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Mindful : April 2015
prescription drug abuse, and other forms of self- medication—a sy ndrome that is well-depicted in the recent Jennifer Aniston movie Cake. While pain medication is a blessing, it often doesn’t relieve all of the pain, and it also comes with serious short- and long-term side effects. One student told me: “Living with chronic pain is like having another full-time job. The extra time it takes me to just get out of the house in the morning, the doctor and chiropractor visits, the extra time I need for soothing and self-care, just so I can still work my regular job. And let’s not mention the extra money I need to spend.” What is pain? Let’s start with a simple question: What is pain? We could say pain is the body’s way to tell the brain “Pay attention! There is something wrong.” And, as such, the pain response is immensely helpful. We actually couldn’t have survived as a species without this mechanism. In some rare cases people are born with an inability to feel pain. They might step on a nail and not notice it. They suffer from many infec- tions and often untreated fractures of the bones, because the system to alert them to pain just isn’t functioning. Acute versus chronic pain What about chronic pain? My personal theory is that chronic pain could be seen as a malfunction- ing side effect of evolution. Think about it: Let’s say you tear your meniscus, the cartilage in your knee. It’s painful. After a while you get surgery because it’s not healing. But after the surgery and healing phase your knee is still in pain. Your doctor says, “Well, there isn’t really anything I can do now. I can g ive you a nother prescription for your meds but otherwise you’ll have learn how to live with that.” Wouldn’t it be nice to be able to switch off the pain at this point? You know everything you need to know, so now pain’s job to alert you is done. But no such luck. Instead the pain keeps telling you over a nd over: “Pay attention! There is something wrong.” This constant alerting is exhausting to the Christiane Wolf, M .D., Ph.D., is a physician turned mindfulness meditation teacher and teacher trainer. She is coauthor of the forthcoming book Clinician’s Guide to Teaching Mindfulness. ner vous system, as anyone suffering from chronic pain will tell you. And, if that ’s not enough, resea rch shows that the pain threshold is lowered over time: At the extreme, even slight touch can be felt by the alerted brain as pain. Pain doesn’t seem to be some- thing we can get used to, allowing it to fade into deep background, like sounds or sights. Instead we have to learn how to live with it. And mindfulness practice is a wonderful opportunity to do just that. It helps to shift the locus of control from the outside (“this is happening to me and there is nothing I can do about it”) to the inside (“this is happening to me but I ca n choose how I relate to it”). We learn to attend to our experience in a kind, curious manner instead of fighting or denying it. We learn to cope with the pain in new ways. Some stud- ies on pain suggest that the greatest benefit from learning mindfulness meditation is the coping. For example, studies show that the reported quality of life goes up while the “objective” pain ratings don’t change much. A regular meditation practice (which can include short a nd long sessions and everything in between) is the best ongoing foundation for working with pain. It helps us to hone the skills we need to attend to pain—or any challenging experience we encoun- ter for that matter. Suffering is optional Before we look at working with pain in more detail, let’s start out with a bigger picture perspective. You might have heard the saying, “Pain is inevitable, suf- fering is optional.” While this is an easy-to-remem- ber phrase, most people still wonder “How exactly does that work?” Living with chronic pain is like having an extra full-time job. It takes so much added time to just get out of the house in the morning, visit the doctor and chiropractor, and to deal with soothing and self-care—just to be able to work a regular job. 72 mindful April 2015 mindful practices insight