Working With Pain in Meditation and Daily Life (Week 1 Part 1) Ines Freedman 09/13/06 Welcome everyone. I want to start out by very briefly telling you about my personal history with pain. I started as a young child of maybe five or six. I was very sensitive to fabrics, to cotton, wool and velvet. The wool blanket bothered me. Things that touched my skin bothered me. Any labels on anything were painful to me. I was uncomfortable most of the time. I didn t know how to express it. Nobody knew anything about it. It didn t feel good. A few years later, when I was eight, I began to have arthritic pain. It was just one joint that got injured and deformed. My mother took me to the doctor, and they didn t know what to do with it. A couple of years later, it happened to another joint. During this time, with this pain that just wouldn t go away, I felt wrong about it. Nobody else around me had the pain. Everyone else had normal lives, and I was just hurting, so I felt I had to hide it. Nobody knew about it except my family, and they didn t know that much about it. They knew I had pain, but they didn t know it was this ongoing constant thing. I never told any of my friends about it. As I kept getting older, and more joints got involved, I started doing yoga. The yoga practice was a very aggressive yoga. It wasn t like the kind of yoga you see these days. It was actually more damaging to me than it was helpful. They told me that it would cure everything, so I really tried hard. None of it was particularly pleasant for me to do, but I tried hard for a number of years working with it. By the time I became a chiropractor, I had multiple joints involved. Being a chiropractor is a very physically demanding profession. I tried a lot of different alternative approaches and nothing particularly helped. My main relief came from jogging every day. Jogging would get the endorphins going, the hormones in my brain. For a few hours afterwards I would feel pretty good. Getting my husband to massage me worked really well, too. I was able to stay active. I played racquetball. I did a lot of different things, and as long as my attention was on something else, I was able to work with the pain. But, as I continued to age, and with the demands of my profession, it started to get worse. At that point, I started to meditate regularly. For the first number of years, the meditation worked fantastic. It created a lot more spaciousness in my life, it decreased the level of pain and things were going really well. And then it got worse.
That was a major blow for me, because for so many years I had been handling it so well. It was there, but I sort of had the belief that it wasn t going to get worse. The joints got worse, and I had to stop running and stop playing racquetball. So, my life changed quite a bit. I had been doing mindfulness meditation, and the way I had been doing it was by fixating on my pain. So, every time I closed my eyes to meditate, my attention would go, What is the most dominant thing here? Ah! pain. So my mind was conditioned to be continuously noticing the pain more than ever. So I was stuck in a cycle where meditation wasn t enjoyable, and it wasn t helping. Finally, what happened at that point I did a month-long retreat that used a very different approach to meditation. It was a very deep concentration practice where I focused away from the pain. We focused on something pleasant. I was able to increase my concentration away from the pain, and was able to enter very wonderful, pleasant states again and it made meditation enjoyable. The interesting thing about the concentration states is that you can t maintain them when you come out of meditation. They last for a while, and they help overall, but they only last a couple hours until you are back to normal. But it gave me enough of a space and well feeling in my life again, and it let me start using mindfulness meditation in a more skillful manner. So, I could use both. I could use the strict concentration that makes you feel good, and I could use mindfulness practice in a way that didn t fixate on the pain. Are there any of you that are very new to mindfulness meditation practice here? (A few people.) In mindfulness meditation, we pay attention to whatever is going on. Under normal conditions, you might be sitting there paying attention to what s going on and you might notice a little bit of pain, then you may notice your thinking, then notice that you re a little impatient. So the mind goes to whatever is happening and from one thing to another. As the mind gets quieter, it settles in and isn t very busy. The instructions in mindfulness meditation are to give attention to whatever comes up and becomes dominant. Sometimes with chronic pain, the pain is the only thing that calls to us. The longer we have had chronic pain, the more we have conditioned our minds to always go there. So we have to consciously train ourselves to start going elsewhere: that we have another choice. Not to push the pain away, not to pretend it s not there, not to deny or suppress it. But to actually consciously give ourselves another choice. Right now, no matter how much pain you have right this moment, you have a thousand other sensations that you could be paying attention to. You could be paying attention to
your feelings, your thoughts, other people in the room, my voice. There are so many other things. With chronic pain, we ve conditioned our minds that pain is like a magnet, we keep being drawn to it. So we have to train our minds to have a lot more flexibility to be able to shift; that I have a choice and I don t have to pay attention to the pain. I can be with the pain, and I can also have peacefulness at the same time side by side. We have a lot more options. The techniques that we re going to talk about help you create that. There are a number of things about pain, it is both simple and complex. It s simple in that it s an alarm system in the body that says, There s something wrong, and you need to do something. It s complex in that when pain gets initiated it affects every system in our body. And when the pain cycle occurs, it involves every system in our body. So that once we have chronic pain, we have created a complex way of living our lives. The way our hormonal system responds and circulatory system responds [changes]. So it requires a lot of de-conditioning of the way we hold ourselves and the way we live. The traditional view of pain is that it either has a physical cause or a psychological cause. But, all physical pain is affected by the constantly changing influence of the mind. All pain is affected by the way we view things, and the way we hold things in our minds. In Buddhism, we talk about primary and secondary suffering. Primary suffering is the actual pain. The hurt, illness, trauma, injury or fatigue. All those basic things which are the very initial pain. The secondary suffering is the human anguish that we experience as a reaction to the primary pain. The secondary suffering is when we don t want it to be there. When we re unhappy that it s there. Feelings of anger, fear, depression, anxiety and despair. Those are all things that we pile on top of our primary suffering. With mindfulness, we can reduce our experience of secondary suffering. If we are able to eliminate or reduce the secondary suffering our lives become a better quality, even if the primary pain remains unchanged. One interesting thing to think about is the anatomy of the brain. On the surface of the brain, we have an area called the motor and sensory cortex. It is as if there were a little [map of the whole] person in that area. There is a corresponding part for every part of your body. The little toe, the hand, the face, and every part of the body has a corresponding part in those nerves. If you re a pianist, the hand part is really huge compared to a dancer whose foot part might be a lot bigger. The brain itself changes based on what we do in our lives every day. It changes dramatically. So, everything we do actually changes the structure of our brain. Our brain is plastic, it s not so set. Our thoughts actually change the structure of our brain. There is a process called facilitation. When learning any skill, for example, the skill of playing the piano. Every time you play it gets easier. The nerve pathway gets more and
more facilitated. That s how you develop any skill, no matter what it is: including meditation or including negative skills like negative thoughts. Let s say you feel sorry for yourself. And you don t notice that. And you do it again. And again. It gets easier and easier to feel sorry for yourself. What mindfulness does is let you notice these patterns, and very carefully, very consciously change them. We are going to break up the subject into three basic areas: The first is the very physical. Right in the body, my knee hurts. These are the physical sensations of pain. The second is called the affective area. That is how we feel about the pain. Our emotions, our dislike, our anger or our fear. It s also if we find the sensations of the body as pleasant or unpleasant. The third area is the cognitive. That is our beliefs about the pain. Those affect our moods. For instance, if we feel that we are a failure because we have this pain, or we have bad karma for stuff I did. Or, I was so stupid, and you judge yourself because it s your fault that you hurt yourself. All those beliefs are things that deeply affect your ability to work with pain. So what we re talking about tonight is how we train our mind. What I ll be doing is a few guided meditations. They may be a little bit different than what you are used to doing and will work directly with these different areas. To give you a little encouragement if you are working with very severe pain: They did a study not long ago using transcendental meditation. They had a group of meditators that had been meditating for 30 years. They tested them for how sensitive they were to pain. They found that the brain response to pain was 45% lower than the control group. So the same pain caused by an electric shock caused 45% less pain. What was really interesting is that they took the same control group, and trained them for five months. At the end of the five months you can tell a difference, (I think they were practicing 20 minutes, twice a day) they were able to decrease their perception of pain 45%. So just by meditating, (and that kind of meditation doesn t even look at your attitude) just the effects of calming the mind on a daily basis reduces our perception of pain. So, if any of you don t have a daily practice, please, that s a really important part of the picture to do it on a regular basis. There are two ways of approaching pain in meditation. One of them is to pay attention to the pain, and the other is to pay attention away from the pain. We re going to work with approaches in both directions.
I want to briefly define the difference between mindfulness and concentration. Mindfulness has a broad way of looking at things. It notices whatever is going on. It doesn t try to hold on to any particular experience. A concentration practice is a practice where you really pay close attention to one point. For instance, you can do that with the breath: you can totally fixate on the breath so that the mind doesn t leave it at all. You don t let anything else enter. The advantage of the concentration practice where you don t let your mind move and roam is that it decreases pain, and creates pleasure. The advantage of the mindfulness practice is that it lets you see what is going on at any given time. Both of those practices support each other, and we will be working with both of them. The thing about concentration is that you can t take it off the pillow. You can do concentration and focus on one point, but the moment you go out into the world, it s gone. So you have to have other skills in the world, also. One of the main approaches that I m going to be working with is based on Shinzen Young s work. He wrote a really wonderful book (which I list information about in the handout). It s a relatively small book in working with pain in meditation and has six guided meditations on the included CD. If this approach feels like something you want to work with, I highly recommend that you get his book and CD. It s really helpful to have someone guide you through it. One thing that he talks about that I really like, is that the approach he uses towards working with pain is, divide and conquer. He breaks pain up into small little pieces, and with those small little pieces they become more manageable. When we see pain as a whole it can overwhelm us. It s just too intense, too big. So we train the mind to see these little, small pieces. I notice a few people are lying down here, which is great. It s ok to lie down for meditation. If you are able to do it sitting, it s a little bit easier, so I recommend you do it sitting. But, if due to your condition, it s better to lie down, and especially if you are used to meditating lying down, it s great. One of the teachers here spent an entire three month retreat laying on her back. It s very doable, however there is a tendency to fall asleep easily. So if you re not used to meditating on your back there are a couple of things that might be helpful. One of them, depending on your condition, is to keep a hand up. The elbow is still resting on the floor, and you keep the hand up. So if you fall asleep you know right away. The other way is that you keep the knees apart in such a way that if you fall asleep, they fall back inward. Again, your condition may not allow that, you may need to have your legs relaxed.
Another approach you can use for lying meditation is having your eyes open and have a very soft focus. It may be a little bit too bright in here for that. Don t stare, try to keep a nice easy soft focus if you re doing open-eyed meditation. That will help you stay awake. Some people after a while will have no problems staying awake just like in any position. I think it s great for everybody to practice lying meditation in the morning before you first get out of bed or at night before you go to sleep. The Buddha said you should meditate in four positions: lying down, standing, walking or sitting. So it s good to have flexibility in all of those postures. Some meditation techniques suit some people and some don t. We re going to be doing some different techniques, so give them a chance, because sometimes they don t come right away. But keep in mind that sometimes something works better for one person. We re all so different. The main quality that we want to use in this meditation is the quality of opening up to the pain and observing it. So, try to start the meditation with an attitude that you re going to open up to it. You re not going to resist it, you re not going to fight it. Regardless of what comes up, if you don t like it, if you re angry about it, whatever even those reactions you re going to open up to. So we re looking for an attitude of equanimity, of opening, of not resisting what happens, of not pushing the experience away. We want to have a mind that says, yes to whatever experience is going on. So right now, we re going to start our first meditation, so make sure your body is in as comfortable a position as possible. If you re sitting in a chair, both feet flat. Don t add to the pain by picking an uncomfortable position because you think it s good for you. When we meditate, try to be as still as possible. The stillness of the body, the less you move, the easier it is for the mind to settle down. If you have to move because of your condition, go ahead and do so, but do it very slowly, very mindfully. Don t just move real quick and jerky, but really notice before you re going to move. If you re very mindful of the process, you won t lose your concentration. But, don t just move for minor discomforts. Really try to be with any minor discomforts. Only move if you really need to for your condition. In our first meditation (and these are going to be relatively brief meditations), we re going to explore the emotional reactions to pain or discomfort.
Is there anybody here who doesn t have any pain or discomfort right now? (So, a few people.) What I d like for you to do at least for the first part of the meditation is when we start, make a fist that is tight, not so tight that you re going to hurt yourself or hurt afterwards, but that is tight enough that you can tell that you re going to get tired after about a minute. So that you will kinda want to not do that. So that s what you ll use for the beginning of this meditation. [25:40 Guided meditation] So, go ahead and close your eyes and take a deep breath in. As you breathe out, let your whole body settle into the posture. Allow the weight of the body to settle down towards the earth. Take a few deeper breaths, and let go a little bit more on each out-breath. Now, allow the breath to return to normal. Notice how you feel in your body, and your emotions. Second by second, you may have an emotional reaction, or you may have none whatsoever: you may be neutral. If you find that you have an emotional reaction, I d like you to label it. Label it mentally, silently with a very light, gentle tone like a whisper in the mind. It could be anger, dislike, fear, sadness, or impatience. Label it with the simplest word that comes up. You don t have to be super-accurate. If you really don t know what it is, but you know it s something, just say something. Part of your attention should be to how does that feel?. For example, if you re angry that the pain is there, then pay a little bit of attention to how that anger feels. The labeling should be just 10% of your attention. Do it at a slow leisurely pace. Irritation (6 second pause) sadness... If nothing is there, you might notice that you re calm, so say calm or peaceful. Whatever emotion you have label it moment by moment. (1:30 of silence) Now, place your attention on the discomfort or pain that you have, but keep noticing your emotions also as they come and go. Remember to have a friendly attitude towards your emotions; a friendly attitude towards your pain or discomfort. Second by second, there is either an emotional reaction to the pain or you re emotionally resting. Either is fine. Greet the emotional reactions with gentle matter-of-factness. When there are no reactions, enjoy the restfulness.
(2:00 of silence) Now, let go of the labeling, and just establish a simple contact with the sensations in your body. Now, we come to a very important point in a period of practice. This is the transition from stillness to practice in action. Slowly, mindfully begin to move your body. Stay in contact with your body and come to a standing position. Bring the qualities of openness and interest to your movement. Stay mindful. Once you re standing, close your eyes again. Now, very briefly for just one minute, I d like you to begin to make very simple, gentle, small movements. You can move your hands, your fingers, whatever you want, your shoulders, the muscles in your face, your feet. Stay connected with the sensations in your body. Now, set the intention to stay mindful of your body as we proceed. Or if this were at home to stay mindful for your next activity, maintaining an attitude of presence, openness and alertness. Go ahead and very mindfully sit down again or lie down. Go ahead and open your eyes, if they are not open already. This transition phase between meditation and the rest of your life is really important. It s very easy for people to do all this work in meditation, then get up and go on to the next thing and totally go mindless. What we want to do is bring mindfulness to every moment of our day. So the transition is how we develop that. It s the most important time of the day, when you go from this very aware, awake state into the next thing. (Instead of rushing on to the next thing.) This emotional labeling is something we can practice anytime, anywhere. If you re in the car, let s say you re in gridlock. It s the perfect time to just sit there and go impatience irritation anger worry. Whatever comes up and eventually hopefully amusement, calm and peace. But it s really something you can do anytime. You want to develop an ease in finding and connecting with your emotions and noticing them, because they will run us. And when we don t see them as they come up, we act on them, and we contract around them. So, before we go on to the next one, does anybody have any questions or comments on how that meditation was for them.
Student 1: I m a little hard of hearing, and when your voice got soft, I couldn t hear some of the instructions that you were giving. Ines: Oh, I m really sorry. Student 1: Well, you didn t know. Ines: If that happens at all, feel free to say something even though we re meditating. I d appreciate it. I ve never been told my voice is too soft. [laughs] That s the first time. So, how was that practice for you? Was it different than the way you ve been practicing with emotions? Student 2: I started focusing more on the pain, like you said that you did early in your practice, rather than the emotion. The pain got more intense. The pain was much higher focus than the emotion. Ines: So you had trouble focusing on the emotion. This is a training, a really great practice for you if you had a hard time doing it. You go: Oh yeah, pain then you go back to, Oh, I don t like that pain. Focus on what you don t like about it: on the feeling of not liking. Over and over and over again, eventually you can disentangle the two. Student 3: I was actually surprised at my emotion. When I first started, I thought there was no emotion here, just straight line. As I was more attentive, I noticed dread, panic and a lot of emotion. Ines: Most of those things are usually under the radar for most of us. That s what we want to with this practice is bring them to the surface. Student 4: Not to be a Pollyanna here, but the one positive thing about pain is that when you have a little bit of it, it keeps you more alert. Tonight, I m sitting here and I have no pain, and I m much more drowsy. It s harder to stay completely present because there s nothing that s calling me really strongly. Ines: When I started meditating, they talked about the five hindrances to meditation. One of them is Sloth and Torpor. I never experienced that, it was incredibly rare. Because, the pain was always there to some degree to keep me alert. But, some people, even with a lot of pain they can still get very sleepy, so everybody is a little bit different that way. Any other comments or questions? Did anyone have a hard time doing it? Did anybody not connect with any emotions whatsoever?
Student 5: What happens to me in meditation, I start thinking that the sitting position itself is causing the pain. So, I am concluding that I shouldn t be sitting because I am hurting my body by doing it. That s the dilemma that I get into. I ve worked a lot with my position: How I m sitting, my posture and so on. I have back pain, so sitting is not an ideal activity for my back. If I really get into deeper states of meditation, I can have the pain there, but it doesn t really bother me. It s in the background. Ines: Is the pain aggravated after you meditate? Student 5: It has been in the past. I had a one-day meditation where I hurt for two weeks afterwards because I was sitting improperly. So, I m very reluctant to spend much time sitting. Ines: It s not a simple answer. The question is about sitting meditation. If you were to sit at your desk, and write some emails for 45 minutes would your back get aggravated? A day-long is a long period to be sitting if you don t do it on a regular basis. If your muscles aren t up for it, you have to work hard to get to that point. So it s not a good idea. When I sit at a long retreat, I alternate I ll sit like this and I ll sit on a kneeling bench, so I don t use my muscles the say way all day long. A lot of people go between lying down and sitting. Everybody is a little bit different, without knowing your back and your history: you really want to examine that. Going into a day-long retreat when you have a problem with the back, it s way too long to be spending the whole day sitting. Sitting is hard on the back in general, [even] sitting in chairs. Student 6: I have been to a one week meditation, where the entire meditation is walking meditation with only two 10 minute sitting sessions in the day. Ines: Lying down might be a good option to alternate with sitting. [End of Week 1, Part 1]