POSITIVE PSYCHOLOGY: Yes it's a pain – but taking a breath can help

PEOPLE living with chronic pain often find themselves in a psychologist’s office at some point in their journey to obtain good pain management.

Chronic pain can be defined as pain that usually lasts at least 12 weeks and can affect any part of the body. The International Association for the Study of Pain has defined chronic pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”.

There are many familiar conditions that cause chronic pain, including arthritis, back pain, headaches, fibromyalgia, Lyme disease, cancer, endometriosis. Chronic pain can also be accompanied by psychological symptoms such as anxiety and depression, poor sleep, alcohol or substance abuse which further impact people’s lives.

Medical management of pain often utilizes a variety of medications including muscle relaxers,

non-steroidal anti-inflammatory drugs, topical products, opioids, analgesics, steroid injections, nerve blocks. Physical therapy includes exercise, manipulation and massage as well as techniques such as electrical stimulation and dry needling.

Psychological techniques have been proven to help with good pain management. Back in 1979, a physician named Jon Kabat-Zinn developed a programme called Mindfulness Based Stress Reduction (MBSR) and in the decade that followed, began introducing it to patients living with chronic pain.

His observation was that despite the type of medical management described above patients were still not experiencing optimal pain management. Kabat-Zinn, a western-trained physician, had also studied mindfulness under several Buddhist teachers including Thich Nhat Hanh.

He wanted to combine his western medical training with his eastern learnings about mindfulness and meditation with the aim of helping his patients.

He founded the Center for Mindfulness at the University of Massachusetts Medical School and the Oasis Institute for Mindfulness-Based Professional Education and Training and he developed the widely used secular MBSR program which we know today.

This evidence-based programme uses mindfulness meditation to help alleviate physical as well as emotional suffering. Participants commit to practising mindfulness techniques on a daily basis over the course of eight weeks.

According to Kabat-Zinn one of the most healing things you can do for your body during the day is to direct your breath into the area of pain, feeling the breath as it moves into the tension and then visualizing the pain softening and dissolving as you breath out.

One very powerful technique taught on the MBSR course is the body scan meditation. Put very simply this meditation teaches participants to bring their attention to different regions of the body in a non-judgemental and curious manner. It teaches you to become familiar with your body and the pain you are experiencing.

If pain or discomfort is registered, you are taught to acknowledge it and move on without getting stuck by thoughts and concerns about this pain. You just breathe in and out of the pain, letting go.

As a meditation technique the body scan is used to build up participants’ attention, concentration and a sense of calm. Paradoxically patients are advised not to be goal-focused or to want to feel a certain way, rather, they are advised to practise the body scan for its own sake, without expectation and judgement.

The practise is the important thing so that attention improves and a capacity to feel pain without tensing up more, to sit with it rather than fighting and resisting it and then to move attention away from it.

Psychologists often refer to two types of pain – primary pain and secondary pain. The primary pain is the physical experience of the pain sensation and the secondary pain is the psychological and emotional experience.

The psychological perception of pain varies from person to person and is dependent on a number of factors. For example, if you are experiencing emotions such as anxiety, anger, frustration and impatience with the pain, your body naturally tenses up.

Judgements about the pain often cause more tension, “Why is this happening to me?”, “This is awful, I cannot cope with this”, “Is this going to get worse?” These can intensify your symptoms and even create additional ones.

Also, if your focus of attention is solely on the pain this can heighten your perception of pain. That is why when we sit with the pain, breathe into it and cast all the judgments aside which trigger these emotions, we often find that we can turn our focus of attention to something else and the pain seems to diminish.

Kabat-Zinn advises that a commitment of 45 minutes daily to the body scan meditation, even if it feels boring or like it’s not helping. You just do it.

We often advise people when they are starting their meditation practice to pick a time and to practise at that time every day, so that meditation happens regardless of your mood or the kind of day you are having.

The body scan encourages participants to be curious and open to the body and the sensations, any pain or any discomfort they experience, and to cultivate kindness and acceptance in their relationship with their bodies and their pain.

The research evidence is that people who practise the body scan consistently experience an increased sense of well-being, improved quality of life and have less pain-related distress such as depressed mood and a reduced perception of pain.

We often practise meditation with clients on an individual basis in therapy as well as with groups of people when we run our classes in the community.

We encourage our clients to build up their own practice; there are a number of apps (some of which are free to download) such as “Insight Timer” and a number of meditations available to view on YouTube, including the original Jon Kabat-Zinn, body scan.

Even if realistically it is more likely that we have 10 minutes rather than 45, just spending that 10 minutes connecting with the breath and the body will benefit both our minds and our bodies.

Julie O'Flaherty and Imelda Ferguson are chartered clinical psychologists, both based in private practice in Tullamore. Through Mind Your Self Midlands, they run courses on Positive Psychology and Mindfulness through the year. They can be contacted through the Psychological Society of Ireland www.psychologicalsociety.ie (Find a Psychologist section) or on their Facebook page, Mind Your Self Midlands.