Pain, Presence, and Healing

“Go back and take care of yourself. Your body needs you, your feelings need you, your perceptions need you. Your suffering needs you to acknowledge it. Go home and be there for all these things.”

Tich Nhat Hanh

 

What I didn’t understand until I started studying mindfulness and holistic healing was the difference between healing and curing, and the role of unadulterated presence in processing difficult experiences.

My personal process with cultivating presence through challenging times started a long time ago, long before I knew what mindfulness was. As I like stories and find them an easy way to start writing about challenging topics, I feel compelled to start with this story, and from there touch upon more general aspects of mindfulness and cultivating presence even (and especially) amidst pain.

What did it do for me? What can it do for you? What exactly is going on at a physiological level when we “stay with the pain” – whether it’s physical, emotional, or both? Keep reading: we’ll explore all of this in the paragraphs that follow.

 

My Story

My first experience of mindfulness is sitting on a chairlift at a ski resort in Vermont. I grew up ski racing in the Green Mountains, and some winter days – especially those in late January – brought cold temperatures that would leave me with a frostbitten nose and painfully numb toes.

One particular day – I was about 10 years old – I sat on the lift huddled with my friends, and spontaneously decided to observe what felt like unbearable pain from cold in my toes. Instead of tapping my feet, holding my breath, and squirming around, waiting to get to the top where I could go into the warmth of the lodge, I observed. There was a sensation, an uncomfortable sensation, in my toes that I labeled as cold. For the rest of the chairlift ride, I dissected this feeling, giving as many descriptions as I could to the physical feeling of cold. And you know what? The pain lessened. The sensation was there, but the experience of pain…it dissolved.

I didn’t recall this story until a similar experience in a Vipassana meditation course fifteen years later, when I experienced the sensation of what felt like my knees ripping apart from sitting immobile in meditation for several hours. In that space, knowing that my knees weren’t, in fact, ripping apart, but that there was a lot of pain in them, I began to understand more clearly what it means to (quite literally) sit with the pain. That experience of pain, too, eventually dissolved.

There have been heavier health and healing projects in my life, too: situations that have asked me to stay with physical discomfort, emotional upheaval, and judgements deeply woven into the patterning of my mind.

There have been heartbreaks and surgeries and reactivated core wounds that have left me wanting to get as far away as possible from the pain process. But one of the most important healing lessons I’ve learned through these experiences is that pain wants to be seen. And it is through seeing it and staying with it, non-judgmentally, with mindfulness, that deep healing takes place.

Easier said than done? Yes. But when it comes to holistic healing, staying present may very well be the “x” factor that yogis and meditators have recognized for millennia, and modern science is now starting to understand.

The magnitude of the situation can vary from a bee sting to an utterly broken heart, but the practice of presence remains, at its roots, the same.

 

The Brain on Pain

Pain is a subjective phenomenon: a perception meant to indicate danger, thereby motivating us to stop or change our present behavior. This is a survival mechanism built into the brain. If you stub your big toe, for example, pain receptors called nociceptors are activated by the tissue damage, a signal travels up through the nerves of the foot, leg, and finally spinal cord, where neurotransmitters are released to activate other nerves that continue passing the signal to the brain.

When these signals reach the brain, the thalamus acts as a switchboard that signals the somatosensory cortex, frontal cortex, and limbic system. These aspects of the brain are responsible for physical sensation, thinking, and emotional processing, respectively.

The end result is the sensation of pain in the big toe, and often simultaneous reactions of thoughts like, “that hurt!” and emotions of anger or irritation. The entire process takes a fraction of a second.

While this is a basic example of the experience of pain, it is important to note here that deeper pains – especially those we associate with difficult emotions – also entail communication within the structures of the brain that ultimately result in judgements of the pain itself.

The impulsive reaction of aversion towards the pain– of “this is bad, go away” – is the same.

It is within this aversion that pain finds its power; it is also within this aversion that conscious presence works to disrupt reactivity to shift the fundamental ways that your brain processes pain. In yoga therapy, we call it the freedom gap.

 

The (Neural) Path to Freedom

In early 2015, a video of a Thai Buddhist monk meditating over a fire in a vat of boiling oil went viral. While plenty of skeptics – even scientists – attempted to refute the image, to those who study the brain on meditation there was nothing unbelievably abnormal about the scene.

It is known amongst meditators that a fully focused citta, or mind, can cut off pain signals to the brain. In advanced practitioners, this can result in seemingly supernatural capabilities to intercept signaling in the brain before it is registered as pain. The good news is that this can be practiced by anyone, in small doses, to improve quality of life by staying present with what your brain interprets as pain.

A normal reaction to pain is reaction with judgement; if we can allow the mind to stay with the pain without judgement, we can stop it from jumping from perception to judgement. In the example of the stubbed toe, this would mean intercepting the signal before it jumps from an observation of “strong sensation” to the thought of “that hurts, I’m irritated, go away!” This is the practice of mindfulness.

The pattern of the mind in perceiving pain is this: sensation, judgement, processing, running away from present moment.

In the case of the stubbed toe, this might look like: sensation, “ouch, that hurts!”, “I don’t like that”, distracting the mind with something else and cultivating aversion towards the present experience.

The practice of mindfulness disrupts this unconscious process by observing the sensation before it jumps to judgement. This results in staying with the present moment before allowing the mind to run away from it – a crucial aspect of healing since running from the present moment results in undigested experiences.

These undigested experiences can be stored in the bodily tissues as tension, in the energetic channels as blockages, in the emotional body as suppression, and in the mind as thought patterns that shape one’s perception of reality. Over time, these undigested experiences result in deeply embedded patterns understood by yogis as samskaras.

 

Presence and Healing

Recent studies on mindfulness as a healing approach toward pain management, addiction, and disorders tied with emotional challenges show unparalleled success in terms of improving quality of life and easing the experience of pain itself.

A 2014 study designed to evaluate the long-term efficacy of mindfulness-based relapse prevention in smoking addiction showed that mindfulness was five times as effective as standard programs designed to help people quit smoking.

One of the foremost studies on chronic pain management conducted in 1982 by famed researcher Jon Kabat-Zinn demonstrates the potential for improved quality of life through mindfulness even whilst the condition itself is not cured. After 51 chronic pain patients who had not improved after treatments in traditional medical care went through 10 weeks of specific mindfulness training, 65% showed significant reduction in pain despite underlying medical conditions (supposed to cause the pain) still remaining.

In both studies (along with several similar studies), the general conclusion regarding pain is the same: when turning towards the pain (the physical sensation, the fear, the addiction, the difficult emotion), people experience less of it. Breaking the connection between the structures in the brain responsible for registering sensation, like the amygdala, and structures responsible for evaluating those sensations, like the prefrontal cortex, are achieved through mindfulness.

Consequently, habituated patterns of aversion towards difficult sensations that lead to long-term suffering (again, we can refer to these as samskaras) are also broken. The result is decreased suffering, significantly improved quality of life, and a depth of healing that is simply not possible without the power of presence.

 

Take-Home Tips for Mindfulness

Mindfulness is a practice, and one that asks for patience and persistence. As a yoga therapist, I find that the most challenging point to explain to clients is that healing on deep levels and the shifting of patterning in the brain and body takes time.

A trust in oneself and in the practice is necessary. And while you can spend hours exploring the internet and reading up on specific studies that support presence and mindfulness as an avenue for healing, I find that there is, as one of my teachers emphasizes, a leap of faith somewhere in this process. So, my first take-home tip is just that: take the leap.

Here are a few additional tips for practicing presence through mindfulness:

 

  • Cultivate a practice, a basic mindfulness meditation that you commit to for 10 minutes each day. Sit in a meditative posture with the spine straight, and begin by focusing on the breath; notice the sensation inside the nostrils on each inhale and each exhale. Whenever a thought or emotion comes up, notice it, and label it (for example, thought or pain or anger). Then, let it pass. Continue to focus on the breath, and when the mind wanders to something else, notice, label, and return to the breath. Soften towards yourself if you catch the mind wandering: each time you notice and bring it back to the breath, it’s like doing a push-up for your brain – this is mindfulness!

  • To be aware of every sensation, reaction, emotion and thought pattern in everyday life could be exhausting. While a vigilant mindfulness practice is excellent during meditation, don’t beat yourself up about getting caught up in certain patterns throughout the day. When it comes to mindfulness throughout the day, start with small situations. For example, I go to use my bicycle and see that it has a flat tire: what do I notice, how do I feel? This doesn’t have to happen all day, every day. Simply note when there is a reaction, and practice acknowledging it before the “judgement” step that I discussed earlier.

  • Finally (and this can actually be quite fun), take steps to notice when you are distracting yourself from an unpleasant sensation.This continues to be a huge learning point for me. I find that the most common distraction from difficult sensations – especially emotions – for most people are alcohol, food, and use of electronics. When we turn to certain activities, even those we enjoy, there may be underlying intentions, like avoiding pain. These are opportunities to take a moment between the impulse to indulge in an activity and actually starting the activity to ask the question, “how am I feeling?” It’s not to say you can’t go on to eating the chocolate cake or scrolling through facebook, but creating the pause, the gap, starts to bring mindfulness into our actions on a larger scale.

 

 

Resources:

Bowen S, Witkiewitz K, Clifasefi SL, et al. Relative efficacy of mindfulness-based relapse prevention, standard relapse prevention, and treatment as usual for substance use disorders: a randomized clinical trial. JAMA Psychiatry. 2014;71(5):547-56.

Kabat-zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. Gen Hosp Psychiatry. 1982;4(1):33-47.

Muench, Kristin. (10 Nov 2015). Pain in the Brain. Stanford Neurosciences Institute. Retrieved from https://neuroscience.stanford.edu/news/pain-brain.