exhaustion.

• Meditation will not trick you into passivity or resign you to your fate. On the contrary, mindfulness boosts mental and physical resilience.

• Meditation will not seduce you into adopting a fake "positive" attitude to life. It simply creates a form of mental clarity that helps you to enjoy life and achieve your goals.

• Meditation does not take a lot of time. The program in this book takes around twenty minutes per day. Many people find that it liberates more time than it consumes because they spend far less time having to cope with chronic pain, illness, and stress.

• Meditation is not difficult or complicated, although it does require some effort and persistence. You can meditate on more or less anything (see the Coffee meditation in Chapter 3). You can also do it virtually anywhere—on buses, trains, aircraft, or even in the busiest office.

MINDFULNESS FOR HEALTH

This book operates on two levels, which unfold week by week. The core mindfulness program takes eight weeks, and a chapter is dedicated to each step. Each week you'll be asked to carry out two meditations on six days out of seven. These take just ten minutes each.

You'll also be encouraged to break some of your unconscious habits of thinking and behaving. These can embed a surprising amount of suffering because much of what we think and feel is locked in place by ongoing ways of approaching the world. By simply breaking some of your more ingrained habits, you will help dissolve your suffering. Habit-breaking—we prefer the term habit-releasing —is straightforward. It can be as simple as watching the clouds from a park bench or waiting for the kettle to fully boil before making a cup of tea or coffee (rather than rushing to switch it off).

The program in this book is best carried out over the recommended eight weeks, although you can do it over a longer period if you wish. Many people find that mindfulness gives them so many benefits that they continue with it for the rest of their lives. They see it as a journey that continuously reveals their true potential.

It can be a long and fruitful journey. We wish you well.

* * *

The next chapter explains the science behind mindfulness and how it dissolves pain, suffering, and stress and restores well-being. Reading it will improve the effectiveness of the whole program. If you wish to begin the program immediately, feel free to do so, but try to come back to Chapter 2 when you get the chance. It enhances the whole experience.

The accompanying CD contains the meditation tracks that you will need to carry out the program. For best results, we suggest that you first read through the meditations found in each of the eight practice chapters to familiarize yourself with what's required. Then, it is best if you carry out the actual meditations while listening to the corresponding tracks. You can also download these as MP3 files from http://us.macmillan.com/books/9781250052674.

What You Resist Persists

Claire stared at the computer screen before cocking her head slightly to one side. She winced as a sharp pain angled its way through her neck and down her left arm. Her fingers went numb and then began to throb. Claire's youthful good looks dissolved and she suddenly looked twenty years older. She stretched her arm and slowly began rubbing her neck to loosen the muscles. Her shoulders and neck had cramped up, making her whole upper body look tense and contorted. She reached for a glass of water and gulped down two more painkillers.

Why won't this pain just stop? Why won't these blasted painkillers work anymore? They're useless. I'm so sick and tired of this.

Three years previously, Claire had been injured in a car crash and suffered two broken ribs, a fractured wrist, and whiplash. Her ribs and wrist had healed completely within three months, but the aftereffects of her whiplash refused to go away. The doctors were puzzled by her pain. Several scans had shown that her neck had completely healed, but the pain stubbornly remained. It was worse if she stayed in one place for too long. After twenty minutes, sharp, jagged pains would arc up and down her neck. When she finally did move, she would feel stiff and achy all over.

Claire felt increasingly trapped and broken. Her doctor had prescribed several courses of physiotherapy without any long-term success. Now she was forced to continually take painkillers and anti-inflammatory drugs. They worked, more or less, but often left her feeling washed-out and jaded. They were okay for stubborn achiness, but did nothing for the frequent sharp twinges of pain. Lately her doctor had begun suggesting antidepressants to lift her mood. Her response was always the same: "I'm not depressed," she'd snap. "I'm angry because that man who drove into me has taken my life away. I used to dance all night. Now I can barely walk!"

Experiences like Claire's result not just from whiplash, but from a range of diseases. Conditions such as a "bad back," migraines, chronic fatigue syndrome, and fibromyalgia can all cause pain long after the original injuries have healed or without any obvious cause that shows up on scans or tests. Even with a clear physical cause, as with arthritis, heart disease, or cancer, the pain often comes and goes without any apparent rhyme or reason. Doctors then feel forced to prescribe long-term courses of painkillers, but these can have side effects such as memory loss, lethargy, and even addiction.

Claire and millions of others exist in a world of suffering, a place where even the simplest of tasks can amplify their pain. This often leads to anxiety, stress, depression, and exhaustion, each of which further enhances suffering in a downward spiral. Such vicious cycles are driven by newly discovered psychological forces that underlie the perception of pain. Crucially, this discovery offers a wholly new approach to the management of pain and illness that has the potential to transform suffering. It is important to understand these underlying forces because such knowledge enhances the effectiveness of the whole mindfulness program.

WHAT IS PAIN?

The commonsense view of pain is that it arises from damage to the body. This attitude was formalized in the seventeenth century by the French philosopher René Descartes with his "rope-pull" model of pain: just as pulling a rope in a church steeple rings a bell, Descartes thought that damage to the body is a tug that causes the awareness of pain in the brain. For centuries after Descartes, doctors regarded pain in a similar light. The intensity of pain was thought to be directly proportional to the degree of damage to the body, which would mean that if different people had the same injury, they would experience the same amount of pain. If no obvious physical cause was found, the patient would be regarded as malingering or making it up.

Since the 1960s, science has come to accept another model of pain, known as the Gate Theory and developed by Ronald Melzack and Patrick Wall. They suggest that there are "gates" in the brain and nervous system that, when open, allow you to experience pain. In a sense, the body sends a continuous low-level "chatter" of pain signals to the brain, but only when the gates are opened do the signals reach your conscious mind. These gates can also close, which is what happens when your pain lessens or fades away.

Opening and closing these pain gates is a phenomenally complex process. Although the details are still being worked out, pain is clearly far more subtle and complex than the traditional idea of damage signals being sent to the brain, which are then passively felt. Pain is a sensation, which means that it is an interpretation made by the brain before it is consciously felt. To make this interpretation, the brain fuses together information from the mind as well as the body. This means that the thoughts and emotions flowing through your mind, both conscious and unconscious, have a dramatic effect on the intensity of your suffering. Not without reason did the ancient Greek philosophers consider pain to be an emotion.

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Excerpted from You are Not Your Pain by Vidyamala Burch, Danny Penman. Copyright © 2013 Vidyamala Burch and Danny Penman. Excerpted by permission of Flatiron Books.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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