Therapy for Chronic Pain, Part 3: Mindfulness for Chronic Pain
By Laura Meli, PhD
When I introduce mindfulness to patients seeking help with chronic pain, it’s common to hear that it’s already been tried and failed. Despite growing scientific evidence and heartfelt individual testimonials, mindfulness for chronic pain often gets a bad rep. For many, mindfulness has been pitched as a “cure-all” or a more clinical way of saying “Just relax! It’s mind over matter.”
As both a chronic pain psychologist and a person with chronic pain, I get it. I promise you that I have tried every self-help tip, home remedy, and trick in the book – with very mixed success and many lessons learned. I’ve also spent years researching the complex causes of chronic pain and practicing various therapies with patients. Informed by these personal and professional experiences, I am more convinced than ever before of the benefits of mindfulness for chronic pain.
Is mindfulness for chronic pain effective?
Yes, and consistency is key. Understanding how to use mindfulness for chronic pain is easiest when you think of each brief practice like any other health-supporting behavior – stretching, physical exercise, or taking a daily vitamin. Each mindfulness practice provides a dose of benefit to your brain, and maybe some short-term relaxation or mental clarity. However, just like with movement and exercise and supplements, consistency is key if you want to see, feel, and maintain desired results. This means, mindfulness works best and you feel the strongest results when you stick to a regular, consistent practice – whatever that looks like for you.
Benefits to mindfulness for chronic pain
Routine mindfulness exercises are a way to tune up or bolster your ability to focus, self-regulate thoughts and emotions, and effectively manage life’s challenges – whether or not you experience chronic pain. However, when it comes to chronic pain, mindfulness can uniquely support your physical body and nervous system to help reduce symptoms over time. While mindfulness for chronic pain isn’t always a quick fix, it is an effective treatment for it, in addition to the common mental health challenges that co-occur with chronic pain.
Here are a few of my favorite ways to practice and teach mindfulness for chronic pain.
3 Ways to use mindfulness for chronic pain
#1– Try mindful curiosity: Get to know your chronic pain.
Chances are your chronic pain made an extremely poor first impression on you when it showed up – understandably. In some ways, chronic pain isn’t too different from any other uncomfortable experience. When we feel emotional discomfort or physical discomfort, our urge is often to avoid, resist, or turn away. We naturally and automatically react to our discomfort with a healthy and normal safety mindset. However, this exact safety mindset can be ineffective for when you’re living with a chronic stressor, like chronic pain. Because the physical discomfort of chronic pain is ongoing, living with a safety mindset can lead to feelings of frustration, sadness, exhaustion, anxiety, and other uncomfortable emotions. When left unchecked, a negative feedback loop develops between our mindset and our emotions, worsening chronic pain symptoms. This is especially true for individuals who may already consider themselves “busy-minded” or overthinkers.
One way to practice mindfulness for chronic pain involves noticing these negative feedback loops and beginning to recognize when you are in a safety mindset. Once you practice drawing your awareness to what you’re thinking and feeling, the fun begins! Instead of a safety mindset, you can try on a “curious mindset.”
What can you learn about your pain when observing it from a distance? Putting aside the role of “feeling” your pain and shifting into the role of “knowing” your pain. You can think of the “knowing” role like being an observer – as though you’re a detective on a fact-finding mission, or as though you’re gently gazing at artwork in a museum from a slight distance. Practicing this mindful curiosity overtime can help reduce uncomfortable emotions, negative feedback loops, and – in some cases – even pain levels.
Mindful curiosity can have some surprising and important practical benefits, too. Many people with chronic pain (and other chronic illnesses or complex health issues) have difficulties communicating with healthcare providers, family, friends, and colleagues about symptoms and needs. While individual communication and coping skills are a piece of the picture and can be supported in therapy, there are societal and systemic forces that interfere with the treatment of chronic pain.
What is pain inequity?
Pain inequity refers to the very real and consistently documented racial bias in chronic pain care, where the pain of patients of color tends to be undertreated and disbelieved more when compared to White patients. Gendered pain inequity is also an active force impacting pain care. Women endure longer delays in diagnosis, receive inadequate treatment, and – particularly in relation to gynecological care and sex-specific diseases – are doubted in terms of self-reported pain severity when compared with men.
Having an objective and data-driven understanding of your pain symptoms can prove helpful in healthcare settings to mitigate implicit biases or pain inequities. Effective self-advocacy is essential when navigating healthcare settings and relationships as an individual with chronic pain. Mindful curiosity practices can make it easier to clearly communicate your experiences and needs with providers and loved ones.
#2 – Try a mindful body scan for chronic pain: Notice what’s there.
As we all can attest, day-to-day stressors on their own can cause tension and strain on our bodies. Chronic stress or unresolved trauma, however, can lead to chronic muscle tension and inflammation, two major causes of chronic pain. One way to practice mindful stress reduction for chronic pain is through a practice called a body scan.
A mindful body scan involves drawing awareness to your breathing, then focusing on specific areas of your body – one at a time. As you focus on different body parts, try feeling any sensations in the body area without judgment, and then shift this mindful attention through the body. The name body “scan” is actually really helpful when you consider it as a visual – imagine a beam of light or color slowly scanning your body from head to toe, inch by inch.
Like shutting down and restarting our computers every once and a while, our brains and bodies need regular breaks from the constant mental processing, emotional decoding, and physical sensing that comes with chronic pain. As you begin practicing body scans, they may not feel useful or productive at first and may not stop your pain in the moment. In fact, many patients tell me they find the exercise boring but enjoy the fact that it provides a moment to relax and close their eyes. Boring and relaxing are ok! Like most mindfulness exercises – the impact is happening behind the scenes and the benefits build up over time and with practice. When starting a mindful body scan practice, I always recommend setting a daily timer on your phone or calendar and making it an automatic 5-minute, daily activity. You’d be amazed at how quickly you can feel results with a little extra accountability and consistency!
#3 – Try mindful breathing for chronic pain: Using your breath.
Before you try any mindful breathing exercise, you need to check-in to see the way that you naturally breath. While laying on your bed or the floor or sitting up in a chair with back support, place one hand on your belly and one hand on your chest. Taking a few regular breaths, notice which hand moves more during each inhale and exhale. Are you breathing more from your chest or from your belly?
Most people who try this activity notice they are breathing from their chest. Chest breathing is incredibly important and useful, but it serves to speed us up and helps us maintain stamina during strenuous activities, like cardiovascular exercise. That said, chest breathing does not support efforts at slowing down or relaxing.
Instead, you want to focus on making the hand on your belly move with each inhale and exhale for mindful breathing. This belly breathing is best for most types of mindful stress reduction and is an essential ingredient in breathwork for chronic pain. Once you have a sense of belly breathing, you can test out a few of my favorite mindful breathing practices for chronic pain.
How to use diaphragmatic breathing
Diaphragmatic breathing is very similar to simple belly breathing, but requires that you pay attention to the tensing and release of upper abdominal muscles, or diaphragm. The diaphragm muscles play a key role in our breathing – expanding to allow us to draw air into our lungs and contracting to push air out of our lungs. To practice diaphragmatic breathing for chronic pain, you take slow, deep inhales with focus on the expansion of your diaphragm and belly, and then slow, full exhales with focus on the contracting of your diaphragm and belly. While this mindful breathing technique is a great stress reliever, it has also been shown to reduce chronic pain, and improve mental health (improving attention and emotion regulation abilities) and physical health conditions, over time!
How to use paced breathing
Paced breathing is a technique that can help to activate stress reduction mechanisms in the body by slowing your breathing down and maintaining your inhales and exhales at a specific, counted pace. To begin, I usually recommend inhaling for 4 seconds and exhaling for 6 seconds, but everyone’s comfort level is different so you can feel free to find a count or combination that works best for you. What’s most important, however, is that you exhale slightly longer than you inhale and that you keep a consistent pace during your practice. This pacing creates a harmony between your heart and lungs, sending signals to your body and brain that it is safe to relax. Paced breathing can help reduce chronic pain, particularly pain due to nervous system sensitization or central sensitization syndromes.
Seek therapy to learn mindfulness if you have chronic pain
For individuals with chronic pain, various health conditions, or traumatic physical experiences, mindfulness practices or focusing on certain areas of the body may prove challenging due to physical discomfort, emotional reactions, or the natural challenge of creating a consistent practice in your life. If that’s the case, I encourage you to seek professional support and specialized care. Working with a chronic pain or trauma psychologist can help guide your mindfulness practice, navigate individual challenges, and support you in gaining the benefits of mindfulness.
About the Author: Dr. Laura Meli is a postdoctoral psychologist at Manhattan Therapy Collective with a special interest in treating chronic pain. As a result of her own journey with chronic pain symptoms, she loves helping patients find strategies that work for them and restoring hope for improvement and relief. Aside from mindfulness, her favorite strategy for chronic pain management is currently doing Yin yoga in the living room alongside her dog, Ozzie.